Graphic sleep monitoring: A clinical program to improve sleep in residentswith mental retardation

Sleep problems in persons who are mentally retarded may reflect environment al disruptions, institutional practices, psychiatric disorders, and/or orga nic pathology. A graphic sleep monitoring system was implemented for 471 re sidents of a state institution over 1 year. The initiation of the campus-wi de data collection system was preceded by a 1-hr training of nonprofessiona l staff in recording and charting methods. After a 90-day start-up phase, p sychology staff in each living unit provided the nonprofessional staff addi tional support with data collection and environmental adaptations as needed . Also, the psychiatrists began to include review of the sleep data in mont hly follow-ups of established cases and as part of diagnostic formulation i n new cases. This intervention resulted in a statistically significant impr ovement in the overall sleep efficiency index (SEI) of about 30 min. The hi gher the SEI, the more efficient the sleep cycle (i.e., the less fragmentat ion due to interruptions and the shorter the sleep latency). The number of residents with fragmented sleep was reduced at 1 year and residents spent l ess time in bed awake. Variables, such as retardation level, age, gender, b ehavioral risk status, and inter-cottage moves, were not significantly rela ted to sleep. Significant effects were found as a function of type of malad aptive behavior. Self-abusive residents had lower SEI scores than residents who were aggressive or destroyed property. Results suggest that a relative ly simple graphic sleep data collection and monitoring system that allowed quick visual analysis was helpful in making environmental and treatment mod ifications that resulted in improved sleep for persons who are mentally ret arded and unable to express their needs directly.