Sleep Health in Older People in Viet Nam: From Insomnia Recognition to Safe, Age-Friendly Care Across Settings

AGE-FRIENDLY CARE QUALITY · LONG-TERM CARE QUALITY

Last reviewed: October 2026

An older person begins waking several times each night and feels exhausted by morning. Over time, they stop taking their usual walks, become less interested in family activities and increasingly depend on afternoon naps to get through the day. Another person recovering from surgery sleeps poorly in hospital because of pain, unfamiliar surroundings and repeated nighttime interruptions. A sleeping medicine is prescribed during admission and remains on the medication list after discharge, even though the original reason for using it has changed. In a long-term care facility, a resident becomes restless at night, and staff assume that the problem is insomnia without considering pain, discomfort, unmet care needs or changes in the person's usual sleep–wake pattern.

These situations are different, but they reveal a common problem. Sleep difficulties in older people are often recognized only when they become disruptive, while their effects on daytime functioning, safety and independence may receive less attention. Sometimes a persistent problem is dismissed as part of aging. In other cases, medication is introduced before the underlying causes have been adequately assessed.

Sleep health deserves a broader perspective. Sleep affects alertness, mood, concentration, physical activity, rehabilitation and participation in everyday life. Poor sleep can reflect an underlying medical or psychological condition, but interventions intended to improve sleep can also cause harm if they lead to excessive sedation, confusion, impaired balance or reduced mobility.

For Viet Nam, this is increasingly relevant as older people receive care across hospitals, rehabilitation services, homes, communities and emerging long-term care settings. The same person may experience different sleeping environments, medications, caregivers and daily routines as they move between services. Sleep health should therefore be considered within age-friendly, integrated care rather than treated as an isolated nighttime concern.

The question is not simply how many hours an older person slept. It is whether their sleep is sufficiently restorative, whether daytime life is being affected, and whether healthcare professionals and caregivers are responding to the underlying problem safely and appropriately.

Sleep Changes With Age, but Insomnia Is Not an Inevitable Part of Aging

Sleep is regulated by several interacting biological processes, including the circadian rhythm that influences when we feel ready to sleep and the homeostatic sleep drive that builds during wakefulness. Both processes can change with age. Older people may become sleepy earlier in the evening, wake earlier in the morning and experience lighter or more fragmented sleep. Medical conditions, medications, reduced daytime activity and environmental changes can further influence these patterns.

According to the US National Institute on Aging, older adults generally need approximately seven to nine hours of sleep each night, although individual requirements vary. Growing older does not eliminate the need for adequate sleep, and persistent sleep difficulties should not automatically be attributed to age.

Insomnia is more specific than sleeping fewer hours than expected. It may involve difficulty falling asleep, difficulty staying asleep or waking earlier than desired and being unable to return to sleep. Chronic insomnia disorder generally involves these difficulties at least three nights per week for three months or longer, despite adequate opportunity and circumstances for sleep, together with significant daytime distress or impairment.

This distinction matters. Someone who regularly sleeps from 9 p.m. until 4 a.m., wakes feeling refreshed and remains active throughout the day does not necessarily have insomnia simply because their schedule differs from that of other family members. Conversely, someone who spends nine hours in bed but experiences prolonged wakefulness, frustration and impaired daytime functioning may have a clinically important sleep problem.

Insufficient sleep caused by caregiving responsibilities, environmental disturbance or repeated hospital interruptions also requires attention, but it is not necessarily chronic insomnia disorder. The appropriate response depends on why sleep is being disrupted and how the problem affects the person.

Good older-person care should avoid two extremes: dismissing persistent sleep problems as normal aging and treating every variation in sleep duration or timing as a disorder requiring medication.

What Does the Vietnamese Evidence Tell Us?

Nationally representative evidence specifically describing insomnia and broader sleep health among older people in Viet Nam remains limited. Available studies involve different populations, settings, instruments and definitions. Their findings are useful, but they should not be combined into a single national prevalence estimate.

A study published in the Journal of Clinical Nursing in 2018 examined sleep disturbance among 440 Vietnamese women aged 60 years and older from 16 rural and urban communities, using data collected between August 2014 and January 2015. Sleep disturbance was identified in 38.9% of participants under the study's definition. Difficulty maintaining sleep was the most frequently reported problem, followed by difficulty falling asleep, reduced sleep quality, early awakening and daytime sleepiness. Body mass index and perceived physical health were among the associated factors.

