^{<h3>Introduction</h3>}

<br/>Sleep disorders are the subject of numerous studies, posing a difficult challenge for medical professionals and hospitalized patients [1, 2]. Their varying incidence and dependence on many factors [3], including health status [4], sociodemographic variables, and type of work performed [5], as well as the multifaceted nature of therapeutic approaches, are emphasized [3].

<br/>Research results confirm that an increasing number of people worldwide report having sleep disorders [4]. Some data have shown that these disorders are common among people over the age of 65 [3]. Research conducted in Poland in 2024 showed that 21% people aged 45-64 slept less than 6 hours per night, and 25.0% of the participants experienced insomnia at least several times a month. In contrast, 37.0% of Polish people experienced insomnia sporadically [6].

<br/>Sleep disorders are characterized by insufficient sleep in relation to the body’s needs. They vary greatly, which may be due to cultural differences and customs in a given community [3, 7]. They can include difficulty falling asleep, staying asleep, and waking up during the night [3, 7]. The diagnosis of sleep disorders should be based on sleep history, sleep habits, sleep environment, information contained in a sleep diary, and sleep questionnaires [7]. The consequences of a single sleepless night mainly include irritability, depressed mood, and cognitive impairment [2]. Symptoms of sleep deprivation include mood swings, difficulty planning, impaired vision, increased sensitivity to pain stimuli, problems with motivation, social functioning [2], somatic complaints, increased risk of disease [2, 7-11], and a greater tendency to injuries/falls [12, 13]. Treatment methods include the use of melatonin and drugs from various groups [3, 9] as well as non-pharmacological methods [14], including cognitive behavioral therapy for insomnia (CBT-I), sleep hygiene education, and sleep restriction therapy [9].

<br/>Hospitalization focused on conservative treatment aims to improve the patient’s health without the need for surgical intervention [15]. Conservative treatment aims to reduce symptoms, slow down the disease progression, improve quality of life, and prevent health complications. It is based on preparation for diagnostic tests, analysis of results, implementation of pharmacotherapy, rehabilitation, and health and dietary education [15, 16]. In view of the above circumstances, it can be difficult for patients to adapt to their role as sick people and to hospital conditions, which often affects their overall mental and physical functioning, including sleep disorders.

<br/>Sleep disorders during hospitalization may result from the ward organization and the work of medical staff (including connecting IVs, measuring parameters, performing patient hygiene), loud conversations between patients, noise from medical equipment (infusion pumps, cardiac monitors), televisions and radios, telephones, and artificial light, as well as stress related to being in an unfamiliar place, concerns about health, treatment, and lack of contact with loved ones. In addition, uncomfortable beds, connection to vital signs monitoring devices, and peripheral or central lines restrict patients’ movements and do not allow them to choose a comfortable sleeping position [14].

<br/>The process of assessing the occurrence of sleep disorders and taking action should involve not only nurses, who take care of the conditions in the ward, ensure peace and quiet, provide information on sleep hygiene, and administer medication as prescribed by the physician [17], but also other staff, as this improves sleep quality and contributes to better patient functioning [3, 17].

<br/>The aim of this study was to assess the prevalence of sleep disorders and sleep quality among patients undergoing conservative treatment.

<h3>Material and methods</h3>

<br/>The study was conducted between July 2024 and February 2025 in one of the hospitals in Lesser Poland, after obtaining the consent of the Scientific Research Ethics Committee (No. 118.0043.1.208.2024) and the hospital management, as well as the informed and voluntary consent of the participants. The criteria for inclusion in the study were legal age, hospitalization in a conservative treatment ward, and the ability to communicate and maintain logical contact with the environment. The exclusion criteria were the patient’s cognitive impairment precluding participation and lack of conscious and voluntary consent for participation in the study. The study was conducted in the form of an interview based on the authors’ questionnaire (questions about sociodemographic variables, health status, hospitalization, sleep disorders, their causes and effects, subjective assessment of sleep quality, sleep-related behaviors, ways of coping with sleep disorders, and the role of nurses in this area). The study was conducted by one person. The interview was conducted at a time convenient for the participant, without interfering with medical appointments, treatments, nursing interventions, meal times, or visits from loved ones.

<br/>Statistical analysis of the collected data was carried out using the Statistica 13.3 StatSoft package. The relationships between variables were assessed using Pearson’s chi-square test. The statistical significance level was set at p < 0.05.

