Overview: Sleep problems affect one in five long-term care residents
Sleep disturbances are a common issue in long-term care facilities, impacting more than 20% of residents. An international study led by researchers at the University of Waterloo analyzed health records from over 21,000 residents aged 65 and older across 228 long-term care homes in New Brunswick and Saskatchewan, Canada, between 2016 and 2021. Using the standardized interRAI assessment system, the research tracked the emergence or resolution of sleep problems over time and revealed important patterns that matter for resident well-being and care planning.
The scope and key findings
At the study’s outset, nearly 22% of residents reported trouble sleeping, though this rate varied widely across facilities—from as low as 3% to as high as 56%. Within a year, about 10% of residents who had been sleeping well developed new sleep issues, while roughly half of those with existing sleep problems experienced improvements. These dynamics underscore that sleep disturbances are not only prevalent but also evolving, and that some residents may experience recovery while others are newly challenged.
What predicts new or persistent sleep problems?
The study identified several predictors associated with the onset or persistence of sleep disturbances. Strong links were found with:
- Pain and chronic conditions, including heart or lung disease
- Moderate cognitive impairment
- Daytime napping
- Use of sedative or antipsychotic medications
These factors help explain why sleep problems cluster in this population and highlight potential targets for intervention. Importantly, the researchers note that many of these risk factors are modifiable, offering a clear path to improving sleep and overall health outcomes.
Health consequences linked to poor sleep
Poor sleep in seniors is strongly associated with a range of adverse health outcomes. The researchers point to a higher risk of cardiovascular disease, accelerated cognitive decline, and increased rates of depression among residents with sleep disturbances. In addition, poor sleep often leads to greater reliance on medications, which can raise the risk of falls, delirium, and other complications—especially in facilities where polypharmacy is common.
Why these findings matter for care teams
The results emphasize opportunities for care teams to improve resident well-being through targeted strategies. Given that many risk factors are modifiable, facilities can implement measures to support better sleep without compromising safety or comfort. Key areas include:
- Enhanced pain management and treatment of chronic conditions
- Careful review of sedatives and antipsychotics, balancing benefits and risks
- Structured daytime activity to reduce unnecessary daytime napping
- Sleep hygiene practices and individualized routines that respect resident preferences
Dr. John Hirdes, a leading author and professor at the University of Waterloo, stresses that improving sleep can reduce medication use and associated complications, creating a virtuous cycle of better health and quality of life for residents.
Practical steps for facilities
To translate these findings into action, facilities can:
- Review and optimize pain management plans, ensuring effective relief with minimal sedative reliance
- Conduct medication reconciliation to evaluate sleep-related side effects
- Establish consistent bedtime routines and wake times aligned with residents’ rhythms
- Incorporate non-pharmacological sleep supports, such as exposure to natural light, physical activity, and relaxation techniques
- Train staff to recognize early signs of sleep disturbance and adjust care plans accordingly
These strategies are aligned with the study’s implications: addressing sleep issues can improve overall health, reduce risks of falls and delirium, and promote better cognitive and mood outcomes for seniors in care homes.
Conclusion
The University of Waterloo-led study provides robust evidence that poor sleep among older adults in long-term care is linked to serious health risks and that many contributing factors are modifiable. By prioritizing pain control, mindful medication use, and sleep-friendly routines, care facilities can make meaningful strides in enhancing the health and happiness of residents.
