Given that noise and light are stimuli that can disrupt sleep, nurses should make efforts to reduce these as much as possible and as appropriate. Straightforward measures include:

Measures to block external stimuli, such as providing earplugs and eye‐masks, can provide a simple and inexpensive way of promoting sleep (Dubose and Hadi [53]). In particular, these are useful when efforts to reduce light or noise are not successful, or when it is impractical to reduce noise levels caused by equipment (Darbyshire and Young [47]) – for example, in the intensive care unit (ICU). The use of earplugs in patients admitted to the ICU has been associated with a significant reduction in the risk of delirium (Litton et al. [110]).

Daytime bright‐light therapy has been shown to aid sleep at night, the rationale being that it helps to regulate the patient's circadian rhythms by maintaining a dark–light cycle (Tamarat et al. [223]). In hospitals, a similar effect can be achieved by opening blinds or curtains during the day in order to facilitate sleepiness at night. In addition, this can be complemented by encouraging daytime physical activity, for example a walk outside, serving food in a separate room or even bed exercises. Avoiding daytime napping can promote sleep at night; however, a short nap in the daytime may compensate for less sleep at night (Tan et al. [224]) and so should be considered in context.

Clear and effective communication is integral to the quality of patients’ experience in hospital (Barber [15]) and should not be overlooked in aiding sleep promotion. Conversations and planning regarding overnight interventions can aid sleep promotion. By preparing the patient about what to expect, feelings of safe care can be established – for example, warning the patient that they have antibiotics due at midnight, or that the nurse will be entering the room to record vital signs (Salzmann‐Erikson et al. [203]). Involving patients in this way allows them to have more control in their care and is therefore more likely to achieve a ‘home‐like’ experience in line with their normal routine that is conducive to sleep (Gellerstedt et al. [72]). The way that information is communicated is also relevant; Gellerstedt et al. ([72]) reported that open body language, kind facial expressions and gentle tone of voice evoked feelings of security, made patients feel relaxed and therefore facilitated better sleep. On the other hand, a lack of bedside manner awakened feelings of abandonment and insecurity, creating a disturbing factor for sleep.

The idea of ‘cluster care’ involves clustering several routine or nursing care events together rather than spacing them out over time, the main goal being that the patient has fewer disruptions and longer periods of rest (Valizadeh et al. [235]). For example, continence care can be combined with recording vital signs. Patient interactions should be limited during typical sleep hours to those that are truly necessary for patient care (Auckely et al. [13]). Reviewing timing of medications, taking samples at appropriate times and avoiding routine checks can all be considered to avoid unnecessary interruptions during the night.

Sleep‐promoting interventions can be formalized into a ‘sleep checklist’ based on the concept of ‘intentional rounding’, which is carried out in the majority of hospitals and is a formal means of carrying out and documenting regular checks of patients’ fundamental care needs. Box 9.3 provides an example checklist.

Carrying out a sleep assessment aims to address the patient's normal sleep routine and identify any reasonable adjustments that can be made to improve their experience of sleep while in hospital. Questions can include (Gilsenan [77]):

It is important that care is planned with the multidisciplinary team so that interventions can be clustered to minimize the number of times the patient is disturbed, allowing longer periods of rest. The results of the sleep assessment, any techniques used to promote sleep and the effectiveness of these should be documented within the patient's notes, together with the amount and quality of sleep experienced. This will assist in the continuity of this aspect of patient care and comply with the Nursing and Midwifery Council's documentation standards (NMC [162]).