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Disease and treatment

Inpatients’ health suffers if they sleep poorly

Anxiety, light, physical inactivity, noise and many other factors can cause patients to sleep poorly in hospitals. This negatively affects patients’ immune systems and recovery processes, which can result in longer hospital stays.

Researchers have confirmed again and again that sleep is incredibly important in ensuring good health. Sleep affects metabolism, immune function, wound recovery and many other processes in the body. Sleeping poorly can increase people’s risk of developing many different diseases.

It is therefore paradoxical that virtually no hospital anywhere incorporates the treatment goal of ensuring that inpatients can sleep well. If they sleep better, they may recover faster and can be discharged sooner.

A major new review article has compiled the leading research in this field, and the conclusion is clear: integrating sleep as a core part of inpatient care has major benefits.

“The basic function of sleep is to enable the body to relax so that it can repair itself and be ready for the next day. If inpatients sleep poorly, they will clearly take longer to recuperate. So much evidence confirms the health benefits of sleeping well that not incorporating this into inpatient care is indefensible,” says the main author, Christian Benedict, Associate Professor, Sleep Research Laboratory, Department of Neuroscience, Uppsala University.

The review article has been published in Sleep Medicine.

A sick body needs sleep to heal itself

Sleep clearly plays an extremely important role in good health.

When we sleep, the body starts to prepare us for the following day so we are ready for the challenges we face. For example, our immune function works hard during the night to combat all the potentially pathogenic microorganisms that have invaded us during the day. Being more predisposed to illness if we do not get enough sleep is therefore not surprising.

The body also needs times when it is not exposed to more harmful bacteria, and this is usually the case while we are asleep.

Similarly, the body uses the night to repair muscles. This means that poor sleep can, for example, result in various injuries to or in the body not recovering optimally.

Inpatients therefore need to get enough good sleep to optimize immune function and to repair he body, especially when they need their body to be functioning optimally to become well again.

“The body knows that it needs to work at times and then relax at other times to become well again. Not providing the body the time and sleep it needs to repair itself adversely affects recuperation, and people definitely do not need this as inpatients,” says Christian Benedict.

Many factors disrupt sleep

Christian Benedict and his colleagues compiled and read most of the available scientific literature in this field. This involved reading hundreds of scientific articles to summarize the data in a major review article.

The highlights include the following.

Generally, the studies reviewed indicated many reasons why inpatients sleep poorly.

• Anxiety. Several studies suggest that doctors should improve their methods of calming inpatients so they do not lie awake at night and worry. Anxiety disrupts sleep, and inpatients need to avoid this.

• Light. The light in most hospitals does not vary naturally according to the light-dark cycle of the sun. Some hospital wards leave bright lights on all night, so an inpatient’s body cannot determine when it should relax and when it should be active. Exposure to light at the wrong time of day worsens sleep quality.

• Noise. Most hospital rooms have multiple beds and therefore several inpatients, who do not necessarily have the same circadian rhythms. For example, some may watch films at night, and this can disrupt the sleep of other inpatients. Inpatients in severe pain can also disturb others in the room, disrupting their sleep.

• Exercise. Exercise promotes good sleep, but many inpatients stay in bed all day. Exercise is likely to aid sleep so the body can heal itself.

The percentage of people who say they have insomnia ranges between 6% and 11% worldwide, but 30% of inpatients say they have problems sleeping.

“Hospital wards differ, as do the potential remedies in individual hospitals. Intensive care units often need to have bright light continuously, and other wards cannot provide single-bed rooms. No one solution suits all hospitals and hospital wards. However, all wards should try to incorporate trying to optimize inpatients’ sleep quality in treatment,” explains Christian Benedict.

Inpatients near windows recuperate more rapidly

According to Christian Benedict, relatively simple initiatives could improve sleep for many inpatients. One example is getting inpatients to eat meals outside their room, making them get up and move about.

Another option is to design the lighting in rooms to mimic the natural variation in light and dark . The body can then discover through darkness, for example, that evening is approaching, and produce melatonin, a chemical that makes us tired and finally enables us to fall asleep.

“I teach medical school, and the lack of emphasis on sleep is amazing. Disrupted sleep can contribute to worsening health, but many relatively simple initiatives can help create conditions for good sleep in hospitals. Light plays an extremely important role,” says Christian Benedict.

The researchers emphasize one study showing that inpatients whose beds were located closer to a window were hospitalized for less time than those who slept further away. The reason for this was that natural light from outside the hospital helped these inpatients to get better and more health-promoting sleep.

Medication timing affects absorption

Medication is another factor affecting good sleep. This applies both to the choice of medicine and when inpatients take it.

Several studies showed that some forms of pain relief medicine and even beta-blockers inhibit the release of melatonin in the brain. In addition to its important effects on tiredness and falling asleep, melatonin influences the functioning of the immune system.

Further, timing the intake of medicine during the day strongly affects absorption. Like everything else, metabolism follows a circadian rhythm. If people take medicine at night when the body is about to shut down, they absorb less medicine than if they take it in the morning when the body is rested and ready to absorb nutrients.

“More and more evidence is emerging on how strongly medication timing affects the recovery process. It is fantastic that this can make such a major difference, but this also needs to be considered in treating patients,” says Christian Benedict.

Christian Benedict explains that more and more doctors are fortunately aware of how important sleep is for optimizing recovery, which he can see based on how often his scientific articles in this field are downloaded.

“Remember that this is not just good for inpatients’ health. Inpatients who recover more rapidly can be discharged and this can save healthcare systems a lot of money,” he concludes.

A narrative review of interventions for improving sleep and reducing circadian disruption in medical inpatients” has been published in Sleep Medicine. In 2014, the Novo Nordisk Foundation awarded a grant to Christian Benedict for the project The Role of the Fat Mass and Obesity Gene for Sleep Loss–Related Health Consequences in Humans.

Christian Benedict
Professor
Our research aims at unravelling molecular and behavioral mechanisms through which sleep loss or misaligned sleep contribute to the development and maintenance of metabolic and neurodegenerative diseases in humans.