<h4>Characteristics of study participants</h4>

<br/>A total of 104 patients (54.8% women, 45.2% men) participated in the study. The youngest participant was 18 years old, while the oldest was 97. Among the participants, the largest group consisted of people with higher education (32.7%), married individuals (53.8%), and residents of large cities (58.7%).

<h4>Health status of participants and course of hospitalization</h4>

<br/>Health status was rated as average by 44.2% of the participants, as good by 38.5%, and as poor by 17.3%. No addictions were reported by 68.3% of participants, while among the rest, 24.0% smoked cigarettes and 1.9% regularly consumed alcohol. 73.1% of participants were hospitalized for the first time, and 58.7% were admitted on an emergency basis. 70.2% of participants reported accepting the need for their current hospitalization. The participants reported their diagnosed diseases, which were mainly: hypertension (58.7%), type II diabetes (30.8%), and obesity (12.5%). 26.9% of participants reported accepting their diagnosis. On the day of the study, 82.7% of the participants were in a stable mood. 51.0% of participants considered the conditions in the hospital to be good, and 42.3% considered them to be very good. None of the participants rated the quality of nursing care as “poor”.

<h4>Sleep characteristics of the study group</h4>

<br/>On the day of the study, 75.0% of participants reported getting enough sleep, and 51.9% stated that they slept well frequently. Sleep disorders were reported by 46.2% of the participants, most often in the form of difficulty falling asleep (36.5%), waking up too early and being unable to fall back asleep (10.6%), waking up during the night (9.6%), and insomnia (5.8%). The use of sleeping pills in the hospital was reported by 27.5% of participants, of whom 74.4% used them daily. Their effectiveness was reported by 38.5% of participants, while 56.4% confirmed their definite effectiveness. 79.5% of participants reported taking medications, most frequently Dobroson (zopiclone), estazolam 2 mg, and hydroxyzine 25 mg. Sleep quality was rated as very good or good by 60.6% of the participants, as poor by 9.6%, while 29.8% of the participants had difficulty assessing it.

<br/>Among factors influencing the occurrence of sleep disorders during hospitalization, participants considered the most important, based on the obtained mean (M) results, to be deterioration of health (M = 2.05), artificial light in the room (M = 1.97), and severe stress (M = 1.75). Detailed data are presented in Table 1.

<br/>The most noticeable effects of sleep disorders for the participants were fatigue (M = 2.38), excessive daytime sleepiness (M = 1.89), and difficulty getting up in the morning (M = 1.52). Detailed data are presented in Table 2.

<h4>Methods of coping with the consequences of sleep disorders in hospital settings</h4>

<br/>The most effective methods for participants to cope with sleep disorders in hospital conditions were ensuring darkness (M = 2.06), maintaining silence (M = 1.9), adjusting the room temperature (M = 1.86), avoiding naps during the day (M = 1.33), taking medication to help fall asleep (M = 1.05), and avoiding caffeinated beverages in the afternoon (M = 1.01). Prayer, stimulants, psychological help, refraining from using electronic devices, and activities before bedtime received significantly fewer responses.

<br/>Participants stated that they followed sleep hygiene rules, mainly by avoiding alcohol (M = 3.3), not eating a heavy dinner before bedtime (M = 2.88), waking up at the same time every day (M = 2.76), treating the bedroom as a quiet place (M = 2.74), limiting light and electronic devices in the bedroom (M = 2.55), not forcing themselves to sleep (M = 2.34), setting the temperature in the bedroom between 15.6°C and 20°C (M = 2.32), sleeping 7-8 hours every night (M = 2.29), and using the bed only for sleeping (M = 1.96).

<h4>Nursing interventions</h4>

<br/>Interventions undertaken by nurses to improve the quality of sleep in participants mainly included limiting exposure to artificial lighting in the room (M = 2.62), ensuring silence (M = 2.59), and administering medications to facilitate falling asleep as recommended by the physician (M = 2.1). Details are provided in Table 3.

<br/>Analysis of the relationship between gender and the prevalence of sleep disorders did not reveal any statistically significant differences (p = 0.088) – they were slightly more common (55.3%) among men (Table 4).