The study provides valuable community-based evidence, but its findings cannot represent all older Vietnamese adults. The participants were women, and the results reflect the circumstances and measurement approach of that particular study period.

Another community-based study, published in the Vietnam Journal of Community Medicine in 2024, examined 255 older people in Tan Vinh Commune, Luong Son District, Hoa Binh Province, using the Insomnia Severity Index. The researchers reported insomnia symptoms in 77.3% of participants according to their assessment approach. Marital status, late-evening stimulant consumption and longer daytime naps were among the associated factors. However, this was a cross-sectional study conducted in one community. Its findings cannot establish national prevalence or demonstrate that these factors caused insomnia.

More recent evidence was published in the Vietnam Medical Journal in August 2026. Researchers studied 104 outpatients aged 60 years and older attending Clinic A at Thanh Nhan Hospital in Hanoi. Data were collected between March and October 2025 using the Pittsburgh Sleep Quality Index, Insomnia Severity Index and Geriatric Depression Scale. Sleep disturbance was identified in 58.7% of participants under the study's assessment approach. Difficulty falling asleep, nonrestorative sleep and early-morning awakening were common complaints. Living alone, smoking and musculoskeletal pain were significantly associated with sleep disturbance in this selected outpatient population.

These figures should be interpreted carefully. The differences between 38.9%, 77.3% and 58.7% do not establish whether sleep health among Vietnamese older people has improved or deteriorated over time. The studies examined different populations and used different measurement methods and thresholds. Screening positive for insomnia symptoms or poor sleep quality is not equivalent to receiving a clinical diagnosis of chronic insomnia disorder.

The more defensible conclusion is that sleep problems have been documented at substantial levels in selected Vietnamese community and outpatient populations, while representative evidence across hospital, rehabilitation, home and long-term care settings remains insufficient.

The findings also suggest why sleep assessment should extend beyond nighttime symptoms. Pain, physical health, living arrangements, daily routines and social circumstances may all be relevant. Rather than moving immediately to medication, healthcare professionals should first understand what is affecting the person's sleep and how it relates to their overall health and functioning.

Viet Nam Has an Important Policy Foundation, but Not a Dedicated Geriatric Insomnia Guideline

On 1 July 2026, the Vietnamese Ministry of Health issued Decision No. 1976/QĐ-BYT, introducing professional guidance on caring for older people at home and in the community. The guidance covers several aspects of older-person care, including physiological changes associated with aging, common health conditions, psychological well-being, nutrition, physical activity and everyday care.

Sleep is addressed within this broader context. The guidance recognizes the importance of adequate rest and sleep in maintaining health and managing certain conditions. It also identifies sleep disturbances and changes in the sleep–wake cycle among problems that may occur in people living with dementia, including their effects on family caregivers.

This is an important starting point because sleep health is closely connected with physical conditions, psychological well-being and daily functioning. However, Decision 1976 should not be described as a comprehensive Vietnamese clinical practice guideline for insomnia. It does not establish a dedicated national pathway for cognitive behavioral therapy for insomnia, a standardized clinical sleep-assessment protocol or a complete framework for pharmacological management of chronic insomnia in older adults.

Circular No. 34/2026/TT-BYT, issued on 8 September 2026, provides further implementation context for the National Target Programme on Health Care, Population and Development for 2026–2035, Phase I: 2026–2030. In its provisions on community-based older-person care, the Circular refers to Decision 1976 as professional guidance for relevant training, education and care activities. This provides an opportunity to strengthen workforce awareness and practical care capabilities, but it does not create a separate national insomnia-management program.

Internationally, the World Health Organization's 2024 publication, Long-term care for older people: package for universal health coverage, supports the development of integrated, person-centered services that respond to health and functional needs. The publication is intended primarily to inform long-term care planning and policy development, not to serve as a detailed clinical insomnia guideline.

These documents provide complementary foundations. Viet Nam can incorporate sleep health into older-person assessment, care planning and workforce development while relying on appropriate evidence-based clinical guidance for specific diagnostic and treatment decisions.

