Sleep is a health habit that we don’t think much about unless we are having trouble with it. As I have aged, I have become a frequent member of the Insomnia Club. It is amazing how cranky I can get with just one sleepless night. Compound that sleep loss and other things start going wrong. The CDC links chronic sleep loss with a number of chronic conditions including Type II Diabetes, Cardiovascular Disease, Obesity, and Depression. That means sleep is a health habit we want to cultivate for ourselves and for our patients.

Yet, our inmate patients have an even more difficult situation for sleeping. Most sleep guides such as this one from the CDC want you to control the lighting and noise in your sleep environment – not possible in jails and prisons. Providing prescription sleep medications is also ill-advised in the correctional setting. These medications are not appropriate for self-administration (KOP) due to the likelihood of abuse in the prison environment and the last pill line of the day is rarely close to the bedtime hour to allow the medication maximum effect. In fact, the entire daily timetable can be topsy-turvy in a setting where meal times and bedtimes are governed by security procedure. Some prisons serve breakfast at 3am and lunch at 10am. The body clock may never adjust to these changes and be unwilling to shut down for sleep when needed.

One of my Facebook friends recently sent me this message – a good example of the sleeping situation we need to deal with:

I have several inmates that have trouble sleeping. I am quite sure this is not an unusual problem in jail, but one in particular is really having a hard time. My situation is that I leave at 4:30pm and do not give ‘sleep aids’ anyway.  Soooo, short of medications, do you have any suggestions as to what he could do to assist him in resting better? He does get to work road crew some days and that helps, but not much. Any ideas?

Correctional nurses need to creatively apply common principles of good sleep to the realities of the correctional environment to help our patients get the rest they need. We have an opportunity to improve our patient’s sleep through influence and education.

Influencing the Sleep Environment

You may or may not be able to improve the sleep environment of your patients but you will never know if you don’t give it a try. Here are some actions you can take:

• Find out what the current situation is for most of the inmates in your facility. For example, is there a lights out policy that is enforced? What is the earliest hour activity starts each morning in the housing areas? What are the noise levels and policies governing noises such as the television or radios?
• Check out what is available to the inmates through the commissary (inmate store). For example, are non-prescriptive sleep aids available such as melatonin or valerian ? If not, could they be considered?
• Make a case for the security benefit of rested inmates with the custody side of the house. Sleeplessness affects the mind. Tired, irritable inmates are difficult to manage.

Sleep Hygiene Behind Bars

The Prison Health Taskforce out of the UK has a helpful guide to sleep in prison. Since they provide the guide as an MSWord document, you have opportunity to download and modify the patient teaching to fit your facility situation. Here are some key points to consider:

• Stay Active: Many inmates mistakenly try to sleep away their sentence by taking cat naps all day long. This only leads to more insomnia. Help your patients create a list of daytime activities that will keep them out of the bunk most of the day.
• Have a Bedtime Routine: Even though it will be different than home, establishing a new routine helps the body shut down and move into sleep mode. Nurses can help create a routine that will work in the housing unit.
• Reduce Noise and Light: Consider alternatives that might be possible in the housing area such as eye-shades or ear-plugs. Even reversing the pillow end of the bunk or rigging a towel curtain may help block out distracting light.
• Nightmares and Anxieties: Address these possibilities with your sleepless patient. If they are worried about assault or have concerns about family issues, you may be able to direct them to a resource to deal with the underlying issue. Sleeplessness may be an acceptable ‘medical’ condition that masks an underlying emotional or psychological concern. Ask the questions that go deeper into  issues that may need to see the light of day.

How do you deal with sleepless inmates? Share your tips in the comment section of this post.

Photo Credit: © Emir Simsek – Fotolia.com