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Sleep Assessment: The Quiet Challenge

Sleep is the glue that keeps life together. When we have an important life decision the old adage tells us to “sleep on it”, make the decision after a night of slumber. Sleep recharges our batteries, metaphorically speaking. After a good sleep the mind and body feel better, ready for the next cycle of thinking and physical activity. The regenerative nature of sleep is a kind of magic.

Sleep is an active process of ridding the brain of by-products, building new neural pathways, consolidating memories and processing the inputs from when we were awake. Sleep is also associated with the release of human growth hormone that helps repair the body’s bone cells, muscles and the immune system. So when we don’t have a good sleep our health suffers. Our immune system becomes compromised as do our thought processes and mental wellbeing, heart health and body healing. Needless to say, consistently poor sleep leads to declining health.

There are many factors that impact on the quality of sleep for older people and these would be high on the list; uncontrolled pain, depression and anxiety, restless legs and movement disorders, urination frequency, muscle cramps, sleep apnoea, and certain drugs such as types of antipsychotics, analgesics and benzodiazepines. Dementia, particularly Alzheimer’s Disease greatly affects sleep quality and sleep patterns.

Sleep remains challenging to understand and assess. It is hard to self-report accurately. We rely on our rough recall documenting the night’s events using a sleep log.  Observations from another are sporadic and in residential aged care, the standard sleep observation method is generally by night staff missing out on documenting naps during the day. Despite the quietness of a person’s shoes, the opening and closing of doors and movement in a room to observe sleeping can cause waking. These types of observations don’t help with understanding the complete period of sleep nor can it assess the architecture of sleep, the non-rapid eye movement (NREM), rapid eye movement (REM) as well as periods of wakefulness. The number of times we cycle in and out of each of these stages over the length of time we are asleep define its quality and can provide a sleep score.

 

There are a number of consumer devices available such as the Fitbit, Apple Watch and Garmin that provide sleep scores however wearable devices for monitoring sleep though they have their drawbacks when it comes to aged care services. Unlike wearable devices, the Sleepsense is plugged into a power point (most beds have a powerpoint nearby) and requires wifi, it doesn’t have a battery and doesn’t require recharging.

Sleepsense is a smart device that uses AI and ballistocardiographic technology placed under the leg (or wheel) of the bed. It monitors sleep quality reporting on sleep cycles when lying in bed as well as heart rate and breath rate in real time – a full 24 hours profile of sleeping and daytime napping. In home care it can link to an app providing peace of mind to family and friends and in residential aged care Talius integrates the device and its alert functions to the call bell system and its cloud based data platform.

sample report of or dashbord with data gathered from sleepsense technology

Example of an individual sleep report

 

Sleepsense has clever features that can signal a light to turn on and off as a person leaves or returns to bed, reducing falls and help with wayfinding. Alerts can be set to support staff, such as reminders for pressure area care, exits from the bed and time to get back to bed. The device is set to reflect the individual capabilities and preferences of the person requiring care. The data from the device is autonomous meaning that it doesn’t require any staff to collect or manage the data. It is continuous data organised in a way that makes both the real time monitoring of vital signs and movement as well as sleep scores and trends in sleeping, easy to understand. Such information is an important part of medication management and provides evidence for designing care that improves the quality of sleep. Changing patterns of sleep behaviour can give additional insights around cognitive decline, mental and physical wellbeing.

An evaluation of Sleepsense in a 139-bed Canadian residential aged care home found a 20% reduction in staff time by unnecessary checking on sleeping residents, as the Sleepsense shows the client is asleep and breathing there was no requirement for the staff to open the door, and disturb the residents sleep.

The results also showed:

  • 35% improvement in the resident’s quality of sleep;
  • A significant 23% reduction in falls; and,
  • An 80% reduction in time understanding new resident’s care needs.
talius sleepsense

Sleepsense is one of a number of devices that can help an organisation use technology with data to better inform care. Making sleep an important assessment will with evidenced-based interventions will inevitably improve quality of life.

 

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