Julia Worrall, RN, CCRN, is the Executive Director of the Foundation for Airway and Craniofacial Excellence in La Jolla, CA. This post is based on her session “Sleep Quality: An Important Health Issue for Staff and Inmates” taking place at the 2018 Spring Conference on Correctional Health Care in Minneapolis, MN April 21-24, 2018. Learn more about the conference and register HERE.

Jails and prisons are noisy places. Depending on the unit, incarcerated patients must try to sleep with lights on, equipment noises, and the voices of staff and other inmates. Even usually good sleepers can be challenged in such a situation. Yet, sleep is a vital health need. According to the CDC, sleep issues are linked to many chronic health and mental health conditions such as diabetes, hypertension and other cardiovascular conditions such as atrial fibrillation, obesity, and depression. Even memory issues, dementia, and Alzheimer’s disease are associated with a chronic lack of sleep.

Why Can’t Inmates Sleep?

There are several factors that make it difficult for inmates to get adequate sleep.

• An environment that is perceived as dangerous can affect sleep.
• Jails and prisons that are over-crowded will have more issues with inmates showing signs of sleep deprivation.
• Security checks that take place every 30 minutes can disrupt sleep. While this may be for safety or suicide prevention, an indirect side-effect could be contributing to mental illness, anxiety, and depression in inmates by frequently interrupting their sleep.
• Drugs, prescribed or not, affect sleep architecture and may cause insomnia or depression of the central nervous system leading to respiratory disturbances during sleep.
• Hypervigilance during the day creates an overactive sympathetic response making it difficult to settle at night, fall asleep, and stay asleep.
• Some inmates may try to ‘sleep away their sentence’ by taking frequent naps throughout the day thereby making it more difficult to sleep at night.

Change the Environment to Improve Sleep

While just being in a new environment will affect sleep for new inmates, other environmental changes are needed for continued improved sleep.

• Ideally, every inmate would be single-celled to enhance their feeling of security during one of the most vulnerable times in the day. Where this is not practical, frequent ‘check-ins’ by custody and/or medical staff about how safe the inmate feels with their cellie becomes invaluable.
• Disposable eye masks and earplugs could be provided on a weekly basis. This addresses both the sound issues and the flashlight ‘in the face’ during night time security checks.
• Other ideas to consider are having officers use a swipe card instead of a baton to verify a cell check or have a Velcro wrap for keys during the night to minimize jangling.
• Educating custody about the importance of adequate, efficient sleep actually creates a safer environment for everyone to live and work in. Armed with sleep information, officers could assist medical staff in finding ways to address the sleep environment for inmates.

While possibly challenging to implement, the use of classical music piped in 30 mins before ‘lights out’ could trigger the brain to begin to shut down for the night. The brain needs at least 30 minutes of darkness for your brain to release melatonin. During this time, inmates could do relaxation techniques that have been demonstrated to them over the closed circuit television system to help them slow their breathing and calm their nervous system in preparation for sleep.

Sleep Hygiene

Sleep hygiene is the habits and practice that help a person drift into sleep. Many of us have developed rituals at bedtime that tell our brain it is time to turn off for the night. Inmates must rearrange or create new pre-bed habits in order to fall asleep in new and stressful surroundings. Worrall recommends the following tips for sleep hygiene behind bars.

• Minimize or avoid naps altogether
• Reduce caffeine, especially 6 hours before anticipated bedtime
• Try to wake at the same time each day
• Develop a standard nighttime routine

Correctional Nurse – Heal Thyself!

How can correctional nurses help their patient’s sleep better? First and foremost, nurses need to be well-rested themselves. According to sleep studies, just one night of sleep deficit affects emotional empathy or compassion.

Another way we can help our patients is to actually ask them about their sleep during sick call or chronic care visits. Open the conversation. Let your patients know that sleep, or lack thereof, is a critical pillar of health and that you are concerned.

If your patient is having sleeping difficulty, here are a few nursing interventions to undertake.

• Review prescribed medication and the effect on sleep architecture
• Screen patients for signs and symptoms of sleep breathing disorders
• Ask your patient to keep a sleep log
• Encourage mindfulness techniques and good sleep hygiene practices like those described above

How do you manage sleep quality in your setting? Share your experience in the comments section of this post.

This post is part of a series discussing topics addressed during sessions of the 2018 Spring Conference on Correctional Health Care. All posts in this series can be found HERE.