Insomnia in an adult inpatient setting

Sleep disturbance is common among inpatients of healthcare facilities, particularly those in critical care. In addition to the usual contributing factors, loss of routine, displacement from usual sleeping environment and other environmental factors (eg noise, observation checks, excess light) can cause sleep problems. Opportunity to exercise is often limited and patients may nap during the day, further impacting on nocturnal sleep efficiency.

Improving sleep in inpatients follows the same principles as treating insomnia in the general population:

• address modifiable factors that are barriers to sleep— this includes providing adequate pain relief
• educate patients about good sleep practices and aid implementation (eg encourage daytime routine, discourage daytime naps, avoid caffeinated beverages after midday, provide access to bright light during the day [especially in the morning], minimise light at night and provide eye masks and ear plugs)
• provide psychological and behavioural interventions (eg relaxation therapies).

Short-term pharmacological therapy may be required if a patient is significantly distressed or impaired by insomnia—see When to use a drug for insomnia in adults. The risk of harm associated with drug use (eg sedation, falls, confusion) may be increased in a psychically unwell patient. If a drug is used for insomnia in the inpatient setting, reduce the dose and stop it before discharge. If this is not possible (eg the patient has been taking the hypnotic for several weeks), create a deprescribing plan to stop the drug in the community—see Insomnia in an adult who has taken a hypnotic long term.