Sleepless in the Hospital: A Randomized Controlled Trial to Test White Noise to Improve Inpatient Sleep for Older Adults

Background Adequate sleep while hospitalized is difficult to achieve. Environmental noise is a modifiable variable in the inpatient setting. Based on the premise that white noise can decrease the difference between the baseline/background noise and loud sounds (sound level changes, or SLCs), we hypothesized that white noise is a potential strategy to help improve sleep. We hypothesized that white noise would improve objectively and subjectively measured sleep for participants. Methods We used a single-blind, sham-controlled randomized trial using a cross-over design. Participants were assigned to either a control or intervention level of white noise on their first night in the study, played continuously between 2200 and 0600. They crossed over to the other arm of the study for the following night. We measured the number of SLCs ≥ 17.5 dB (which has been shown to increase the probability of arousal from sleep) using sound meters placed in each room. Actigraphy was used to measure objective sleep metrics, including sleep fragmentation and total sleep duration. Subjective sleep was assessed using the Richards Campbell Sleep Questionnaire (RCSQ). Results A total of 29 participants were randomized, and 18 people completed both nights of the study. Intervention-level white noise was associated with decreased SLCs ≥ 17.5 dB compared to control levels of white noise [median of 24 (IQR 13–89) SLCs ≥ 17.5 dB on the control nights, and median of 11 (IQR 7.25–21) on the intervention nights, p = <.0001]. Sleep fragmentation did not differ between groups, and RCSQ scores were also not different. Conclusions White noise may be a viable solution for improving the inpatient sound environment. However, no differences were observed in patient sleep measures.