Recognizing Sleep Problems Starts With Listening to the Older Person

A useful sleep assessment begins with the person's experience rather than a fixed target for sleeping hours.

Some older people struggle to fall asleep. Others fall asleep easily but wake repeatedly during the night. Some wake earlier than intended and cannot return to sleep. Others appear to sleep for many hours but still feel exhausted the following morning. These patterns may have different causes and require different responses.

Assessment should explore usual bedtime and waking time, time taken to fall asleep, nighttime awakenings, estimated sleep duration, daytime naps and associated symptoms. It should also establish how long the problem has been present and whether it began after illness, hospitalization, bereavement, medication changes or a change in living arrangements.

Daytime consequences are equally important. Has the person become unusually sleepy during meals or conversations? Have they stopped exercising, meeting friends or participating in family activities? Are they having difficulty concentrating or completing rehabilitation exercises? Have fatigue, irritability or nighttime care needs increased?

A sleep diary maintained for approximately one to two weeks can help identify patterns that may be difficult to remember accurately. It can record bedtime, estimated time to fall asleep, awakenings, final waking time, naps and relevant factors such as caffeine consumption or symptoms. Caregivers can assist when necessary, although their observations should complement rather than automatically replace the older person's account when reliable self-report remains possible.

Validated instruments such as the Insomnia Severity Index and Pittsburgh Sleep Quality Index can support structured assessment and monitoring. They are not substitutes for clinical judgment and should not be treated as stand-alone diagnostic instruments. Routine objective sleep testing is generally unnecessary for typical chronic insomnia, but additional evaluation may be appropriate when another sleep disorder is suspected.

The purpose of assessment is to understand what is disrupting sleep, how it affects everyday life and what needs to change.

Not Every Nighttime Problem Is Insomnia

Several medical and sleep-related conditions can disrupt sleep in older people. Recognizing these possibilities matters because treatment directed only at insomnia symptoms may fail to address the underlying problem.

Obstructive sleep apnea may cause repeated breathing interruptions during sleep. Loud snoring, witnessed breathing pauses, gasping, choking or significant daytime sleepiness can raise suspicion. Some older people present less typically, reporting fatigue, fragmented sleep or difficulties with concentration rather than obvious sleepiness. When sleep apnea is suspected, appropriate clinical evaluation and diagnostic testing may be needed.

Restless legs syndrome is another possibility. It typically involves an uncomfortable urge to move the legs that begins or becomes worse during rest, particularly in the evening or at night, and improves temporarily with movement. Periodic limb movements can also disturb sleep in some people. These conditions require assessment that differs from the evaluation of ordinary insomnia.

Changes in circadian timing may cause earlier sleepiness and awakening. In people living with dementia, sleep–wake rhythms may become irregular, with increased daytime sleeping and nighttime wakefulness. These changes should not automatically be classified as chronic insomnia disorder.

Pain, nocturia, breathlessness, cough, reflux, itching, anxiety, depression, medications and environmental disturbances may also interfere with sleep. An older person may wake frequently because they need assistance reaching the toilet or changing position. Another may be disturbed by noise, lighting or routine care activities.

These contributors do not necessarily exclude chronic insomnia. Insomnia can coexist with other medical or psychological conditions and may require its own treatment even when those conditions are being managed.

Sudden or rapidly worsening sleep-related symptoms accompanied by acute confusion, significant breathing difficulty, chest discomfort, major behavioral changes or dangerous nighttime events require timely clinical assessment rather than routine sleep advice alone.

Treating every nighttime disturbance as insomnia risks overlooking the condition or unmet need that is actually causing the problem.

The Goal Is Better Sleep and Better Daytime Function

For older people, improving sleep should mean more than increasing total sleep time. A meaningful improvement may involve waking with more energy, participating in rehabilitation, walking more confidently or remaining alert during family conversations.

Persistent sleep difficulties are associated with poorer mood, concentration, quality of life and aspects of physical functioning. Excessive daytime sleepiness can also make ordinary activities more difficult or unsafe. However, these relationships are complex. Chronic illness may affect both sleep and physical function, while pain, depression or reduced mobility may contribute to several problems simultaneously. Observational associations do not prove that improving sleep alone will reverse functional decline.

