gms | German Medical Science

Background: During a hospital stay, disturbances in sleep quality and duration are a common issue, even though restful sleep plays a central role in the recovery and quality of life. The negative effects of sleep disorders on immune function, memory performance, wound healing, as well as an increase in insulin resistance, pain perception and mortality are well described [1]. There is a wide range of pharmacological and non-pharmacological measures available for the treatment of sleep disorders in the hospital, which are prescribed situationally and depend on the respective experience and knowledge of the doctor or healthcare provider. Currently, general recommendations for the treatment of sleep disorders during hospitalisation do not exist. Therefore, the aim of this study was to identify pharmacological and non-pharmacological measures for the treatment of sleep disorders, taking into account specific patient groups in the hospital, in order to derive recommendations for daily routine in the hospital setting.

Materials and methods: 18 experts from various healthcare professions in hospital, including doctors, nurses, and pharmacists, were asked to evaluate pharmacological and non-pharmacological suggestions for the prevention and treatment of sleep disorders during hospitalisation. These suggestions were developed based on a literature review. Expert consensus was obtained during a 2 round delphi survey without face-to-face meetings.

Results: All eleven non-pharmacological measures (providing earplugs, offering sleep masks, using light-blocking curtains in patient rooms, ensuring adequate daytime lighting in patient rooms, reducing nighttime “checks”, inquiring about pre-existing sleep disorders, thorough assessment of pre-existing conditions, avoiding caffeine in the evening, daytime physical activity, administering sleep-disrupting medications only during the day, and having a list of sleep-disrupting drugs) were strongly endorsed by the experts. Regarding pharmacological measures to improve sleep, experts supported not abruptly discontinuing “traditional sleep medications”, offering primarily non-drug approaches, and using herbal preparations. The experts also agreed on the primary use of melatonin for all patients who couldn't sleep despite non-pharmacological measures and valerian administration. Older multimorbid patients should be prescribed the sedative antidepressant mirtazapine or, alternatively, sedative antipsychotics like melperone or pipamperone without requiring doctor consultation.

Conclusion: The results of this study provide a suitable basis for developing a sleep care concept in the hospital to improve the sleep quality of patients during their hospital stays. The introduction of such a concept is just a starting point and must be a) evaluated and b) periodically adjusted based on new evidence.