Nine-year-old McKenna Meuller of Los Angeles used to hate when she had to go to the hospital to get treated for her lung infections. All night long she’d get poked and prodded, leaving her feeling worse-off than if she’d stayed at home.
Then Mattel Children’s Hospital UCLA changed its policies in the intensive care unit and began prioritizing patient sleep.
Lights in the hallways were turned down at 10 p.M. A nurse helped McKenna’s mom, Amanda, move a sleeper chair right next to the hospital bed so she wouldn’t have to get out of bed if her daughter needed comfort. Staff grouped their visits, so rather than disrupting her sleep twice they’d check McKenna’s vitals when they came in to give her the albuterol she needed to get her lungs working better.
This change is part of a growing national recognition among hospitals that sleep is crucial for healing.
Although that idea seems obvious to anyone who has ever had a bad cold, hospitals have traditionally been designed around the need to gather information and check in on patients — according to the caregivers’ schedule.
“Patients really don’t sleep in the hospital,” says Margaret Pisani, a pulmonary critical care doctor at Yale University School of Medicine, adding that lack of sleep is what patients complain about most.
In addition to leaving patients cranky, lack of sleep can slow recovery and trigger the confusion of delirium, which can lead to longer hospital stays and even dementia, she says.
Technological improvements may help — allowing nurses to watch patients from their stations instead of entering patient rooms, for instance — but changing the hospital culture to prioritize sleep isn’t easy.
“It’s a lot easier to deliver health care with the lights on and when you’re physically in a patient’s room,” says Dana Edelson, an assistant professor of medicine at University of Chicago Medicine.
Hospital workflow also has meant that some scans and blood work is done at night, when technicians have excess capacity, and to give time for results before doctors make their 6 a.M. Rounds.
Changing such hospital routines has been challenging but worthwhile, says Theresa Kirkpatrick, a clinical nurse specialist at Mattel Children’s Hospital, who helped lead the effort to prioritize sleep in the pediatric intensive care unit.
Now, nurses weigh babies before bedtime, and residents come in quietly at 6 a.M. To do quick assessments, waiting until later for a more thorough exam, particularly of their teenage patients.
Since the program began late last year, Kirkpatrick says, patients need less medicine at night, babies’ schedules are less mixed up between day and night, and the alarms that do go off are actually meaningful rather than just a nuisance.
Night nurses have adapted and now appreciate this pro-sleep approach, Kirkpatrick says. Other departments are eyeing what she has done in the PICU, though the whole hospital has yet to adopt the practices.
Amanda Meuller says the changed focus on sleep has made a huge difference for patient families like hers. When kids are exhausted, it’s tough for them to try their hardest at therapy and to keep a chipper attitude through all that needs to be done at a hospital, she said. Parents can be more creative, supportive partners when they’re not awakened every hour for weeks at a time.
Such constant awakenings arose from the desire to treat every patient equally, Edelson says.
But while someone needs to be checked every few hours if he is struggling to breathe and his blood pressure is crashing, everyone else is better off left alone to sleep, she says. For them, “it’s very unlikely that vital signs taken in the middle of the night are going to pick up anything that’s alarming.”.
Pisani’s research shows that hospital lighting also interferes with patient body clocks. Bright lights at night prevent patients from unwinding and falling into a deep sleep; too little daylight in the morning interferes with their ability to reset their clocks and feel alert.
The result is a lack of restorative, or slow-wave, sleep, leading critically ill patients in particular to wake up feeling groggy and disoriented, she says.
But hospitals are proceeding carefully, Pisani notes, because of competing demands. They don’t want to miss a patient who may be struggling, or neglect to turn over a patient at risk for bedsores.
Edelson says she’s also worried that the pendulum will swing too far and hospitals will feel the need to prescribe lots of sleep medications, the way they turned to pain medications when patient pain became a prominent public issue.
What’s needed instead, she says, is a nuanced, personalized look at the costs and benefits of waking patients up vs. Letting them sleep.
“We could just fire all our night staff and we wouldn’t wake people up at night,” Edelson says, “but that will have its own separate problems.”.
In the meantime, the changes that have happened at Mattel have made life better for patients and their families, Meuller says. Perhaps best of all, she says, instead of dreading the hospital, McKenna now sees it as a place to get well.