This is why individualized goals matter. One person may want to resume morning walks. Another may hope to participate more consistently in rehabilitation. Someone else may simply want to spend less time awake at night worrying about whether they will sleep.

Medication-related sedation should not be confused with restorative sleep. A person may appear to sleep longer or remain quieter after receiving a sedating medicine but become more confused, less mobile or excessively drowsy the following day.

The aim of sleep care should be to improve rest and daytime life without introducing unnecessary risks.

Cognitive Behavioral Therapy Should Be Central to Chronic Insomnia Care

An important principle in evidence-based insomnia management is that medication is not necessarily the best starting point for chronic insomnia disorder.

The American Academy of Sleep Medicine's 2021 clinical practice guideline gives a strong recommendation for multicomponent cognitive behavioral therapy for insomnia, commonly called CBT-I, in adults with chronic insomnia disorder. The 2025 US Department of Veterans Affairs and Department of Defense guideline also recommends CBT-I and suggests using it over pharmacotherapy as first-line treatment.

CBT-I is not simply general advice about sleeping earlier, avoiding coffee or keeping the bedroom quiet. It is a structured behavioral and psychological treatment that addresses factors contributing to the development or persistence of insomnia.

Treatment commonly involves stimulus control, adjustment of time spent in bed to improve sleep continuity, cognitive strategies addressing unhelpful beliefs and worry about sleep, relaxation and relevant sleep education. For someone who spends hours awake in bed worrying about another sleepless night, these approaches can help change the behaviors and thought patterns that perpetuate the problem.

There is an important distinction between CBT-I and sleep hygiene education alone. The AASM recommends against relying on sleep hygiene as the sole treatment for chronic insomnia disorder. Regular sleep–wake routines, appropriate daylight exposure, attention to caffeine intake and a comfortable sleeping environment may be helpful, but they are not equivalent to a complete evidence-based treatment.

For older people, CBT-I requires individualization. Some components, particularly reducing time spent in bed or getting out of bed when unable to sleep, may need adaptation for people with frailty, mobility limitations, significant daytime sleepiness or a high risk of nighttime falls. Interventions should not be applied mechanically without considering clinical conditions and environmental safety.

The challenge in Viet Nam is not only whether CBT-I is effective, but how suitable older people can access it. Availability of trained providers may vary across healthcare settings. Brief behavioral treatment for insomnia and appropriately supported remote or digital CBT-I could improve access for some individuals, but their suitability depends on clinical needs, provider competency, language, cognition, sensory abilities, digital literacy and access to technology.

Improving chronic insomnia care will therefore require practical referral and treatment pathways, not simply more advice about healthy sleep habits.

What Does the New Evidence From 2026 Add?

Two developments in 2026 provide useful insights into non-pharmacological insomnia care and the role of medication.

A systematic review and network meta-analysis published in BMC Medicine in February 2026 included 34 randomized controlled trials involving 3,078 adults aged 60 years and older. The study examined 21 non-pharmacological interventions and found that several were associated with improved sleep quality. CBT-I and CBT-I combined with positive mood strategies performed favorably in the network comparisons.

These findings support continued attention to structured behavioral and psychological care. However, they should not be interpreted as establishing a definitive ranking of treatments for every older person. The included studies were heterogeneous, and the certainty of evidence was very low for most comparisons. People with significant cognitive impairment or severe medical conditions were generally excluded, limiting the applicability of the findings to frail older people and those with complex care needs.

An additional development came in April 2026, when the American Academy of Sleep Medicine published a clinical practice guideline specifically addressing the combination of CBT-I and insomnia medication in adults with chronic insomnia disorder.

The guideline makes two conditional recommendations based on low-certainty evidence. It suggests combining CBT-I with insomnia medication rather than using medication alone. However, it also suggests against routinely choosing combined treatment over CBT-I alone.

These recommendations are not contradictory. Adding CBT-I to medication may offer benefits compared with medication alone, but the available evidence does not demonstrate a clinically meaningful overall advantage from routinely adding medication to CBT-I. Combined treatment may still be reasonable for selected patients who particularly value an early increase in total sleep time, following individualized assessment and shared decision-making.

The guideline specifically evaluates treatment in which CBT-I and medication are initiated concurrently. It does not establish definitive recommendations for every possible sequence of starting, adding or withdrawing medication. The authors also acknowledge limitations in adverse-event reporting and long-term outcome data.

