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It really is hard to sleep in the ER

Patients who spend the night in the emergency room may get much less rest than patients who sleep in beds in hospital rooms, a small study suggests.

For the study, researchers surveyed 49 emergency room patients waiting to be admitted to the hospital and 44 people already admitted to inpatient wards. They asked the patients to describe noise levels in their rooms and rate sleep quality on a scale from 1 to 100, from worst to best. The questions focused on five aspects: how lightly or deeply they slept; how easily they fell asleep; how often they awoke during the night; how easily they returned to sleep when they did wake up; and whether they thought they had a good or bad night’s sleep.

After researchers accounted for patient characteristics that might impact sleep like their age and the severity of their illness or injury, they still found that people who got inpatient rooms rated their sleep environment as 65% quieter than patients stuck in the ER for the night.

ER patients also rated their sleep significantly worse across all five aspects of sleep quality, researchers report in the Emergency Medicine Journal.

“Often in my experience patients react with dread at the idea of spending a night in the noisy ER – bad enough you are unwell, and been told you need to stay in hospital, without then having to stay in the sleepless ER for the night,” said Richard Prendiville, lead author of the study and a researcher at National University of Ireland in Galway.

“Hopefully the finding will show hospitals that ER patients sleep measurably worse, and that this needs to be addressed,” Prendiville said by email.

Patients stuck in the ER were much older than people who got inpatient beds for the night. Half of those stuck in the ER were at least 60 years old, compared with 47 for people given inpatient rooms.

In the ER, patients were also sicker. Roughly three in four of them were ranked as the most seriously ill and injured patients when they first arrived, compared with slightly less than half of people given inpatient beds for the night.

The study wasn’t a controlled experiment designed to prove that staying in the ER or moving to an inpatient bed might directly impact sleep or health outcomes. Another limitation of the study is that researchers lacked data on differences in pain levels and use of painkillers, which might impact how well patients sleep, the study team notes.

Poor sleep in the hospital has previously been linked to a variety of health issues, said Dr. Prabath Nanayakkara, a researcher at Amsterdam University Medical Center who wasn’t involved in the current study.

“Insufficient sleep causes stress, high anxiety which increases sleepiness during the day and may limit mobility,” Nanayakkara said by email. “This will cause loss of function especially in the elderly, and can also cause delirium with and negatively impact general wellbeing.”

Patients may not be able to control where they sleep in the hospital, but there are still things they can do to try to get a better nights’ rest, Prendiville said.

“It is not a bad idea to bring ear plugs and an eye mask if you have to stay overnight in an ER,” Prendiville said. “However, a more ideal solution would be that patients just don’t sleep in the ER.”

SOURCE: Emergency Medicine Journal, online August 22, 2019.

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