Randomized, Controlled Trial of a Nonpharmacological Intervention to Improve Abnormal Sleep/Wake Patterns in Nursing Home Residents

OBJECTIVES: Abnormal sleep/wake patterns are common in nursing home residents. Lifestyle and environmental factors likely contribute to these poor sleep patterns. The objective of this study was to test a multidimensional, nonpharmacological intervention to improve abnormal sleep/wake patterns in nursing home residents. DESIGN: Randomized, controlled trial. SETTING: Four nursing homes in the Los Angeles area. PARTICIPANTS: Residents were screened for excessive daytime sleeping (asleep > or = 15% of daytime observations) and nighttime sleep disruption (asleep < 80% of nighttime hours, according to wrist actigraphy). Four hundred ninety-two residents were screened; 339 had excessive daytime sleeping. Of these, 133 had nighttime sleep disruption and consented to participate; 120 completed baseline assessments, and 118 (77% female, mean age 86.9, 90% non-Hispanic white) were randomized to intervention versus usual care. INTERVENTION: Five consecutive days and nights of efforts to decrease daytime in-bed time, 30 minutes or more of daily sunlight exposure, increased physical activity, structured bedtime routine, and efforts to decrease nighttime noise and light. MEASUREMENTS: Seventy-two consecutive hours of wrist actigraphy (nighttime sleep) and structured behavioral observations (daytime sleep and participation in social and physical activities and social conversation) at baseline and repeated at follow-up while the intervention or usual care condition was in place. RESULTS: The only effect on nighttime sleep was a modest decrease in mean duration of nighttime awakenings in intervention participants (10.6 minutes at baseline, 9.8 minutes at follow-up) versus an increase in controls (9.8 minutes at baseline, 13.8 minutes at follow-up) (F=4.27, P=.04). There were no significant effects on percentage of nighttime sleep or number of nighttime awakenings. There was a significant decrease in daytime sleeping in intervention participants (32% of daytime observations asleep at baseline, 21% at follow-up), with no change in controls (32% at baseline, 30% at follow-up; F=20.68, P<.001). Intervention participants had increased participation in social (F=22.42, P<.001) and physical (F=12.65, P=.001) activities and social conversation (F=5.04, P=.03). CONCLUSION: A multidimensional, nonpharmacological intervention into lifestyle and environmental factors that likely contribute to abnormal sleep/wake patterns in nursing home residents resulted in decreased daytime sleeping and increased participation in social and physical activities and social conversation. Nonpharmacological interventions should be considered in the management of abnormal sleep/wake patterns in nursing home residents. The main effect may be a significant decrease in daytime sleeping, which may translate to an improvement in quality of life.