This distinction is particularly important in geriatric care. Evidence from general adult populations cannot automatically establish the same balance of benefits and harms in frail older people, residents of long-term care facilities or people with advanced cognitive impairment.

The practical conclusion is that structured behavioral and psychological treatment should remain central to chronic insomnia management, while medication should be considered selectively, with a clear clinical rationale and review plan.

Sleeping Medicines Require Particular Care in Older People

Sleeping medicines may provide benefit in selected circumstances, but their potential harms deserve careful consideration in older people, particularly those with frailty, multimorbidity or polypharmacy.

The 2023 American Geriatrics Society Beers Criteria identify important concerns involving benzodiazepines and nonbenzodiazepine hypnotics, commonly called Z-drugs. These medicines can increase the risk of cognitive impairment, delirium, falls and fractures. Their effects on balance, reaction time and daytime alertness may be especially consequential for someone already experiencing functional limitations.

First-generation sedating antihistamines, including diphenhydramine and doxylamine, also require caution because of their anticholinergic effects. These may contribute to confusion, constipation, urinary difficulties, dry mouth and other adverse effects, particularly when several medicines with anticholinergic properties are used together.

The American Geriatrics Society's 2025 publication on alternatives to medications identified in the Beers Criteria further emphasizes evaluating the contributors to sleep disturbance and using CBT-I as the initial treatment for chronic insomnia. It also discusses selected pharmacological alternatives when medication is clinically necessary, while acknowledging that these options are not entirely risk-free and that evidence specific to older adults remains limited.

These US recommendations are valuable international references for medication safety, but they are not Vietnamese legal requirements. Nor do they establish the approval status, availability or prescribing conditions of particular medicines in Viet Nam. Clinical decisions must consider applicable Vietnamese regulations, product information, professional responsibilities and individual patient circumstances.

Other sedating agents sometimes used for sleep, including certain antidepressants and antipsychotics, also require a clear indication. A medicine should not be considered appropriate for chronic insomnia simply because it causes drowsiness. Melatonin, herbal preparations and traditional products should likewise not be assumed to be universally effective or harmless. Evidence supporting a product for a particular circadian-rhythm disorder cannot automatically be extended to chronic insomnia disorder.

In clinical practice, medication reconciliation should include what the older person actually uses, not merely what appears on the current prescription. This may include medicines from previous prescriptions, pharmacy purchases, over-the-counter products, herbal preparations or products recommended by relatives.

A useful review should establish why a sleep-promoting medicine was started, whether it continues to provide meaningful benefit, and whether morning drowsiness, confusion, falls or other adverse effects have occurred. Duration, interactions and the need for ongoing treatment should also be reassessed.

Long-standing sedative use requires particular care because some medicines can produce physical dependence. Abrupt discontinuation may cause withdrawal symptoms or rebound insomnia. Any reduction or discontinuation should be appropriately planned and supervised according to the medicine and the person's clinical condition.

A sleeping medicine should not be judged solely by whether it helped someone fall asleep. Its consequences for daytime alertness, mobility, cognition and safety are equally important.

Sleep-Supportive Care at Home Must Be Realistic

Home is often the most familiar sleeping environment, but not every older person can fully control the conditions in which they sleep.

Someone may share a room with family members, experience noise from nearby activities or depend on another person for nighttime transfers and toileting. Another may spend long periods indoors with limited daylight exposure or physical activity. Caregiving responsibilities, financial constraints and household routines may also influence sleep.

An individualized plan should consider the person's preferred sleep–wake schedule, opportunities for suitable activity and daylight, evening routines, room temperature, lighting, noise and access to assistance. Regular sleep–wake patterns can support circadian regulation, while appropriate daytime activity may improve sleep in some individuals.

Caffeine-containing drinks, including coffee and tea, may interfere with sleep, particularly when consumed later in the day by susceptible individuals. Daytime naps should also be considered in context. Long or late naps may contribute to nighttime difficulties in some people, but rest during the day may be appropriate for those recovering from illness or experiencing substantial fatigue. Blanket instructions to eliminate naps are not necessarily suitable for frail older people.

