The Nursing Home at Night: Effects of an Intervention on Noise, Light, and Sleep

OBJECTIVES: The sleep of nursing home residents is fragmented by frequent awakening episodes associated, at least in part, with environmental variables, including noise and light changes. The purpose of this study was to improve sleep by reducing the frequency of nighttime noise and light changes. PARTICIPANTS AND SETTING: Two hundred sixty‐seven incontinent nursing home residents in eight nursing homes. DESIGN: A randomized control group design with a delayed intervention for the control group. MEASUREMENTS: Bedside noise and light monitors recorded the number of 2‐minute intervals at night with peak sounds recorded above 50 dBs and the number of light changes of at least 10 lux between adjacent 2‐minute intervals. Daytime behavioral observations measured sleep and in‐bed time during the day, and wrist activity was used to estimate sleep at night. Awakening events associated with the environmental variables were derived from the wrist activity data. INTERVENTION: A behavioral intervention implemented between 7:00 p.m. and 6:00 a.m. that involved feedback to nursing home staff about noise levels and implementation by research staff of procedures to both abate noise (e.g., turn off unwatched television sets) and to individualize nighttime incontinence care routines to be less disruptive to sleep. RESULTS: Noise was reduced significantly, from an average of 83 intervals per night with peak noises recorded above 50 dBs to an average of 58 intervals per night in the group that received the initial intervention, whereas noise in the control group showed no change (MANOVA group X time P < .001). All 10‐dB categories of noise from 50 to 90 + dBs were reduced, and light changes were reduced from an average of four per night per resident to two per night (P