P46 Development and evaluation of a personalised sleep care plan on child and adolescent in-patient mental health wards

Introduction Sleep disturbance has a significant impact on adolescent mental health. The total sleep requirement for adolescents is longer than adults with specific differences in circadian rhythms. However, in-patient mental health wards can directly cause poor sleep, independent of the problem that led to admission. Sleep disruption significantly impacts mental health and is an independent risk factor for suicide and behavioural disturbance. In addition, sleep disorders such as insomnia, delayed sleep phase syndrome and restless legs syndrome are common in adolescents with mental health problems. These sleep disorders remain under diagnosed despite effective therapies. We have previously shown in adults that the timed hourly overnight observations were disruptive, not necessary for all and a personalised sleep care plan was safe with reduced hypnotics used.

Methods A pilot study was carried out on 4 Children and Young Person Services (CYPS) mental health wards, (including learning disability units, general adolescent service and intensive care) to test a package of measures to safely enhance sleep management specifically for adolescent in-patients (TeenSleepWell). The aim was to evaluate the outcomes and if successful, for this to be used trust-wide across all CYPS inpatient units. This is novel for the UK. The measures are detailed in figure 1 below with identified ward sleep champions and regular 3 monthly review of hypnotics, those able to have protected sleep and any adverse events measured over a 2 year time period.^1–3

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Results Staff, patient and parent feedback interviews were positive with no adverse events relating to protected sleep but decreased total issue of hypnotics, this allowed 57% of patients to have a protected 8 hour sleep period at any one time.

Discussion A personalised sleep care plan was safely implemented allowing protected sleep for many adolescents and reducing inappropriate hypnotic use. This service improvement had positive feedback.

References

1. Horne S, Hay K, Watson S, Anderson KN. An evaluation of sleep disturbance on in-patient psychiatric units in the UK. BJPsych bulletin, 2018;42(5):193–197.

2. Novak C, Packer E, Paterson A, et al. Feasibility and utility of enhanced sleep management on in-patient psychiatry wards. BJPsych Bulletin, 2020;44(6):255–260.

3. Veale D. Against the stream: intermittent nurse observations of in-patients at night serve no purpose and cause sleep deprivation. BJPsych Bull. 2019;43(4):174–176.