One of my clients was surprised to find staff yelling down the hall to the nursing station at night. Another found staff turning on the bright fluorescent light directly over the resident's bed whenever they entered the resident's room. For me this would be like trying to sleep in a motel directly facing a working lighthouse. Since this discovery, staff try to use a penlight whenever possible to perform nighttime procedures in a resident's room. Consensus is that therapy should include nonpharmacologic approaches.
Key components are sleep hygiene, sleep restrictions, relaxation training and cognitive therapy.
In fact, each resident taking sedative hypnotics should have their care plan reviewed to ensure that good sleep hygiene is actively promoted. An example would be a physician who routinely places a newly admitted resident on a long-acting benzodiazepine without any record of medical necessity prior to admission. We encounter reluctance to consider options such as prn versus routine dosing. We tried diplomacy, working through the medical director and so on. After months of progress notes documenting persistent insomnia, sleeping most of the day, weight loss and ataxia, we were finally able to overcome good old-fashioned prescriber stubbornness.