What drives sleep problems in long-term care facilities?

(Press-News.org) Sleep problems affect more than one in five residents in long-term care facilities, with pain, daytime napping and certain medications emerging as key contributors.  
 
An international team led by University of Waterloo researchers analyzed health records from more than 21,000 residents aged 65 and older living in 228 long-term care homes across New Brunswick and Saskatchewan between 2016 and 2021, using data from the standardized interRAI assessment system. 

The researchers tracked who developed – or recovered from – sleep disturbances over time. At the start, nearly 22 per cent of residents had trouble sleeping, although facility rates varied widely, from three to 56 per cent. Within a year, about 10 per cent of residents who had been sleeping well developed new sleep issues, while half of those with existing problems saw improvements. 

The study identified several predictors of new or persistent sleep problems, including pain, chronic conditions such as heart or lung disease, moderate cognitive impairment, daytime napping and the use of sedative or antipsychotic medications. 

“Poor sleep is strongly associated with adverse health outcomes, including an increased risk of cardiovascular disease, cognitive decline and depression,” said Dr. John Hirdes, professor in Waterloo’s School of Public Health Sciences and senior author of the paper. “It also often leads to greater medication use, which can in turn raise the risk of falls, delirium and other complications.” 

Hirdes said the findings highlight opportunities to improve resident well-being. “Many of the risk factors we identified are modifiable. Improving pain management, reviewing medication use and promoting better sleep routines could make a real difference.” 

Dr. Sophiya Benjamin, a geriatric psychiatrist and researcher at McMaster University and an adjunct professor at Waterloo, noted that poor resident sleep doesn’t just affect individuals – it also takes a toll on caregivers and the broader health-care system. “When residents sleep poorly, it can heighten stress and burnout among staff, ultimately affecting quality of care,” she said. 

Benjamin added that long-term care homes should make sleep quality a routine part of health monitoring and, where possible, explore non-drug strategies to improve rest. “Facilities should also pay attention to environmental factors like noise, lighting and nighttime routines – elements that can have a major impact on residents’ sleep but weren’t part of this particular study.” 

The paper, “Predictors of change in sleep disturbance in Canadian longterm care facilities: a longitudinal analysis based on interRAI assessments,” was published in European Geriatric Medicine. 

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