Insomnia Symptoms and Environmental Disruptors: A Preliminary Evaluation of Veterans in a Subacute Rehabilitation

ABSTRACT

Objectives

Evaluate insomnia symptoms and environmental disruptors at admission and discharge in a subacute rehabilitation care setting.

Methods

Veterans (age ≥50) admitted to a Veterans Health Administration (VA) Hospital subacute rehabilitation between March and August 2022 completed baseline (N = 46) and follow up (N = 33) assessments with the Insomnia Severity Index (ISI), Sleep Need Questionnaire (SNQ), Epworth Sleepiness Scale (ESS), and an assessment of environmental sleep disruptors. Veterans were offered sleep resources after admission evaluations and outpatient referrals after discharge evaluations. Pearson correlation determined associations between length of stay (LOS), ISI, SNQ, and ESS scores at admission and discharge; chi-square and Wilcoxon Signed Rank Tests compared insomnia at admission and discharge.

Results

One-half of participants reported clinically meaningful insomnia symptoms and sleep needs at baseline with no significant change at discharge. Almost all (89.1%) Veterans reported sleep was disturbed by environmental factors, primarily staff awakenings. LOS was correlated with ESS scores at discharge (r = .52, p = .002).

Conclusions

Environmental sleep disruption was common during a subacute rehabilitation admission and were not adequately addressed through sleep resources and treatment due to low uptake.

Clinical Implications

Providers should assess sleep at admission and lessen environmental sleep disruptors by reducing noise, light, and non-essential awakenings at night.

KEYWORDS:

• Insomnia
• older adults
• rehabilitation
• veterans

Acknowledgments

We would like to thank staff and leadership within the Geriatrics and Extended Care Program at VA Boston for their support during this project. We would like to thank staff within the 41B Neighborhood of the VA Boston Community Living Center for their support and collaboration on this project. We would like to thank staff who consulted on the creation of this project, including Lindsay J.M. Lefers, PT, DPT and Addie Middleton, PhD, DPT. We would also like to thank trainees involved in portions of the data collection, including Soraya Masse and Jennifer Daks, PhD. Thank you to Margaret Boyle, MS., for creating and donating the CLCzzz logo for use in this project. Last, but not least, a special thank you to the Veterans who donated time during their admissions to answer our questions.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.