Management of sleep disturbances in people with dementia living in care homes: The SIESTA qualitative study

Abstract

AbstractBackgroundSleep disturbances, including difficulty falling asleep, night time awakening, and excessive daytime sleepiness, effect nearly 40% of people with dementia living in care homes. Though hypnotic medications are commonly used, they are not recommended as they have been linked to increased risk of falls and mortality, and have little efficacy. There are currently no evidence‐based treatments. Through the SIESTA qualitative study (Sleep problems In dEmentia: interviews with care home STAff), we aimed to explore the alternative ways that sleep disturbances in residents with dementia are managed by care home staff.MethodWe interviewed 18 nurses and care assistants working both day and night shifts at four care homes in the UK providing residential and nursing care. We used a topic guide to explore staff experience of sleep disturbance in residents with dementia. The interviews were audio‐recorded, transcribed, and analyzed thematically by two researchers independently.ResultAll staff described a range of strategies they used to manage sleep disturbance in residents with dementia. Often this began with preventative techniques in the daytime, with staff ensuring where possible residents stayed active, ate well, and took part in activities to avoid napping. In the evening time staff settled residents into a dark, noise free, comfortable bedroom environment. When residents woke during the night‐time they were often given caffeinated tea or food, particularly if they had not eaten or drank much in the day due to napping. Tea and comfort were often used together, with staff sitting with the resident providing company and reassurance. If someone was agitated staff would think about pain and discomfort, and would use telecare to monitor residents who often left their bed at night and were a safety risk. As the last resort, sleep medications were used, but staff described how they only worked sometimes, as well as the side effects.ConclusionStaff used a range of techniques and described how these often worked in reducing, maintaining or preventing sleep disturbance, however, some of the strategies reported by staff to deal with sleep disturbances such as feeding or providing caffeinated tea at night might be counter‐productive.