<br/>No correlation was found between sleep disorders and place of residence (p = 0.332), level of education (p = 0.150), or marital status (p = 0.395). The current health status of participants did not affect the occurrence of sleep disorders (p = 0.650), nor did the mode of admission to the hospital (p = 0.053), although this relationship was close to the significance level (Table 5).

<h3>Discussion</h3>

<br/>Sleep disorders are considered a significant clinical concern, requiring the attention of specialists [3], and they co-occur with internal diseases [18].

<br/>Our research conducted in the internal medicine ward confirmed the occurrence of sleep disorders in 46.2% of the participants, most often as problems with falling asleep and waking up too early. Their occurrence among patients in the conservative treatment ward was also reported by Kasperczyk et al. [19]. Sleep disorders have been reported in various non-surgical settings, including neurological [20], intensive care units [14], and units treating patients with COPD [21], rheumatoid arthritis [22], multiple sclerosis [23], and palliative care [24].

<br/>Women accounted for the majority of participants in our study, with an average age of 63, while sleep disorders were more common in men, although this difference was not statistically significant. For comparison, the majority of participants in Marć’s study were women and people over 60 years of age [20]. The background to these results may be provided by the nationwide study by Nowicki et al., in which women were more numerous, the average age was lower, and more women complained of subjective insomnia [25]. A review by Patel et al. showed that sleep disorders (mainly insomnia) are more common in women, especially after menopause, and in older people – over 60 years of age [9]. Bhat and Dsouza investigated perceptions of sleep problems among women, finding that participants did not perceive them as a disease, but attributed them to natural aging or lifestyle [26]. Some studies report that sleep disorders are common in older people, especially those treated in hospitals [27]. Our study did not show a tendency for sleep disorders to occur more frequently in older people.

<br/>Sleep disorders may be related to health status. Symptoms such as headache, back pain, and nausea significantly affect sleep quality [28], similar to cancer [29] and metabolic diseases [30] and elevated triglyceride and LDL-C cholesterol levels in patients with dyslipidemia [31]. Our study did not analyze the relationship between sleep disorders in the participants and specific diseases, but rather the relationship between self-assessed health status and sleep disorders, which was not statistically significant, as was the relationship between the mode of hospitalization and the occurrence of sleep disorders.

<br/>More than half of the participants subjectively rated their sleep quality as good or very good. The study by Karabiber et al. showed that patients with chronic diseases more often reported a deterioration in sleep quality due to pain, stress, and anxiety related to the course of the disease [32]. Locihová et al., on the other hand, found that patients in the general ward experienced a deterioration in sleep quality during the first days of their stay [33].

<br/>The analysis of sleep disorders also takes into account the duration of sleep. Our research did not concern the amount of time the participants usually spent sleeping, but rather their feeling of being “well-rested”, to which the vast majority of participants responded affirmatively. Wesselius et al. found that a hospital stay shortened sleep by about an hour, leading to sleep deprivation [34]. Stewart also found a reduction in sleep duration during hospitalization [21]. The National Health Survey of Polish People showed that 19.0% of Poles spent less than 6 hours sleeping, and 74.0% slept 6-8 hours [6].

<br/>Factors associated with sleep disturbances during hospitalization mainly included deterioration of health, artificial lighting in the ward, severe stress, and excessive room temperature. In comparison, Wesselius et al. reported that sleep disturbances in hospitals were most often the result of activities undertaken by medical staff and more frequent use of the toilet during the night than at home [34]. The respondents also referred to the activities of medical staff, attaching great importance to movement and conversations. El Arab et al., on the other hand, divided the causes of sleep disturbances in a hospital environment into environmental factors, such as noise, visitors, and artificial light, and individual factors, such as pain, stress, and family involvement [35].

<br/>Sleep disturbances in the present study were most often the cause of fatigue, excessive daytime sleepiness, difficulty getting up in the morning, and increased sensitivity to pain stimuli. The consequences mentioned by the participants are well known [2]. The participants also experienced eating disorders (the least frequently reported) and cognitive dysfunction, as well as irritability, depressed mood, and mood swings. The review by Sykut et al. presented in detail the consequences of sleep disorders, which, as in our study, had an impact on mental, physical, and social functioning [2]. Spinweber also emphasized that sleep disorders affect cognitive abilities, reaction time, and overall performance [36], and a meta-analysis conducted by Crowley et al. confirmed the negative impact of sleep restriction on memory processes [37].

