From the Guidelines
Yes, sleep hours should be calculated for all behavioral health facility patients. Tracking sleep patterns is essential for comprehensive patient care as sleep disturbances are common in mental health conditions and can significantly impact treatment outcomes 1. Staff should document total sleep hours, sleep quality, and patterns of insomnia or hypersomnia using standardized sleep logs or electronic health record systems.
Key Considerations
- This monitoring should occur consistently throughout a patient's stay, with particular attention to changes following medication adjustments (especially when using medications that affect sleep like antipsychotics, antidepressants, or benzodiazepines).
- Sleep data helps clinicians make informed treatment decisions, as inadequate sleep can worsen psychiatric symptoms, while excessive sedation may indicate medication side effects requiring adjustment.
- Additionally, establishing healthy sleep patterns is often a therapeutic goal itself, with improvements in sleep duration and quality frequently correlating with overall clinical improvement, as suggested by the American Academy of Sleep Medicine 1.
Implementation
- Regular sleep monitoring also provides valuable information for discharge planning and ongoing outpatient care.
- The use of actigraphy, as suggested by the American Academy of Sleep Medicine, can be a useful tool in estimating sleep parameters in adult patients with insomnia disorder 1.
- However, it is crucial to note that actigraphy should not be used in place of electromyography for the diagnosis of periodic limb movement disorder in adult and pediatric patients, as strongly recommended by the American Academy of Sleep Medicine 1.
From the Research
Sleep Hours Calculation in Behavioral Health Facilities
- Calculating sleep hours for all behavioral health facility patients can be beneficial in assessing their sleep quality and quantity, which are essential for overall physical and mental well-being 2.
- Sleep health is often individualized based on three elements: sleep quality, sleep quantity, and timing of the sleep window, which correspond to overall physical and mental well-being 2.
- Cognitive Behavioral Therapy for Insomnia (CBT-I) is a effective treatment for adults with chronic insomnia, with clinically meaningful effect sizes, and can be used to improve sleep quality and quantity 3, 4.
Importance of Accurate Sleep Duration Measures
- Accurate sleep duration measures are crucial in assessing sleep health, and subjective measures such as sleep diaries and questionnaires may not always agree with objective measures such as polysomnography 5.
- Patients with insomnia disorder may report shorter sleep duration compared to polysomnography, while good sleeper controls may report longer sleep duration compared to polysomnography 5.
- The disagreement between subjective and objective measures suggests that they capture different aspects of sleep, and studies assessing sleep duration should take into account both the investigated population and the assessment method when interpreting results 5.
Treatment Options for Insomnia
- CBT-I is a multi-component treatment for insomnia that targets difficulties with initiating and/or maintaining sleep, and is delivered over the course of six to eight sessions 4.
- Trazodone, a pharmacological treatment, may be more effective than CBT-I in improving objective sleep duration and reducing hypothalamic-pituitary-adrenal axis activation in patients with insomnia with objective short sleep duration phenotype 6.
- Behavioral approaches, particularly CBT-I, have a more favorable benefit-to-harm profile than medications, and are increasingly being recommended as the first line intervention for insomnia 3, 4, 2.