Graphic sleep monitoring: A clinical program to improve sleep in residents with mental retardation

Sleep problems in persons who are mentally retarded may reflect environmental disruptions, institutional practices, psychiatric disorders, and/or organic pathology. A graphic sleep monitoring system was implemented for 471 residents of a state institution over 1 year. The initiation of the campus-wide data collection system was preceded by a 1-hr training of nonprofessional staff in recording and charting methods. After a 90-day start-up phase, psychology staff in each living unit provided the nonprofessional staff additional support with data collection and environmental adaptations as needed. Also, the psychiatrists began to include review of the sleep data in monthly follow-ups of established cases and as part of diagnostic formulation in new cases. This intervention resulted in a statistically significant improvement in the overall sleep efficiency index (SEI) of about 30 min. The higher the SEI, the more efficient the sleep cycle (i.e., the less fragmentation due to interruptions and the shorter the sleep latency). The number of residents with fragmented sleep was reduced at 1 year and residents spent less time in bed awake. Variables, such as retardation level, age, gender, behavioral risk status, and inter-cottage moves, were not significantly related to sleep. Significant effects were found as a function of type of maladaptive behavior. Self-abusive residents had lower SEI scores than residents who were aggressive or destroyed property. Results suggest that a relatively simple graphic sleep data collection and monitoring system that allowed quick visual analysis was helpful in making environmental and treatment modifications that resulted in improved sleep for persons who are mentally retarded and unable to express their needs directly.