The nursing home at night: effects of an intervention on noise, light, and sleep

The sleep of nursing home residents is fragmented by frequent awakening episodes associated, at least in part, with environmental variables, including noise and light changes. The purpose of this study was to improve sleep by reducing the frequency of nighttime noise and light changes.

Two hundred sixty-seven incontinent nursing home residents in eight nursing homes.

A randomized control group design with a delayed intervention for the control group.

Bedside noise and light monitors recorded the number of 2-minute intervals at night with peak sounds recorded above 50 dBs and the number of light changes of at least 10 lux between adjacent 2-minute intervals. Daytime behavioral observations measured sleep and in-bed time during the day, and wrist activity was used to estimate sleep at night. Awakening events associated with the environmental variables were derived from the wrist activity data.

A behavioral intervention implemented between 7:00 p.m. and 6:00 a.m. that involved feedback to nursing home staff about noise levels and implementation by research staff of procedures to both abate noise (e.g., turn off unwatched television sets) and to individualize nighttime incontinence care routines to be less disruptive to sleep.

Noise was reduced significantly, from an average of 83 intervals per night with peak noises recorded above 50 dBs to an average of 58 intervals per night in the group that received the initial intervention, whereas noise in the control group showed no change (MANOVA group x time P < .001). All 10-dB categories of noise from 50 to 90+ dBs were reduced, and light changes were reduced from an average of four per night per resident to two per night (P < .001). Despite these significant changes in the environmental variables, there was a significant differential improvement in the intervention group on only two night sleep measures: awakening associated with a combination of noise plus light (P < .001) and awakening associated with light (P < .001). However, there was a significant correlation between change in noise and change in percent sleep from baseline to intervention (r = -.29, P < .05), suggesting that the intervention did not reduce noise to low enough levels to produce a significant improvement in sleep. The intervention effects on all environmental variables were replicated in the delayed intervention group, who again showed significant improvement on the same sleep measures. Observations of day sleep and in-bed time did not change over the phases of the trial for either group.

The significant reductions in noise and light events resulting from the intervention did not lead to significant improvements in the day sleep and most night sleep measures. An intervention that combines both behavioral and environmental strategies and that addresses daytime behavioral factors associated with poor sleep (e.g., excessive time in bed) would potentially be more effective in improving the night sleep and quality of life of nursing home residents.