<br/>Our study also investigated coping with sleep disorders during hospitalization. The simplest method to implement, i.e., turning off the lights, was the most common. Maintaining silence, although also frequently reported, may be difficult to achieve in a hospital setting. Praying, although rarely reported, was still more common than seeking the help of a psychologist. A small percentage reported drinking alcohol or smoking cigarettes before bedtime; it is difficult to comment on these coping methods, as the questions concerned methods used during hospitalization. Among the participants, coping with sleep disorders was associated with taking medication (74.4% of individuals took it daily). For comparison, in the study by Rinehart et al., only 28.0% of patients received sleep-inducing medication [38], while in the study by Heinemann et al., the percentage was higher, at 45.0%, but 37% patients receiving sleep-inducing medication for the first time [39]. Pharmacotherapy implemented in a hospital (considered absolutely necessary) eliminates the need for the patient to make their own decision about taking medication and is associated with a sense of security and trust in therapeutic recommendations. Taking medication daily in a hospital can also be perceived as a routine procedure, which reduces internal resistance to its use.

<br/>The questionnaire also addressed sleep hygiene practices, which have been investigated previously [40].
The participants claimed that they avoided alcohol consumption, gave up heavy meals before bedtime, and tried to wake up at the same time every day. The answers indicate knowledge of sleep hygiene principles, but it is possible that this knowledge comes more from cultural and social influences than from purely scientific knowledge. In addition, the fact that participants were being interviewed and felt they were being evaluated may have influenced their self-reported behaviors.

<br/>The participants also shared their opinions on nursing interventions that minimize the occurrence of sleep disorders. These interventions are consistent with the scientific literature [14, 17]. The most frequently indicated interventions were limiting artificial light, ensuring silence in the room, and administering medication to facilitate falling asleep as prescribed. The question arises as to why emotional support and conversational engagement by nurses did not attract more interest among the participants. Perhaps nurses are perceived as overworked and tired, or there are barriers that prevent conversation about problems. A study conducted by Song et al. showed that nursing interventions, including psychological support, health education, and environmental optimization (reduction of noise and artificial light), led to a decrease in the incidence of sleep disorders [41].

<br/>Nurses can also minimize sleep disturbances by maintaining a constant level of dim lighting, turning down electrical and electronic devices, muting their voices during conversations, closing the doors to patient rooms (if possible), suggesting that patients use earplugs [14] and, if possible, compensating for and minimizing medical activities during the night (changing the patient’s position, connecting infusion fluids, administering emergency medications) [14]. Important interventions also include education on sleep hygiene [14, 17, 42], conducting interviews about sleep disorders, observing sleep and using pharmacotherapy as prescribed by the physician, evaluating its effectiveness [17, 42] and documenting it [42], as well as showing therapeutic behaviors that build an atmosphere of safety and trust [43].

<br/>The present research results emphasize the need for further action to assess the prevalence of sleep disorders, increase access to non-pharmacological treatment methods, improve the effectiveness of health education, and develop effective support strategies for patients struggling with sleep disorders.

<h3>Research limitations</h3>

<br/>The study was conducted in a single ward, and therefore the results cannot be considered representative, although they constitute an extension of the existing database. The number of participants also warrants comment. Some patients had long stays, which meant that it was not possible to admit new patients and recruit them to participate in the study. In addition, not every patient agreed to participate in the study, or their health condition did not meet the criteria for inclusion in the study. The study was conducted on the basis of the authors’ interview questionnaire in order to establish better contact with the patient, which meant that the study took longer, and sometimes the situation in the ward did not allow the study to be conducted.

<h3>Conclusions</h3>

<br/>The study group experienced sleep disorders of various types and consequences. More than half of the participants rated their sleep quality as very good or good.

<br/>The most frequently mentioned causes of sleep disorders in a hospital environment were deterioration of health, artificial lighting, and severe stress. Sleep disorders were not related to gender, place of residence, marital status, education, health status, or mode of admission to the hospital.

<br/>Sleep disorders among hospitalized patients constitute a real problem requiring targeted observation and a variety of therapeutic interventions.

<h3>Disclosures</h3>

<br/>This research received no external funding.

<br/>The study was approved by the Scientific Research Ethics Committee (Approval No. 118.0043.1.208.2024).

<br/>The authors declare no conflict of interest.

<h3>References</h3>