Division of Psychiatry, UCL, London, United Kingdom.
Centre for Health Services Studies, University of Kent, Canterbury, United Kingdom.
PLoS One. 2022 Aug 9;17(8):e0272814. doi: 10.1371/journal.pone.0272814. eCollection 2022.
Sleep disturbances affect 38% of care home residents living with dementia. They are often treated with medication, but non-pharmacological interventions may be safer and effective yet more difficult to implement. In the SIESTA study (Sleep problems In dEmentia: interviews with care home STAff) we explored care home staffs' experience of managing sleep disturbances in their residents living with dementia.
We conducted one-to-one semi-structured interviews in four UK care homes, and purposively recruited a maximum variation sample of 18 nurses and care assistants, who were each interviewed once. We used a topic guide and audio-recorded the interviews. Two researchers independently analysed themes from transcribed interviews.
Staff used a range of techniques that often worked in improving or preventing residents' sleep disturbance. During the daytime, staff encouraged residents to eat well, and be physically active and stimulated to limit daytime sleep. In the evening, staff settled residents into dark, quiet, comfortable bedrooms often after a snack. When residents woke at night, they gave them caffeinated tea or food, considered possible pain and discomfort, and reassured residents they were safe. If residents remained unsettled, staff would engage them in activities. They used telecare to monitor night-time risk. Staff found minimising daytime napping difficult, described insufficient staffing at night to attend to reorient and guide awake residents and said residents frequently did not know it was night-time.
Some common techniques, such as caffeinated drinks, may be counterproductive. Future non-pharmacological interventions should consider practical difficulties staff face in managing sleep disturbances, including struggling to limit daytime napping, identifying residents' night-time needs, day-night disorientation, and insufficient night-time staffing.
睡眠障碍影响了 38%居住在养老院的痴呆症患者。这些患者通常会接受药物治疗，但非药物干预可能更安全有效，但实施起来更困难。在 SIESTA 研究（痴呆症患者睡眠问题：与养老院工作人员的访谈）中，我们探讨了养老院工作人员在管理居住在养老院的痴呆症患者的睡眠障碍方面的经验。
我们在英国的四家养老院进行了一对一的半结构化访谈，并对护士和护理助理进行了最大变异性样本的有目的招募，每个受访者接受一次访谈。我们使用主题指南并录制了访谈内容。两名研究人员独立分析了转录访谈的主题。
工作人员使用了一系列技术，这些技术通常可以改善或预防居民的睡眠障碍。白天，工作人员鼓励居民吃得好，进行身体活动和刺激，以限制白天的睡眠时间。晚上，工作人员让居民在吃点零食后，在黑暗、安静、舒适的卧室里安顿下来。当居民在夜间醒来时，他们会给他们含咖啡因的茶或食物，考虑可能的疼痛和不适，并安慰居民他们是安全的。如果居民仍然不安定，工作人员会让他们参与活动。他们使用远程护理来监测夜间风险。工作人员发现白天小睡时间难以控制，夜间工作人员不足，无法重新定向和引导清醒的居民，并且居民经常不知道现在是夜间。
一些常见的技术，如含咖啡因的饮料，可能会产生适得其反的效果。未来的非药物干预措施应考虑工作人员在管理睡眠障碍方面面临的实际困难，包括难以限制白天小睡、确定居民夜间需求、昼夜颠倒以及夜间工作人员不足。