Nighttime toileting requires particular attention. Frequent awakenings may reflect urinary symptoms, medications, mobility difficulties or other medical conditions. Advice to restrict fluid intake should not be given indiscriminately, especially when dehydration or other medical concerns are present.

Safety may require practical environmental adjustments. For an older person who gets out of bed during the night, appropriate orientation lighting, a clear walking path and access to mobility or toileting assistance may be more important than maintaining complete darkness.

Caregivers can support agreed routines and observe changes, but they should not be expected to diagnose complex sleep disorders or adjust prescribed medicines independently.

The most useful home sleep plan is not necessarily the most elaborate one. It is the plan that addresses the person's needs and can realistically be maintained within their living circumstances.

Hospitals Should Protect Sleep Without Compromising Necessary Care

Hospitalization can disrupt sleep within a short period. Pain, acute illness, unfamiliar surroundings, lighting, noise, anxiety, monitoring equipment and repeated nighttime interruptions may all contribute. Reduced daytime mobility, medication changes and altered daily routines can make the problem worse.

Some nighttime interruptions are essential. Monitoring, urgent treatment, medication administration and assistance with immediate care needs cannot simply be stopped to protect sleep. The quality question is whether avoidable disturbance can be reduced while necessary clinical care remains reliable.

Hospitals can review whether nonurgent tasks unnecessarily interrupt rest, whether lighting and noise are appropriately managed, and whether pain, breathlessness, urinary symptoms or other discomforts are being addressed. When clinically appropriate, patients should have opportunities for daytime activity, natural light and routines that support normal sleep–wake patterns.

Sleep preferences also matter. An older patient who normally sleeps late may struggle with a rigid early bedtime, while someone accustomed to waking early may find institutional routines equally disruptive. Individualization is not always possible, but unnecessary variation from familiar routines should be considered.

Sleep difficulties during acute illness must also be interpreted carefully. Several disturbed nights in hospital do not automatically justify a diagnosis of chronic insomnia disorder. Acute medical problems, medications, environmental factors and delirium may require more immediate attention.

Sleep disturbance and delirium are clinically related, but it would be inappropriate to assume that a particular sleep intervention independently prevents delirium. Multicomponent hospital approaches may address sleep alongside orientation, mobility, sensory support, hydration and medication review. Their effects should be interpreted according to the available evidence rather than attributed to one component without justification.

Protecting sleep is part of patient-centered hospital care. The objective is to improve rest and recovery without compromising necessary treatment or monitoring.

Care Transitions Should Communicate Sleep Needs, Not Just Medication Lists

Sleep management can become fragmented when an older person moves between care settings.

Someone may enter hospital without using sleep medication and leave with a sedative started during admission. Another may have established routines that help manage chronic insomnia but lose those routines after transfer to rehabilitation or residential care. A person returning home may face different noise levels, caregiving arrangements or access to follow-up services.

Medication reconciliation is necessary, but it is not sufficient to ensure continuity of sleep care.

A safer transition should communicate clinically significant sleep complaints, suspected or confirmed sleep disorders, usual sleep–wake patterns, interventions that have helped, current medications, relevant adverse effects and any reassessment or referral plan.

If a sleeping medicine was started for an acute problem, the indication, intended duration and review arrangements should be documented. It should not become an indefinite treatment merely because it appears on the discharge prescription.

Similarly, suspected sleep apnea, persistent insomnia or significant daytime sleepiness should not lose priority simply because the person has moved to another service.

A useful transition plan should explain what the sleep problem is, how it affects the person's functioning, what has already been tried and who is responsible for the next step. This can help prevent unnecessary treatment continuation, repeated assessment and avoidable gaps in care.

Long-Term Care Needs Individualized Sleep Support, Not Routine Sedation

Sleep in residential long-term care presents a particular challenge because the facility is both the resident's home and the setting in which professional and personal care are delivered.

Residents may have different sleep patterns, clinical conditions, levels of dependency and preferences. Some require frequent nighttime assistance, while others remain relatively independent but must adapt to routines shaped by staffing arrangements and organizational practices.

Environmental conditions matter. Noise, lighting, uncomfortable temperatures, prolonged time in bed, limited daytime activity and unnecessary interruptions can interfere with sleep. Pain, urinary symptoms, cognitive impairment, medications and dependence on caregivers for repositioning or toileting may add further difficulties.

