22/11/ Steps Towards a Good Nights Sleep for Older People Receiving Care. Sleep is vital to our wellbeing. The SomnIA Work Packages

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1 10 Steps Towards a Good Nights Sleep for Older People Receiving Care DR INGRID EYERS CRaNe Care Research Network dr.ingrid.eyers@gmail.com The SomnIA Work Packages Understanding Interventions Dissemination WP1 Epidemiology of disrupted sleep and sedative prescribing in later life WP2 Poor sleep among community dwelling older people WP4 Supported self-management for insomnia among older patients WP5 Evaluation of blue-enriched light on quality of sleep among older people in the community WP7 Development and evaluation of sensor-based devices to improve sleep for older people WP8 Healthtalkonline older peoples experiences of sleep problems, and developing a website resource on sleep. WP3 Determinants of poor quality sleep in care homes WP6 Evaluation of blue-enriched light on sleep of care home residents 1 Sleep is vital to our wellbeing Think of a word that describes your personal experience of sleep Good sleep Bad sleep How do you judge the sleep of others? Partner Children People in your care What are the factors that influence your sleep? Good sleep Bad sleep 2 1

2 Relevant evidence based factors Sleep is very individual and is regulated by our brain Our bodies are governed by our personal circadian rhythm which affects our daily sleep pattern Whilst sleeping we all experience sleep cycles that involve five distinct stages of sleep. It is important to note that in Stages 2 and 4, older people are more sensitive to noise The brain is sensitive to light at night, for example a street light outside a bedroom window can disturb the external signals the brain is processing to inform the circadian rhythm Disturbances at night disrupt the sleep cycle and limit the body s ability to experience restorative sleep 8 Importance of Sleep in Later Life Sleep is vital throughout life Good sleep in later life: Enhances cognitive abilities Enhances physical abilities Contributes to recuperation and rehabilitation Reduces the risk of falls Enhances quality of life 3 Why research sleep in care homes? Sleep forms a significant part of the everyday life experienced by older people living in nursing homes and may dominate their lives Getting residents ready for sleep, monitoring sleep and getting residents up in the morning are key to the support in activities of daily living provided by care staff The experience of sleep in nursing homes can be expected to differ from that of sleep at home 4 2

3 Indentifying the determinants of poor sleep in care homes Inform policy Inform practice development Robust and valid evidence base to improve sleep in care homes Data for WP 6 & 7 Actiwatches Diaries Interviews Observations 5 Determinants of poor sleep in care Key findings: Mean time in bed 10hours 47minutes 64.8% of sleep disturbances were related to toilet/continence care 83.3% of residents experience fragmented sleep Routine of the facility determines when someone goes to bed at night and gets up in the morning 6 Determinants of poor sleep in care Key findings: Surveillance and care giving processes disrupt sleep Checking on them that s our work, we have to look after them (Madge, care staff ) When the staff come into my room I wake up (Stanley, resident) Boredom and loneliness Potential contact time during a 12 hour shift (8am -8pm) in a sampled home there was 3 hours potential contact time For the remaining 9 hours there was an activities program 7 3

4 Bringing Research to Practice: How 10 Conference presentations Peer reviewed Publications Workshops with practitioners Making the information accessible with the 10 Steps programme 9 1. Step: Understanding sleep is governed internally by your brain Step: Understanding the sleep pattern and phases 11 4

5 1. Step Ensure all staff and the relatives of residents understand the nature of sleep and the importance of restorative uninterrupted sleep to the well being of older people receiving care Step Support and facilitate direct exposure to natural daylight including daily expeditions out into the fresh air for at least 10 minutes every day Step Ensure good lighting is provided throughout the building, especially in communal areas. However, at night bedrooms need to be dark. 14 5

6 4. Step Consider how the daily routine could be adapted so that the night time routine does not start immediately after the evening meal. For example, a meal served around 5.30pm should not be followed promptly by preparations for the night Step Consider introducing evening events or gatherings e.g. in care homes establish a cosy evening gathering point to just chat and socialise Step Accommodate individual habits of a lifetime relating to activities leading up to going to bed and getting up in the morning. 17 6

7 7. Step Acknowledge the individuality of sleep: e.g. distinguish between larks and owls and take the sleep cycle into consideration Step Establish night time care plans that facilitate uninterrupted sleep Step Evaluate night time continence care needs and establish a personalised toileting or pad changing pattern that maximises uninterrupted sleep. 20 7

8 10. Step Ensure that unless specifically called for, uninterrupted night time sleep is facilitated between 11 pm and 7am. 21 Bringing Research to Practice: Outcomes Findings from a small scale study in a facility that has changed how care is provided indicate Constipation dropped by 76% Residents underweight dropped by 48% Falls dropped by 24% Pain dropped by 23% Pressure Incidents dropped by 15% Challenging Behaviour dropped by 7% 22 Take home message: A good night of restorative sleep will help improve both cognitive and physical abilities thereby improving the well-being and quality of life of older people receiving care. Contributing towards establishing an awareness of the importance of sleep and pointing out that it is time to rethink how care is provided and participating in the process could be your first step Thank you for listening, please don t forget your own need for restorative sleep 23 8

9 Acknowledgement These 10 Steps are built on the foundation of New Dynamics of Ageing funded SomnIA project (RES ) and are the outcome of wide ranging discussions with the care sector in the process of disseminating the research findings to the care sector at a national and international level THANK YOU to everybody who took part 9

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