8Ī lack of diurnal light cycles also can contribute to insomnia, as can clinical activities performed at night. The Environmental Protection Agency recommends a maximum of 45 decibels during the day and 35 decibels at night. 4 One study found the noise level in hospitals to be 50 to 70 decibels during the day and an average of 67 decibels at night.
Noise-from staff conversations, alarms, pagers, intercoms, doors, medical equipment, or televisions-is a major contributor. Many studies have found the hospital environment to be a contributing factor to insomnia. 5 Medications associated with insomnia include anticholinergics, antiepileptics, bupropion, beta agonists, caffeine, corticosteroids, methylphenidate, nicotine, selective serotonin reuptake inhibitors, and theophylline. Other medical conditions associated with insomnia are fibromyalgia, dementia, epilepsy, traumatic brain injury, Parkinson's disease, and stroke. Physical factors that can cause sleep problems include pain stress difficulty breathing (e.g., from chronic obstructive pulmonary disease (COPD), pulmonary embolus, heart failure) cough frequent urination and withdrawal from illicit drug or alcohol use. Psychological factors associated with insomnia include anxiety, depression, and grief. 5 These sleep disorders can lead to nighttime awakenings, sleep-onset difficulty, and daytime sleepiness. 6 PLMD, which is characterized by repetitive flexion and extension of the lower leg during sleep, occurs in about 80% of RLS patients. 6 The estimated prevalence of RLS is 5% to 15%. Usually associated with leg discomfort, RLS is relieved with movement prolonged bed rest during hospitalization can worsen it. RLS is characterized by an urge to move the legs while at rest, especially at night. 4,5 This sleep fragmentation and oxygen desaturation causes snoring or gasping during sleep and can lead to hypertension, cardiac arrhythmias, cognitive decline, and increased mortality. OSA, which occurs in 24% of men and 9% of women in the United States, is characterized by repetitive episodes of breathing pauses (apnea) and hypoventilation (hypopnea) that precipitate brief awakenings. Sleep disorders include obstructive sleep apnea (OSA), restless legs syndrome (RLS), and periodic limb movement disorder (PLMD). Multiple factors can lead to insomnia in hospitalized patients, including sleep disorders, psychological and physical factors, certain medical conditions, medications, environment, clinical activities, and poor sleep hygiene.
1 In a longitudinal observational study of insomnia prevalence in 280 hospitalized elderly patients, 21% reported new-onset insomnia, 38% reported moderate or severe insomnia, and 38% reported sleep disturbances during hospitalization, and severe morbidity, pain, and impaired functional status were significantly associated with insomnia. Interestingly, when the medical records were reviewed, no patient had physician documentation of insomnia symptoms. 2 In one study, 47% of 222 patients reported that they had insomnia and/or excessive daytime somnolence while in the hospital. 1 It is characterized by an increase in sleep latency (trouble falling asleep), a decrease in sleep maintenance (trouble staying asleep), or a decline in sleep quality (less time sleeping compared with time spent in bed). Insomnia is a common complaint in hospitalized patients, especially the elderly.
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