In patients with cancer (P), is noise reduction (I) more effective than the sleep medication therapy (C) at improving the quality and quantity of sleep (O) during the period of admission and years after discharge (T)?
Background of the Question
Hospital noise is the major contributor to sleep disturbance, which is a fundamental component of cancer experience in young and adult cancer patients, survivors, as well as caregivers (Redeker, Pigeon, & Boudreau, 2015). Noise in hospitals also slow healing during hospitalization, cause sleep disturbance, increases the perception of pain (Mazer, 2012), and has implications for the responses to cancer treatment (Redeker, Pigeon, & Boudreau, 2015). Conversely, low levels of noise are closely linked to improved healing and quality of life in cancer patients. For many years, opioid narcotics have been used as the mainstay inducer of sleep and treatment of cancer pain. However, the opioids have been shown to have negative impacts on sleep cycle and cause central sleep apnea (Redeker, Pigeon, & Boudreau, 2015). Employing strategies that can minimize the noise levels can significantly increase sleep quality and decrease sedative use (Tamrat, Huynh-Le, & Goyal, 2014).
Methods of Reducing Noise
The World Health Organization recommend the acceptable noise range in a hospital to be at 40 decibels during the day and 35 decibels during the night. Installing sound meters in the caregivers’ stations and oncology units is a sustainable way of increasing staff awareness about noise levels (Connor, & Ortiz, 2009). The noise meters have lights of distinct colors that indicate acceptable, increasing, and noise levels above the acceptable range. Installation of the sound absorbing panels along the corridor walls and ceiling areas in the unit is also an excellent way of reducing noise. The sound absorbing panels have unique sound-reducing properties. The hospital can also create a proper acoustical floor, ceiling, and wall designs that prevent noise build-up due to reflections. Good acoustical design improves patient's sleep, enhances healing environment, increases confidentiality, and patient satisfaction (Armstrong.com, 2012).
Study Method
Multi-center and longitudinal studies that employ objective sleep measures such as polysomnography are the most appropriate to answer the clinical question (Habibi, Hashemi, Hemati, & Gholamrezaei, 2016).
References
Armstrong.com. (2012).Rx for Improving Patient Outcomes: Enhance Acoustics and Aesthetics. Available at https://www.armstrongceilings.com/content/dam/armstrongceilings/commercial/north-america/brochures/rx-for-improving-patient-outcomes-brochure.pdf
Connor, A., & Ortiz, E. (2009). Staff Solutions for Noise Reduction in the Workplace. The Permanente Journal, 13(4), 23–27.
Habibi, F., Hashemi, M., Hemati, S., & Gholamrezaei, A. (2016). Sleep Quality and its Associated Factors in Iranian Patients with Breast Cancer. International Journal of Body, Mind, and Culture, 3(2).
Mazer, S. E. (2012). Creating a culture of safety: Reducing hospital noise. Biomedical Instrumentation & Technology, 46(5), 350-355.
Redeker, N. S., Pigeon, W. R., & Boudreau, E. A. (2015). Incorporating measures of sleep quality into cancer studies. Supportive Care in Cancer, 23(4), 1145-1155.
Tamrat, R., Huynh-Le, M.-P., & Goyal, M. (2014). Non-Pharmacologic Interventions to Improve the Sleep of Hospitalized Patients: A Systematic Review. Journal of General Internal Medicine, 29(5), 788–795. http://doi.org/10.1007/s11606-013-2640-9
