International Journal on Science and Technology

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The Silent Night Disturbance: Understanding and Managing Hospital-Acquired Insomnia

Author(s) Dr Praveen Kumar, Dr Yashaswi V, Dr Vagesh Kumar S R, Dr Naveen S Hiremath
Country India
Abstract Background: Sleep disruption is common during hospitalization and is associated with adverse outcomes. We evaluated prevalence, determinants, clinical consequences, and short-term outcomes of hospital-acquired insomnia among General Medicine inpatients, prioritizing ICU patients.
Methods: Cross-sectional observational study at Basaveshwara Medical College & Hospital, Chitradurga. A convenience sample of 150 adult inpatients (89 ICU, 61 ward) reporting new or worsened sleep disturbance was enrolled. Sleep quality for the previous night was assessed with the Richards–Campbell Sleep Questionnaire (RCSQ; primary outcome). Baseline insomnia was categorized using the Insomnia Severity Index (ISI). Data collected included demographics, diagnosis category, pain score, anxiety, nighttime disturbances, treatment-related adverse effects, sedative use, delirium, and length of stay (LOS). Descriptive statistics, chi-square tests for categorical comparisons, and recommendation for multivariable modelling were used.
Results: On admission (Day 1), 119/150 (79.3%) patients had poor sleep (RCSQ total <50); Day-2 rate was unchanged (119/150). By Day 3 this declined to 82/150 (54.7%), and by Day 5–7 only 20/150 (13.3%) had RCSQ <50. ICU patients had markedly higher Day-1 insomnia than ward patients (ICU 89/89 [100%] vs ward 37/61 [60.7%]; χ² = 41.69, p < 0.0001). ISI distribution: no clinically significant insomnia 57 (38.0%), subthreshold 22 (14.7%), moderate 14 (9.3%), severe 57 (38.0%). Major contributors included treatment-related effects (n=60), pain (n=40), and ICU-related anxiety/noise/light exposure (predominant in ICU). Outcomes: 85 (56.7%) recovered normal sleep without pharmacotherapy, 30 (20.0%) required short-term sedatives (mostly on days 2–3), 17 (11.3%) were discharged with sedatives, and 8 (5.3%) developed altered sensorium (delirium/psychosis) attributed in part to ineffective sleep. Patients with persistent insomnia were observed to have longer LOS (clinically ~40% longer); formal adjusted analysis of LOS is recommended.
Conclusions: Hospital-acquired insomnia was highly prevalent, especially in ICU patients, and improved as patients acclimatized and disease severity lessened. Non-pharmacological contributors (noise, light, interruptions), treatment side-effects, pain, and anxiety were major drivers. Most patients recovered without long-term pharmacotherapy but a significant minority required short-term sedatives or experienced altered sensorium. Routine assessment and implementation of sleep-promoting bundles are warranted in inpatient care.
Keywords hospital-acquired insomnia inpatient sleep quality Richards–Campbell Sleep Questionnaire ISI ICU
Field Medical / Pharmacy
Published In Volume 16, Issue 4, October-December 2025
Published On 2025-11-30
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