Sleep Hygiene for Nurses

Sleep Hygiene for Nurses

Every nurse knows the significance of sleep for healing and optimal health. It’s included in the foundation level of Maslow’s Hierarchy of Needs, along with air, food, water, and shelter—the elements necessary for survival. 

Starting with their education, and continuing throughout their careers, nurses learn methods to enable their patients to sleep well. You make every effort to keep noises down on the unit to avoid disruption. You diligently teach your patients the importance of getting adequate rest and provide helpful tips to fall or stay asleep. 

The American Academy of Sleep Medicine recommends that adults should sleep 7 or more hours per night on a regular basis to promote optimal health. Sleeping less than 7 hours per night (called “short sleeping”) is associated with adverse outcomes, including:

• Weight gain and obesity
• Diabetes
• Hypertension
• Heart disease/Stroke
• Depression
• Death

But are you following the advice you give? About 100,000 hospital deaths occur each year in U.S. hospitals. Sleep deprivation and disorders have been noted as significant contributors to these deaths. 

The Irony: Nurses Sleep Less

Even though we’re aware that nurses are at serious risk of sleep deprivation and common sleep disorders, we can be guilty of sleeping less. Consider these statistics:

• An academic medical center survey showed 49% of nurses averaged less than 7 hours of sleep per night (6.6 hours), compared to 28% of the general population.
• In the same survey, 31% of the nurses exhibited symptoms of chronic insomnia, such as daytime sleepiness (falling asleep in a quiet situation).
• 27% of the nurses relied on sleep medications, with 13% using medications to stay awake.
• Nurses sleep nearly 90 minutes less on workdays, compared to their days off, according to findings published in the National Sleep Foundation’s journal.
• A 2020 (during the pandemic) survey of nurses found that 55% had insomnia and 52% had anxiety, an adverse effect of sleep deprivation.
• In 2011, the Joint Commission recognized that shift length and work schedule can greatly affect the quantity and quality of health care workers’ sleep.

“Nurse, Care for Thyself”

Ideally, you’d get eight hours of quality sleep every night. Realistically, a standard 12-hour shift schedule, combined with commute time and domestic/parental responsibilities, results in limited time for adequate sleep between shifts. Add in unexpected overtime, rotating shifts, or a stint of 12-hour nights, and carving out time for sleep seems impossible. 

Let’s look at some ways to boost your odds of practicing the same advice you give your patients.

Plan ahead: Before starting a stretch of shifts or a busy workweek, devote time to preparation.

• Spend a few hours preparing healthy meals and snacks for your shifts. If you’re responsible for other family members, make theirs, too. Focus on balanced nutrition and durability of the foods. Package and label for each person. When it’s time to go, just select your foods, put them in your tote/backpack, and head out.
• Depending on your work setting, you may require specific attire or scrubs. For example, some office settings wear a different color scrub for each day of the week. Don’t wait until the last minute: wash, dry, and set out clothing for a few days. Don’t forget socks and underwear. You’ll be more relaxed knowing there won’t be any last-minute “hunts.”
• Keep a calendar. This seems obvious, but you’re less anxious—and less likely to forget—when you write down workdays, appointments, practices, events, and special occasions. Use your phone to track obligations and to avoid work conflicts.
• Maintain a supply of personal work essentials, such as pens, tissues, feminine products, lip balm, or acetaminophen/ibuprofen. It’s crazy how suddenly realizing you don’t have an item can interrupt your sleep.
• Try to minimize “elective obligations” during your stretch of shifts. Example: Trade carpool days or schedule your dental cleaning for a day off.

Special circumstances: Some situations can’t be avoided or changed. It’s always best to think ahead.

• Are you required to rotate shifts or work outside from your usual circadian rhythm? Read our article on Shift Work Sleep Disorder.
• Night shift is an entirely different animal. Read our article on Making the Switch to The ‘Dark Side’--5 Tips for Adjusting to Night Shift.
• Mandatory holiday shifts mean extra “anticipatory planning.” As soon as you know which holidays you’ll be working, start to think ahead: gifts, food, clothing, etc. Even a little bit of preparation can go a long way.

Sleep hygiene: Ensuring your current environment for proper sleep can be the hardest to do and the easiest to neglect. It’s worth the effort.

• Work with your family, partner, or roommates to they understand your need for proper rest. Ask them to avoid or minimize interruptions after you’ve gone to bed. Just as you would with a patient, explain the consequences of inadequate sleep.
• Try to set a regular sleep routine and bedtime. This can be challenging, but your brain and body respond to routine, making it easier to fall and stay asleep. Give yourself 15-30 minutes of “quiet time,” such as reading, listening to soothing music, gentle stretching, journaling, or mindful meditation.
• Avoid eating or alcohol a few hours before bed. Don’t drink caffeinated beverages 6-8 hours before sleep.
• Invest in a supportive mattress and comfortable bed linens. Your head, neck, and spine require proper alignment to prevent strain. Sheets, pillows, and blankets should be inviting and restful.
• Block out light, especially when working evening or night shifts. Use heavy curtains or a sleep mask to prevent light from reaching your eyes and causing more disruption to your circadian cycle.
• Minimize noise with a fan or white noise machine. If necessary, use earplugs or headphones.
• Keep the bedroom temperature 65-68°F (18.3-20°C). Although this varies for each person, research supports sleeping in a cooler room.
• Turn off back-lit devices (phones, tablets, laptops) an hour before bedtime. These devices emit blue light can also reduce the amount of time you spend in slow-wave and rapid-eye movement (REM) sleep, two stages of the sleep cycle that are vital for cognitive functioning. They also prevent the production of melatonin, the hormone that naturally promotes sleep.

Benefits of quality sleep

Before nursing school and demanding career, chances are good that you didn’t have to worry about getting adequate sleep. Even if you skipped a few nights of rest, you could make it up over the weekend or by taking a long nap.

Now, missing sleep can mean mistakes that harm others. The amount of quality sleep correlates with attention and concentration, which are prerequisites for responsible nursing. Sleep also supports other important aspects of cognition, including memory, problem-solving, creativity, emotional processing, and judgment. 

Here are 10 important benefits of quality sleep:

• Positive mood, increased patience, and decreased irritability. 
• Higher energy levels
• Less anxiety and depression
• Decreased risk of heart disease, heart attacks, and heart failure
• Better regulation of blood glucose levels
• Ability of the brain to make new neural connections
• Restoration of the immune system by cytokine production
• Improved stress management
• Muscle growth and tissue repair
• Production of leptin, an appetite suppressor

Support from the American Nurses Association

All nurses--and their employers--should also be aware of the position statement released by the American Nurses Association in 2014. It makes the recommendation “to carefully consider the need for adequate rest and sleep when deciding whether to offer or accept work assignments, including on-call, and voluntary or mandatory overtime.” 

Every nurse needs to remember that to provide the best and safest care to our patients, we need to make sleep a priority each day.  And to advocate for ourselves in order to reduce the risk of errors and potential harm to the vulnerable people we have vowed to protect.

About the Author

Winona Suzanne Ball

Nursing Adviser, RN | MHS, Governors State University, IL
Full member of the American Nurses Association. Learn more