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Invited Commentary
September 2018

Minimizing Sleep Disruption for Hospitalized Patients: A Wake-up Call

Author Affiliations
  • 1Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
  • 2Department of Population Medicine, Harvard Medical School, Boston, Massachusetts
  • 3Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
  • 4Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
JAMA Intern Med. 2018;178(9):1208-1209. doi:10.1001/jamainternmed.2018.2679

“Doctor, I had a horrible time sleeping last night.”

Sleep disruption occurs in two-thirds of general ward patients in the hospital, perhaps unsurprisingly given the unfamiliar and stressful environment characterized by illness and discomfort, a preponderance of noise and light, and around-the-clock interventions.1 Sleep deprivation in the hospital has been linked to important adverse outcomes, including alteration of homeostatic functions, such as glucose metabolism, cortisol regulation, and circadian rhythmicity; difficulty weaning from mechanical ventilation; defects in cellular immunity; and increased risk of long-term sleep disorders that play a role in depression, anxiety, and posttraumatic stress disorder.2 Acute sleep deprivation results in measurable deficits in executive attention and working memory3 and is an important risk factor for the development of delirium.2 When our patients relate their difficulty sleeping in the hospital, they are not reporting only a nuisance but also a direct contributor to adverse outcomes, even mortality.

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    1 Comment for this article
    John R. Dykers, Jr., MD | Chatham Hospital, UNC West

    Thank you so much for such a wonderful study on such an important problem that is so ignored in most hospitals by most people involved in patient care. Simply adding "when awake" to many medication and vital sign orders can work wonders.