Seeing the Unique Rest Needs of Our Patients

Dear Team Members,

Seeing our patients as people, not just as a diagnosis or condition, allows us to appreciate them as individuals. Celebrating and supporting their unique needs can inform and shape how they rest and recover while in our care, which plays an important role in our patients' overall experience at UC San Diego Health.

In March, we observe National Sleep Awareness Month, which provides us with a reminder to refocus our efforts on the importance of sleep and rest in a healing environment. We know that this element of the healing experience is a priority all year long, and seeing how rest affects different patient populations helps us translate this awareness into a daily practice that truly supports recovery and helps us provide more personalized care to our patients.

When we slow down and see our patients as unique individuals, we begin to notice how age, illness severity, environmental stimuli, and frequent interruptions can profoundly impact their rest. Recognizing these differences allows us to adapt our care in thoughtful ways that protect sleep, preserve dignity, and support healing.

From Our Experts: Why Seeing the Importance of Rest Matters

"As we age, normal changes in sleep architecture lead to lighter, more fragmented sleep and fewer sustained periods of deep, restorative rest. Protecting restful sleep in the hospital setting is therefore a core geriatric principle – not merely a matter of comfort, but a clinical priority that supports physiologic healing, preserves cognitive function, reduces delirium risk, and promotes recovery." – Kai Nguyen, MD

“In the ICU, patients are already under immense physiological stress. We sometimes add alarms, bright lights, and some procedures that could be re-timed that upset natural sleep‑wake cycles and increase the risk of ICU delirium. Protecting sleep is not optional – it can reduce delirium and improve outcomes.” – Robert Owens, MD

Rest is not a luxury – it’s essential to healing

According to Kai Nguyen, MD, clinical services chief and clinical professor, Division of Geriatrics, Gerontology, & Palliative Care at UC San Diego Health, when we see our patients as individuals, we can better support their physical recovery, cognitive health, and emotional well‑being. This looks different across patient populations.

Dr. Nguyen says older adults are particularly vulnerable to sleep disruption during hospitalization, making sleep protection an essential component of age-friendly care. He outlines how viewing sleep through the framework of "The 4 Ms" highlights how restorative rest directly supports outcomes that matter most to older adults and are grounded in evidence-based geriatric care.

Applying the 4M Framework to Protect Sleep in Hospitalized Older Adults

What Matters. Aligning the care routine with an older adult’s goals, preferences, and values – including uninterrupted rest at night – respects patients' dignity and autonomy and ensures care is tailored to their priority for recovery and quality of life.
Mental Activity. Preserving a normal sleep-wake cycle supports cognitive health and is central to delirium prevention, a core focus of age-friendly care across settings.
Mobility. Adequate, restorative sleep helps maintain strength, balance, and daytime function, enabling safe mobility and reducing the risk of deconditioning and falls.
Medication. Protecting sleep may reduce reliance on sedatives or other high-risk medications that can interfere with mental activity, mobility, or what matters most to older adult patients.

By consistently applying the 4M lens, clinical teams can proactively protect sleep, cognition, and function – advancing truly age-friendly, person-centered hospital care for older adults.

Caring for the Critically Ill: Rest Is Critical to Recovery

According to Dr. Robert Owens, professor of medicine, Division of Critical Care, Pulmonary & Sleep Medicine, rest at night plays a vital role in recovery in critical care settings – yet it is often unintentionally disrupted.

Dr. Owens highlights the following benefits of rest to patients:

Reduced ICU‑induced delirium. About half of ICU patients experience delirium, with rates rising even higher among those requiring mechanical ventilation (Annals of Medicine, 2024). Disrupted circadian rhythms, constant lighting, alarms, and frequent interventions are key contributors. ICU delirium affects short- and long-term outcomes including cognitive recovery and independence after critical illness.
Improved healing and immune function. Sleep strengthens immune response and supports organ function.
Improved mental health. Rest is essential for emotional regulation and cognitive clarity – particularly for patients under significant physiological stress.
Healthier day-night rhythms. When appropriate, help ICU patients sit up or mobilize during the day. Too much daytime sedation or bedrest can disrupt circadian cues and make nighttime rest harder. Encouraging wakefulness by day and protecting sleep at night can improve recovery and reduce delirium risk.

Seeing the ICU environment through the lens of our patients helps us identify opportunities to better protect rest – even in high‑acuity spaces.

A Restful Culture Begins With Us

Each of us plays a role in creating a quiet, restful, and healing culture – and it begins with seeing our patients as individuals. When we notice how age, illness, and environment affect rest, we can make thoughtful adjustments that support healing.

Inpatient Setting:

Notice vulnerability. Older adults and critically ill patients may be more susceptible to noise, light, and interruptions.
Offer orientation cues. Share the time, date, and part of the day during each shift to support circadian awareness.
See opportunities to protect sleep. Cluster care when possible, dim lights, close doors and blinds, and reduce unnecessary nighttime interruptions.
Advocate for rest. Ask providers when it may be appropriate to adjust vital sign frequency or overnight care routines.
Use sleep supports thoughtfully. Partner with providers on appropriate nonpharmacologic or medication based sleep aids (consult with care team).

Outpatient Setting:

Be mindful of sound carryover. Curtains offer visual privacy – but patients can hear everything around them.
Create a calm visual field. Dim lighting when appropriate and minimize harsh sensory stimuli.
Offer comfort intentionally. Water, warm blankets, and encouraging headphone use can reduce anxiety and promote calm.

Please email us and share your thoughts on how to improve the restfulness of your space for your patients, or share with us what you’d like to see in future editions of Quiet, Restful, and Healing. We’d love to hear from you at experiencetransformation@health.ucsd.edu.

With Gratitude,

The Office of Experience Transformation

Office of Experience Transformation
200 West Arbor Drive #8916
San Diego, CA 92103

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