The Effect of White and Pink Noise on Hospitalized Older Adults

The purpose of this study is to determine if using an over-the-counter, commercially
available sleep noise machine playing pink or white noise will reduce the incidence of
delirium in hospitalized patients over the age of 65. Delirium is an acute change in
cognition which commonly occurs in hospitalized older adults, and is linked with sleep-wake
cycle disturbance. Delirium is associated with increased morbidity and mortality as well as
longer hospital stays. This project will record Nursing Delirium Screening (Nu-DESC) scores
for those receiving the intervention and comparing them to baseline data. Reducing delirium
rates using a noninvasive, inexpensive method in a hospital setting could have a significant
impact on patient outcomes and potentially reduce costs associated with longer hospital
stays.

This protocol is based on two concepts. The first is that white/pink noise aids in promoting
both sleep quality and quantity and the second is that poor sleep is associated with
delirium. Therefore, it stands to reason that improving sleep may decrease the rate of
delirium. It is well documented that the elderly are affected by delirium more than other
demographics, therefore the benefits to this group would be the greatest in terms of
decreasing morbidity and mortality.

White/pink noise was first described as a successful sleep intervention more than 30 years
ago in a cardiac intensive care unit study. From that time to present there have been many
studies that describe positive effects on sleep by noise machines as a single intervention,
but typically they are bundled with other interventions such as earplugs and eye masks.
Within the last 5 years, there has been a resurgence in the clinical study of white/pink
noise on sleep quality and many of these studies use the gold standard of polysomnography,
which employs many sensors to continuously monitor brain waves and sleep patterns. These
studies also show a positive impact on both duration and quality of sleep.

More than 15 recent studies were identified that found a correlation between the sleep cycle
and delirium. In these studies, sleep disturbance is present in the majority of patients with
delirium. There is a clear link between sleep-wake cycle disturbance and delirium, but it is
unclear whether an interrupted sleep-wake cycle causes delirium or vice versa. Despite the
uncertainty, studies do show that sleep-enhancing interventions decrease rates of delirium
and the duration of the delirium. The principal investigator would like to determine if
white/pink noise can improve sleep quality and/or quantity, thereby decreasing the incidence
of delirium.

Inclusion Criteria:

- English-speaking

- 65 years of age or older

- have an estimated hospital stay of 3 or more nights

- have no known hearing deficits or wear hearing aids

- be free of delirium on admission

- be legally able to consent

Exclusion Criteria:

- non-English-speaking

- less than 65 years of age

- have known hearing deficits or wear hearing aids

- have delirium on admission

- cannot legally consent to participation

- transferred to/from the ICU before/during being enrolled in the study