Rest Assured: Better Sleep for Better HCAHPS

The “restfulness” of the hospital environment is a new composite measure for the 2025 HCAHPS survey. There are a total of three questions pertaining to rest on the survey (questions 8,9, and 18) and two questions are new this year:

Question 8. During this hospital stay, how often were you able to get the rest you needed? 

Question 18. During this hospital stay, did doctors, nurses and other hospital staff help you to rest and recover? 

Clearly, these questions aim to help ensure patients get as much rest as possible in the hospital. Even in healthy adults, sleep loss can cause hindered cognitive function, depression, irritability, anxiety, and immune functions. If that is how sleep loss affects reasonably healthy people, you can imagine it’s havoc on patients recovering from surgery or serious illness.

These effects can also impact recovery time, increase the risk of injury, and worsen the patient experience. 

The usual (sleepless) suspects

The reasons patients struggle to sleep in the hospital are fairly well-known (since they’re typically the same for most patients). They’re also usually unavoidable since they are simply part of the hospital environment. Still, it’s worth exploring the main causes of sleep loss in the hospital before we dive into solutions.

Pain. Illness, surgery, IVs, and sometimes even the hospital bed itself can cause pain and discomfort, making it difficult to fall asleep or stay asleep.

Medications. Some medications can have side effects that interfere with sleep. Even medications that typically make people sleepy can have the adverse effect on some patients.

Noise and light. Hospitals are busy environments with noise from alarms, staff, and equipment, all of which can disrupt sleep. Light can also be a factor for those trying to sleep.

Interruptions. Patients are frequently awakened for vital signs, medications, procedures, and meals.

Anxiety and Stress. The stress and anxiety associated with hospitalization and illness can make it difficult for patients to relax and fall asleep. The unfamiliar hospital environment can also contribute to sleep problems.

Loss of Autonomy. Patients may feel a loss of control and routine during hospitalization, which can affect their sleep. Even well-intentioned, but ill-timed, visits from friends and family can disturb sleeping patients.

These are the most common reasons for sleep loss. Talk to patients and staff to uncover causes that you might be missing.

Answering the restfulness questions

Once you’ve identified some possible (and probable) sleep disruptors, you’re ready to explore solutions that will help improve both patient rest and your HCAHPS survey score. 

Encourage patients to bring items from home. Having familiar personal items with them can make patients feel more comfortable and support rest. Some items to include are earplugs, headphones, slippers, their own pillow, and pajamas.

Keep patients comfortable. Stay ahead of pain by making sure patients take their pain medication on time and don’t skip any doses. You can also explore other pain relief options, like cold and heat packs. 

Patient comfort also includes their room. Make sure their bedding is clean and warm and their room temperature is pleasant. Encourage patients to speak up about any discomfort. 

Track sleep like a vital. Ask patients how they slept or how long they slept and track their responses. One Penn Medicine intervention found that while patients did not perceive they slept better, tracking the patients’ sleep did impact the nurses’ care. When nurses saw declining sleep times, they made efforts to encourage patient sleep, like clustering care.

Cluster care. Whenever possible, combine multiple care activities into one visit rather than multiple visits. The Penn Medicine intervention found that clustering care helped patients sleep an average of one hour longer each night. A 2024 study found that clustering nursing care provided numerous benefits to ICU patients by decreasing delirium, ventilator-associated complications, and length of hospital stay.

Patients that experience cluster nursing care also report higher levels of patient satisfaction.

Offer sleep kits. Many hospitals are starting to offer patients sleep kits. Items like sleep masks, earplugs, hot tea, and snacks are offered to patients before bed. According to the data, these small interventions made patients feel like they were sleeping better and improved their patient experience. One study said patient-reported sleep quality improved by nearly 36%.

TIP: Incorporate the words “rest” and “quiet” into your efforts so patients remember them when they encounter the HCAHPS questions pertaining to rest. For example, your sleep kit could be called “Rest Remedies” or “Quiet Kits.”

Include rest times on patient whiteboards. Write “rest times” or “rest goals” on patient whiteboards to remind patients to rest.

Communicate. Let the patient and their caregivers know what you’re doing to promote rest. Use the words “rest” and “quiet” so they’ll recall your activities when completing their HCAHPS survey. Here are some example statements and questions:

“This machine is making a lot of noise. I’m going to swap it for a quieter one so it doesn’t interrupt your rest.”

“I’m going to go ahead and get your vitals while you’re taking your meds so you can get some extra rest.”

“Would you like me to close the door, so it’s quieter?”

Additionally, encourage patients to communicate about things they need for better rest, like additional blankets or a position change. Focus on promoting patient comfort.

Conclusion

Medical caregivers are certainly superheroes, but not even your superpowers can immediately eliminate pain, illness, noise, and other unavoidable disruptions to a patient’s sleep while they are hospitalized. You can, however, strive to understand your patient’s experience then use your powers to create an environment that promotes rest and recovery.