This document outlines a sleep program checklist for a long term care facility with operational, clinical, and environmental systems to promote better sleep for residents. It includes eliminating unnecessary noise and tasks at night, assessing sleep preferences, reviewing medications and procedures to minimize disturbances, using appropriate lighting, educating on sleep importance, and monitoring interventions and quality of life scores related to sleep.

1. 1
Sleep Program Checklist
Operational Systems:
 Eliminate stocking of resident rooms during the night-time between 8 PM – 9 AM.
 Eliminate cleaning of resident rooms, resident restrooms and common spaces between
8 PM – 9 AM.
 Schedule housekeeping and maintenance staff tasks so noise does not interfere with
resident sleep cycle before 8 am or after 9 pm.
 Train all staff on purposeful engagement with residents. Develop opportunities for
meaningful engagement in their daily activities.
 Schedule social services staff no earlier than 8 AM with a staggering of staff throughout
the day to address sun-downing needs and behavioral changes in the afternoon and
evening.
 Schedule therapeutic staff and recreational activities during the times residents need
and request engagement. Opportunities for engagement need to be offered at least
until 7:30 PM – 8:00 PM at night and sometimes later based on the resident population.
 Schedule Rehab staff based on the sleep patterns of patients/residents to avoid waking
up in am.
 Reduce extended napping (2 naps +/ day) whenever possible. A resident napping in a
bed should not exceed 1 hour unless medically indicated or long term resident
preference.
 Cueing of hallway lighting in the evenings and night by either engineering fixed timers or
scheduled assignment. Emergency override should be available.
 Elimination of all unnecessary noise including use of personal/bed alarms, staff talking
loudly, and mechanical noises.
 Offering appropriate resident engagement activities i.e. interest boxes, Memory boxes,
Memory Magic, which are accessible to all staff.
 Eliminate garbage removal, vendor repairs, construction projects, etc. before 8 AM
unless emergency circumstances dictate otherwise.
 Encourage residents activities to be offered in rooms or outside with natural light
exposure between 9-11 am and 1-3 pm.
Clinical Systems:
 Assess and provide residents’ sleep/wake preferences and routines.
 Revisit repositioning schedules to minimize sleeping interruptions of residents.
Whenever possible and as determined by appropriate assessment, try to extend the
times between repositioning. Document changes per careplan.
 Use extended wear products at night when appropriate for residents to promote
uninterrupted sleep. Document per careplan.
 Offering snooze foods in the PM and caffeine products in the morning and mid–day.

2. 2
 Thoughtful promotion of fluids with gentle restrictions of fluids after the evening meal.
 Collaborate with dietary and nursing for reduction of offering juices and other bladder
irritants with the evening and night time med passes.
 Use of sleep tracker to enhance quality of sleep, repositioning, continence, pain
management.
 Focused medication (appropriate use, dosage and timing) review to promote non-
disturbance of resident sleep at night.
 Eliminate weighing of residents & other procedures, whenever possible, at night.
 Revisit vital check schedule upon admission – does it need to be as frequent as current
systems mandate?
 Eliminate early lab times before 8 AM unless medical conditions dictate otherwise.
 Environmental:
 Use of amber lighting (nightlights, flashlights, headlamps, etc.) whenever possible at
night to promote fewer sleep interruptions. Promote use of Huglight.
 Open resident window coverings (with their approval) to promote natural sun light in
the resident rooms.
 Integrate appropriate use of lighting (blue/white light during the day, amber/red light at
night) to promote circadian rhythms.
 Promote appropriate light cues to residents and staff (dim lights at night, increase light
levels during day.)
 Assess and provide residents’ sleep surface, coverings and pillow preferences.
 Provide education to residents, families and staff on the importance of sleep.
Miscellaneous:
Review sleep and discuss findings with resident and family during care conference and
implement sleep strategies.
 Utilize sleep tracker to monitor and evaluate interventions for residents with poor
quality sleep.
 Review progress on checklist at monthly QA meetings (should ideally be working on 2-
3 at a time) Review QI results at monthly meeting and discuss action plan to address
site specific issues
 Meet with IDT weekly to discuss those in assessment reference period that flag for
specific QIs.
 Review QM reports for QIs that are flagging.

3. 3
Improve Quality of Life Scores
Are you bothered by noise when you are
in your room?
 4 QOL questions asked quarterly at care
conferences/quarterly assessments
 Results logged and reviewed at monthly
QA meeting
 Negative response followed-up on and
action tracked on log
Are there things to do here that you
enjoy?
Can you go to bed at the time you want?
Can you get up in the morning at the
time you want?