The nursing home at night: Effects of an intervention on noise, light, andsleep

OBJECTIVES: The sleep of nursing home residents is fragmented by frequent a wakening episodes associated, at least in part, with environmental variable s, including noise and light changes. The purpose of this study was to impr ove sleep by reducing the frequency of nighttime noise and light changes. PARTICIPANTS AND SETTING: Two hundred sixty-seven incontinent nursing home residents in eight nursing homes. DESIGN: A randomized control group design with a delayed intervention for t he control. group. MEASUREMENTS: Bedside noise and light monitors recorded the number of 2-min ute intervals at night with peak sounds recorded above 50 dBs and the numbe r of light changes of at least 10 lux between adjacent 2-minute intervals. Daytime behavioral observations measured sleep and in-bed time during the d ay, and wrist activity was used to estimate sleep at night. Awakening event s associated with the environmental variables were derived from the wrist a ctivity data. INTERVENTION: A behavioral intervention implemented between 7:00 p.m. and 6 :00 a.m. that involved feedback to nursing home staff about noise levels an d implementation by research staff of procedures to both abate noise (e.g., turn off unwatched television sets) and to individualize nighttime inconti nence care routines to be less disruptive to sleep. RESULTS: Noise was reduced significantly, from an average of 83 intervals p er night with peak noises recorded above 50 dBs to an average of 58 interva ls per night in the group that received the initial intervention, whereas n oise 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 ch anges were reduced from an average of four per night per resident to two pe r night (P < .001). Despite these significant changes in the environmental variables, there was a significant differential improvement in the interven tion group on only two night sleep measures: awakening associated with a co mbination of noise plus light (P < .001) and awakening associated with ligh t (P < .001). However, there was a significant correlation between change i n noise and change in percent sleep from baseline to intervention (r = -.29 , P < .05), suggesting that the intervention did not reduce noise to low en ough levels to produce a significant improvement in sleep. The intervention effects on all environmental variables were replicated in the delayed inte rvention 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. CONCLUSION: The significant reductions in noise and light events resulting from the intervention did not lead to significant improvements in the day s leep and most night sleep measures. An intervention that combines both beha vioral and environmental strategies and that addresses daytime behavioral f actors associated with poor sleep (e.g., excessive time in bed) would poten tially be more effective in improving the night sleep and quality of life o f nursing home residents.