Sleep Hygiene 

Maintaining good sleep hygiene is another way of saying having a good bedtime and sleep routine. People who have trouble sleeping can often benefit from adopting good sleep hygiene, even patients who are in a palliative care setting. 

Rules for Good Sleep Hygiene 

Bedrooms are for sleeping and intimacy. In general, it's best to keep the bedroom for sleeping only and for intimacy. Of course, this changes when someone is receiving palliative care because the bedroom often becomes a hub of activity in many cases. 

The bedroom is where the television is, where visitors come, where care is given and, often, where meals are taken. If this has happened and your loved one is having difficulty getting good quality sleep, it may be a good idea to try to limit the activity that does go on in the bedroom so that it becomes a peaceful haven. 

If your loved one can be comfortably moved into another area of the house, this could be an option. Perhaps a second bed for him or her to use, away from the bedroom, or a comfortable easy chair, would be helpful, where visitors can be received but still kept out of the bedroom haven. If a separate room isn't available, perhaps adjusting the bedroom so that it doesn't seem like a bedroom during the non-sleeping times. Make it as bright and airy as possible, according to your loved one's comfort, perhaps having a seating area off to the side so that people aren't gathered around the bed all the time. If none of this is possible, perhaps limiting the amount of activity that goes on in the bedroom may be required. 

Routines Are Important 

It's not always easy to maintain a routine when someone is ill or at the end-of-life, but routines are important to good quality sleep. As much as possible, try to keep visiting time to a certain time, meals, television, any activities, as well. Getting ready for bed and the rituals that go along with that should also be very routine. This tells the body that it's time for bed and it's time to start relaxing, anticipating sleep. 

Environment 

For most people, good quality sleep will only happen under the right conditions. In hospitals, the lights, noise, and people can make this very difficult. At home, however, there is the opportunity to adjust things to encourage good sleep. 

Darkness: Try to make the bedroom as dark as possible to encourage good sleep. If you or another caregiver needs to go into the room to check on your loved one throughout the night, to give medications or care, for example, you can try using very low wattage nightlights to give just enough light to see what you are doing. If you must turn a bright light on, some people like to use eye masks to cover their eyes and avoid the sudden shock of light. 

Silence: While some people sleep best in total silence, others like to have some ambient, or surrounding, noise. If your loved one enjoys listening to music in the background or would like some white noise (a fan, a white noise machine, etc.), this may help encourage good sleep. 

Room Temperature: The temperature in a room can have a big effect on the quality of sleep. Someone who is at the end-of-life may have difficulty staying warm or cool enough to be comfortable. If you can't readily change the heating or cooling system of the room, perhaps a portable heater and/or fan may be a big help. Comfortable bed clothes (warm nighties, cool pajamas) are also important. Many people who are cold all the time benefit from wearing a pair of socks at night. 

Physical Comfort 

Physical comfort plays a large role in the ability to get a good sleep. 

Pain: Someone who is in pain isn't going to get a good rest. If your loved one has a habit of waking up in pain in the middle of the night, you should discuss this with the palliative care team. There may be different medication that can be given at night, before bed, that may act longer and last through the night. 

Comfort: Lying in bed all day doesn't make lying in bed at night very appealing to many people. Try to encourage your loved one to get out of bed at least once a day if he or she is able. Even if it's just to sit in an easy chair beside the bed, the motion of getting out of bed can make a difference. 

Body Positioning: If your loved one is having problems moving in bed, body positioning can become an issue. He or she needs to be in a comfortable position in order to fall asleep. This means good body positioning is important: 

When lying on the side: A pillow should be between the legs so the knees don't rub together and the leg on top is even with the hip. Another pillow between the lower legs/ankles adds to the comfort. A pillow pushed into the back will help your loved on stay on the side and provide support. Make sure that a smaller pillow is supporting the neck properly. The shoulder next to the bed should be pulled forward slightly so that your loved one isn't lying directly on it. By placing a pillow under the lower arm/hand of the arm on the top, away from the bed, can provide a lot of comfort and prevents the upper shoulder from being pulled. 

Lying on the back: Most people feel most comfortable when they are not lying completely straight. By bending the knees a bit, with a pillow or two if the bed doesn't bend, you are taking the pressure off your loved one's back. A pillow at the foot of the bed to keep the feet in a natural position is also more comfortable than letting the feet fall forward. Pillows under the lower arm/hand of each arm can also add to comfort.