Sleepless in the hospital: A systematic review of non-pharmacological sleep interventions

Gen Hosp Psychiatry. 2019 Jul-Aug;59:58-66. doi: 10.1016/j.genhosppsych.2019.05.006. Epub 2019 May 24.


Objective: Poor sleep is highly prevalent in inpatient medical settings and has been associated with attenuated healing and worsened outcomes following hospitalization. Although nonpharmacological interventions are preferred, little is known about the best way to intervene in hospital settings.

Method: A systematic review of published literature examining nonpharmacological sleep interventions among inpatients in Embase, PsycINFO and PubMed in accordance with PRISMA guidelines.

Results: Forty-three of the 1529 originally identified manuscripts met inclusion criteria, encompassing 2713 hospitalized participants from 18 countries comprised of psychiatric and older adult patients living in hospital settings. Main outcomes were subjective and objective measures of sleep duration, quality, and insomnia.

Conclusions: Overall, the review was unable to recommend any specific intervention due to the current state of the literature. The majority of included research was limited in quality due to lack of controls, lack of blinding, and reliance on self-reported outcomes. However, the literature suggests melatonin and CBT-I likely have the most promise to improve sleep in inpatient medical settings. Additionally, environmental modifications, including designated quiet time and ear plugs/eye masks, could be easily adopted in the care environment and may support sleep improvement. More rigorous research in nonpharmacological sleep interventions for hospitalized individuals is required to inform clinical recommendations.

Keywords: Hospitalized patients; Nonpharmacological intervention; Sleep.

Publication types

  • Research Support, N.I.H., Extramural
  • Systematic Review

MeSH terms

  • Hospitalization / statistics & numerical data*
  • Humans
  • Inpatients / statistics & numerical data*
  • Sleep Initiation and Maintenance Disorders / therapy*