A resident who repeatedly calls for assistance at night may be experiencing discomfort, anxiety, urinary urgency or another unmet need. Someone walking around during the night may have an altered sleep–wake rhythm, confusion or a clinical problem requiring assessment. Neither situation automatically justifies stronger sedation.

At the same time, residents who require clinical observations, continence support, repositioning or other necessary assistance must continue to receive that care. A sleep-supportive approach should improve coordination and individualization rather than eliminate essential nighttime activities.

Research published in European Geriatric Medicine in June 2026 provides a useful example of the complexities involved. A cluster randomized controlled trial evaluated a structured, team-delivered intervention based on CBT-I among 240 residents across five nursing homes in Belgium. Participants had a mean age of approximately 86.8 years, and sleep outcomes were evaluated using different methods according to residents' cognitive and communication abilities.

The intervention did not demonstrate significant between-group improvements in the main sleep outcomes at follow-up. Exploratory improvements in several behavioral and psychological symptoms were reported among residents with cognitive impairment, but these findings require further investigation and should not be presented as definitive evidence of a broader benefit.

The study is a reminder that interventions effective in other adult populations may be difficult to implement or may produce different outcomes in residential long-term care. Frailty, cognitive impairment, dependency, staffing patterns and organizational routines can all influence effectiveness.

For Viet Nam, the implication is not to abandon non-pharmacological sleep interventions. It is to adapt them carefully, support appropriate staff competencies and evaluate whether they actually improve the resident's sleep experience, comfort, daytime functioning and safety.

A facility that has quieter corridors at night but leaves residents distressed, uncomfortable or inadequately assisted has not necessarily achieved better sleep care.

Caregivers and Staff Need the Skills to Recognize and Respond

Sleep problems are often first noticed by people providing everyday care. A family member may observe repeated awakenings or unusual daytime sleepiness. A nurse may recognize that nighttime restlessness began after a medication change. A rehabilitation professional may notice that fatigue is limiting participation in therapy. A pharmacist may identify medicines contributing to wakefulness or morning sedation.

These observations are valuable only when they are communicated and acted upon.

Healthcare professionals, care workers and family caregivers should be able to distinguish ordinary sleep variation from persistent insomnia symptoms, possible sleep disorders and acute changes requiring clinical assessment. They should understand that sedation is not the same as restorative sleep and recognize when changes in alertness, balance or behavior may indicate a safety problem.

Training should emphasize practical observation, environmental support, medication-related risks, documentation of daytime consequences and appropriate escalation. Staff should not be expected to provide specialist CBT-I without relevant training, supervision and professional support. They can nevertheless help maintain individualized routines and reinforce treatment strategies established by qualified clinicians.

Family caregiver capacity also deserves attention. Repeated nighttime assistance, fragmented sleep or wandering can be exhausting for relatives. A plan that assumes one family member can provide continuous overnight monitoring without considering their own health, employment and support needs may not be sustainable.

Good sleep care should therefore protect both the older person's well-being and the reliability of the caregiving arrangement.

Measuring Sleep Quality Requires More Than Counting Hours

Healthcare organizations may record sleeping hours without necessarily understanding whether sleep care is improving.

Documenting that someone slept six hours can be useful, but it does not establish whether the person felt rested, experienced distress during the night or functioned well the next day. Similarly, fewer nighttime calls or less visible activity may indicate improved comfort, but they could also reflect excessive sedation or reduced ability to communicate needs.

A meaningful measurement approach should consider sleep experience, daytime outcomes and safety together.

Patient-reported outcomes may include perceived sleep quality, difficulty initiating or maintaining sleep, distress associated with awakenings and satisfaction with sleep. Sleep diaries and validated assessment instruments can support monitoring when appropriate.

Daytime outcomes may include alertness, fatigue, concentration, mobility, participation in rehabilitation, social engagement and the person's own assessment of how sleep affects daily life.

Safety measures should examine sedative-hypnotic use, excessive daytime drowsiness, clinically significant confusion, falls and suspected medication-related adverse effects. Organizations may also evaluate whether new sleep medications are reviewed appropriately and whether clinically significant sleep problems are communicated during care transitions.

Process measures can help identify gaps in care. For example, a hospital or long-term care service may examine whether persistent sleep complaints are assessed, individual preferences are documented, nighttime routines are reviewed and appropriate clinical follow-up is arranged.

