Improving Sleep Using Mentored Behavioral and Environmental Restructuring (SLUMBER)

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PROJECT SUMMARY/ABSTRACT The goal of this study is to test a program designed to teach nursing facility staff to improve common sleep- related symptoms among residents. Sleep disturbances are quite common in skilled nursing facilities and affect as many as 69% of residents while staff do not fully understand how to improve sleep without using medications. Medications for sleep are commonly used as first-line therapy for older adults but this is problematic because these medications can lead to greater problems with thinking, more frequent falls, and even worse sleep over time. In addition, poor sleep can lead to depressed mood, greater trouble with thinking and memory, worse pain, and greater need for help with daily activities. There have been efforts to reduce the use of medications for sleep, yet there is still a need to improve the quality of sleep among residents who continue to have difficulties. Because nursing facility residents depend on caregiving staff to meet their basic day-to-day needs, it is essential that staff members participate in sleep improvement efforts. This study will “mentor” nursing facility staff to improve residents’ sleep and related symptoms by using a sleep improvement program called: Improving Sleep Using Mentored Behavioral and Environmental Restructuring (SLUMBER). This program provides mentoring to facility staff from sleep experts to improve the nighttime sleep environment, increase daytime activity levels and light exposure, reduce daytime behaviors that cause sleep disturbances at night, and to help individual residents who are having difficulty with sleep. The study will take place in two units per facility within three nursing facilities in random order. In addition to mentoring staff on strategies to improve sleep, this study will use technology to assist facility staff. This includes decibel meters to record noise levels and wrist actigraphs to measure residents’ sleep quality, activity levels and light exposure. Facility staff will also be given a list of targeted strategies to be used with residents having difficulty with sleep. Staff will be able to record episodes of sleep disturbance and to see a visual display of these data to support their work. This study will test whether the SLUMBER intervention improves nighttime sleep quality, resident reported symptoms of poor sleep, depressed mood, anxiety and pain, and whether the intervention improves cognitive and activity levels. This study will also measure whether staff have created a better sleep environment with decreased nighttime noise, increased daylight exposure and greater use of strategies to promote better sleep.