Aims
of Study:
Disturbed sleep is common amongst nursing home
residents (1) and night time pad changing (and resident
turning) have been found to be associated with sleep fragmentation
(2). However sleep problems are known to be multi-factorial
and it has not been demonstrated that changes in night time continence
management result in less sleep fragmentation. In this study we
aimed to answer the question: What is the effect of different
pad changing regimes on the sleep of elderly women living in residential
settings? In addition, we wished to explore earlier findings (3),
which indicated that a substantial proportion of residents who
were turned by staff, also turned themselves.
Methods:
A cross-over design was used. Following a two
week baseline period subjects from residential settings were randomly
allocated to one of two pad changing regimes, a more frequent pad changing regime (whereby residents were changed
at 22.00, 02.00 and 06.00) or a
less frequent pad changing regime (with residents changed
at 22.00 and 06.00 only). Each regime lasted four weeks and was
followed by the alternative regime. The Visi-lab (Stowood Scientific
Instruments) was used to measure sleep.
This comprises a video tape recorder and a computer attached
to an infra-red camera. A video tape is made enabling direct observation
of the resident’s sleep/wake patterns and activities.
Sleep disturbance is measured by calculating recorded body
movements, using analysis software supplied by the manufacturer.
Sleep recordings were taken for 10 hours, for two nights per subject
during each regime.
Results:
Twenty-one subjects with night time incontinence
from four residential settings for elderly people completed the
study. No significant differences were found in sleep disturbance
between the two regimes (more frequent pad change regime 57.9 SD 39.4 (mean movements per hour), less
frequent pad change 71.4 SD 48.2 (mean movements
per hour)). The trend
towards subjects moving less (and therefore sleeping more) during
the more
frequent pad changing regime is probably spurious,
but a possible explanation may be that subjects who were changed
more frequently were more comfortable and therefore slept more.
During both pad changing regimes staff seldom turned residents.
Five of the subjects turned themselves during the night and all
five were also turned by staff usually because they appeared to
have adopted uncomfortable or precarious positions.
Conclusions:
We found no evidence that a less
frequent pad changing regime results in less
sleep fragmentation for elderly women in residential settings. Sleep disturbance in institutional settings
is multi-factorial and it is therefore likely that a single additional
pad change does not have a measurable effect on sleep. We found that staff seldom turned residents even at the time of
pad changing, although self-turning residents were turned.
1 Allen, S.R., Seiler, W.O., Stahelin, H.B. and
Spiegel, R. (1987) Seventy-two
hour polygraphic and behavioral recordings of wakefulness and
sleep in a hospital geriatric unit: comparison between demented
and nondemented patients. Sleep 10
(2):143-59. 0161-8105.
2 Schnelle, J.F., Ouslander, J.G., Simmons, S.F.,
Alessi, C.A. and Gravel, M.D. (1993)
The nighttime environment, incontinence care, and sleep
disruption in nursing homes.
J-Am-Geriatr-Soc 41, 910-4.
3 Schnelle, J.F., Ouslander, J.G., Simmons, S.F.,
Alessi, C.A. and Gravel, M.D. (1993)
Nighttime sleep and bed mobility among incontinent nursing
home residents. J-Am-Geriatr-Soc 41, 903-909.