Measurement must also account for differences in clinical circumstances. A person receiving end-of-life care may prioritize comfort differently from someone undergoing intensive rehabilitation. A resident with advanced dementia may require observational methods, while someone able to communicate reliably should have the opportunity to describe their own experience.

These are potential quality indicators for local adaptation, not a nationally mandated Vietnamese sleep-care indicator set. Their usefulness depends on clear definitions, feasible data collection and careful interpretation.

The objective is to learn whether sleep care is improving the person's experience, functioning and safety rather than simply achieving a numerical target.

Building a Practical Sleep-Quality Approach for Viet Nam

Viet Nam does not need to wait for a comprehensive stand-alone national geriatric insomnia guideline before improving how sleep problems are recognized and managed within older-person services.

Existing Ministry of Health guidance, international clinical recommendations, geriatric medication-safety principles and Vietnamese research already provide a foundation. The next step is to translate these into practical approaches suited to different care environments, without treating international recommendations as automatic legal or clinical requirements in Viet Nam.

At the clinical level, persistent sleep complaints should prompt structured assessment of nighttime symptoms, daytime consequences and potentially contributing conditions. This should help distinguish chronic insomnia disorder from other sleep disorders, acute illness, environmental disturbance or insufficient opportunity for sleep. Treatment plans should reflect the person's clinical condition, preferences and functional goals, with structured behavioral and psychological care prioritized when appropriate.

At the organizational level, sleep-supportive practices should become part of relevant clinical workflows rather than depend entirely on individual staff members. Hospitals can review avoidable nighttime interruptions and the continuation of newly prescribed sedatives after discharge. Rehabilitation and transitional care services can consider sleep as a potential influence on treatment participation and recovery. Home and community services can support realistic routines, caregiver education and timely referral. Residential long-term care services can review nighttime routines, environmental conditions, medication practices and residents' experiences.

Responsibilities should also be clear. Clinicians need to identify and manage clinical problems within their professional scope. Nurses and care workers need reliable processes for recognizing changes and escalating concerns. Pharmacists can contribute to medication review, while caregivers need accessible guidance and support. When specialized assessment or treatment is unavailable locally, referral arrangements and follow-up responsibilities become especially important.

Any new intervention should be evaluated in practice. Introducing staff education, a sleep diary, a change in nighttime routines or a behavioral treatment pathway does not automatically mean sleep outcomes will improve. Organizations should examine whether the intervention reaches the intended population, can be delivered consistently and produces meaningful benefits without creating additional risks.

This approach is particularly relevant as Viet Nam develops more age-friendly, integrated and long-term care services. Sleep health offers a practical area in which clinical care, organizational routines, medication safety, caregiver support and continuity between settings must work together.

The challenge is not to create a separate sleep program in every facility. It is to ensure that sleep problems are recognized and addressed appropriately within the care already being provided.

From Better Sleep to Better Days

For an older person, good sleep care is not fundamentally about achieving a perfect sleep score or spending exactly the same number of hours in bed every night.

It may mean waking with enough energy to prepare breakfast, enjoying a morning walk, participating in rehabilitation, remaining alert during family conversations or feeling less exhausted by the end of the day. For someone living with dementia, it may mean greater comfort and a more manageable sleep–wake routine. For a frail resident in long-term care, it may mean receiving necessary nighttime assistance without avoidable disturbance or unnecessary sedation.

For families, good care means recognizing when sleep changes deserve attention without being expected to manage complex sleep disorders or medications alone. For healthcare professionals, it means distinguishing clinically important problems from ordinary variation and selecting interventions that are appropriate for the individual. For organizations, it means protecting sleep while maintaining reliable care, communication and safety across different settings.

As Viet Nam continues developing age-friendly, integrated and long-term care, sleep health deserves greater recognition as part of quality care for older people.

The most meaningful question is not simply, "How many hours did this person sleep?"

It is whether we understood what was affecting their sleep, responded safely and appropriately, and helped them remain rested, functional and able to participate in the activities that matter to them.

Better sleep matters because better days matter. The quality of sleep care should ultimately be reflected in the older person's comfort, functioning, safety and quality of life, wherever care is delivered.

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