Sleep on the wards: an ongoing battle
As a junior doctor, aside from the predictable daily tasks, I found an all too familiar request from many patients. “Doctor, I had a terrible night’s sleep, you couldn’t prescribe me something could you?” My colleagues were surprised at the frequency of this request—patients’ sleep not being a subject covered in detail when we were medical students. But, whether it’s a nurse thrusting a drug chart in front of us to request sleeping tablets or a patient regaling their struggle for a good night’s rest, difficulties in initiating and maintaining sleep are a common phenomenon on the wards. 
I have first hand experience of the problem. After a traumatic injury last year, a seven day hospital admission means that I too have tried to achieve a good night’s sleep as an inpatient. I cannot fault the care that I received while in hospital, but my eyes were opened to life on the wards at night. It has been documented that inadequate sleep can negatively affect a patient’s mood and recovery. Being overwhelmed from lack of sleep was the lowest ebb of my hospital journey. I craved the benefits of a good night’s rest because of the physical and psychological turmoil I was enduring.
A combination of environmental, physiological, and psychological factors affect a patient’s ability to sleep. However, it is the environmental conditions, in particular human interaction, that present the greatest barriers to sleep in a hospital. I found this to be true—aside from the occasional byproduct of my injury, the greatest threat to a successful night’s rest was the ward environment. Various elements impaired my ability to sleep and reflected the reasons patients would later complain to me about—being woken for observations, the harsh “pinging” of monitoring equipment, a confused patient shouting gibberish at the end of the bed, and staff talking.
The hospital ward is an environment that is not inherently conducive to sleep. However, despite unavoidable factors such as staff talking as they carry out essential work at night, efforts can be made to identify excessive noise, educate staff, and where appropriate modify equipment. As healthcare professionals it is vital for us to be aware of the problem and be sympathetic to our patients’ plight.Luke Staveley-Wadham, foundation year 1
1St Richards Hospital, Chichester
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Cite this as: BMJ 2013;347:f6318