Getting sleep in the hospital

If you or any of your loved ones has ever been hospitalized, one of the complaints you may have heard about most is how hard it is to sleep in the hospital. There are lots of things about hospital routines that can make things difficult for patients to sleep, besides noise and illness. While some hospitals have taken steps to ensure that patients are not interrupted unnecessarily at night, this is not universal. Here are some things you can expect, and some steps you might be able to take to help the hospital give you a better night’s rest.

Some reasons you might be woken at night might be unavoidable

You might be on a particular medication, such as certain antibiotics, that must be given in the middle of the night, depending on when the first dose was given, and blood tests for levels of some antibiotics must be timed to their dosing, resulting in blood draws in the middle of the night, too. If you are admitted to check for a heart attack, you might also be ordered for timed blood tests that might involve having your blood drawn in the middle of the night. Vital signs, such as pulse and blood pressure, are required to be taken every four hours for some conditions, which would also awaken you.

One study shows the top thing keeping patients awake is pain, followed by vital signs and tests, noise, and medications. Studies have also shown that hospital routines can disrupt patient sleep, and having a designated quiet time, where nonessential tasks are minimized and lights and noise are lowered, may help. Here is a partial list of things that keep patients awake, and what you might be able to do about them.

Pain. Pain is easier to control before it gets bad. Don’t hesitate to ask for pain medicine at bedtime, even if your pain is not yet severe.

You are woken up to have your blood pressure taken. Vital signs are usually taken every eight hours. Often these are done between 11 pm and midnight, after the night shift starts, but it’s often just after you have fallen sleep. Alternatively, the night shift could be taking your vital signs at 6 am, when you’d be awoken for other hospital routines anyway. If you are given the opportunity to give feedback during or after your stay, it would be important to mention this — hospital administrators look closely at patient feedback.

The IV pump that keeps beeping. This is usually because the flow of IV fluid is blocked (occluded), most often because the IV was inserted in the crook of your elbow. Thus, every time you bend your arm, the pump will alarm and start beeping. If this is the case, ask to have the IV put in a different place, like your hand.

You are woken to be given medications. Sometimes a medication or breathing treatment might be ordered “every four hours” or “every six hours” which means the nurse or respiratory therapist is required to wake you to give it to you even if you are asleep. You can ask if the order can be changed to four times a day instead of every six hours, or “every four hours while awake” so you don’t have to be woken.

Noise. Lots of things can be noisy in the hospital at night — staff voices, cleaning machines, your roommate if you have one. You can always ask to have your door closed, and you can ask someone to bring in ear plugs.

You are up all night urinating. If this is not the case when you are at home, it might be because you were ordered for a diuretic to be given late in the day, after 6 pm or so, or you are ordered for IV fluids at a rate that is higher than you actually require. Your nurse can ask the doctor to change these orders.

Blood transfusions at night. If you need a blood transfusion, it is best not to do it during sleeping hours, because it requires the nurse to monitor your vital signs frequently and would keep you awake for hours. If you need a transfusion at that hour, ask if it can possibly wait until daytime.

Frequent nighttime disruptions can often cause patients to want to nap during the day, and throw off their sleep schedules. Patients might already be weak and tired from their underlying illness. If you’re hospitalized, it’s important to keep your normal sleep schedule and circadian rhythm. During the day, keep the window shades open for natural light and keep the room dark during sleeping hours. An eye mask might be helpful if exposure to light at night is unavoidable. A favorite blanket, pillow, photos, and your favorite music can help you relax and be more comfortable.

My colleagues and I at Somerville Hospital (since closed to inpatients) found that when we instituted a program to decrease disruptions during the night, such as purposely avoiding all the things described above, patients used as-needed sedatives about half as often in the hospital. Most hospitals can do better to make nighttime routines friendlier for patients, but institutional change can be challenging. Knowing what to ask for is useful and will help move healthcare forward.


  1. MaryAnn Lavine

    You wrote about Vit D but never gave the amount to take of this as a supplement?

  2. Dain Perry

    I think the last paragraph is the most important and there should be an article devoted to just those issues. “Most hospitals can do better to make nighttime routines friendlier for patients, but institutional change can be challenging.” What more needs to be said! The medical world needs to get out of its own way and institute the changes that are obvious and not a danger to anyone, and there are many. I have far too much experience with this as I have a son with a poorly understood syndrome which has had him hospitalized dozens of times over the last decade. There is so much that can be done to make the patient experience better…if the will is there! Organizing a committee of patients and family members to come up with suggestions and monitor the implementation would be a good first step.

  3. Robert Cater, MD

    Silicone putty ear plugs, like the ones used for keeping water out of the ears, can work wonders. I always have those available for my icu patients.

  4. Daniel Night Shift Lifesaver.

    Thank you for your article, it makes valid points, but it does lack some other points on which I shall elaborate. Quality indicators based on government intervention cite noise as a concern. Hospitals have tried to solve this problem with little success. The hospital is not a hotel. I as a medical professional of 30 years have seen how the art of caring has become more associated with government regulations and frivolous lawsuits. I want to make your stay as enjoyable as possible, but again this is not a hotel. People do not choose to spend their birthday, holiday, or any day confined to a sick bed. The sounds in a hospital are the sounds of misery, but also of healing hands at work. Broken bones hurt as do broken hearts when your loved one has a broken bone. Sickness knows no resting hour. Our me me me, and only me society has little concern for others misery. It is sad that one cannot be allowed to cry if they have pain, or cry if a loved one dies. Yes, we have visiting hours, but patients come in all night long. Nurses and doctors need to communicate at all times of the day and night to take care of you or your loved ones. Most of us do not know sign language so we have to talk. Institutionally, nurses and doctors speak in low voice tones at night and stop overhead paging after certain hours to minimize noise. Please do your part if you are unfortunate and need to be in the hospital yourself; try not to scream too loud when your leg is broken, or your child just got in an accident. In conclusion the hospital will never be a good place to get proper rest based on what it is. Be safe out there, and be good to each other everyday.

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