We thank the authors for their comments and thoughts about our recent publication.1 Their suggestion that the incorporation of principles from the “Nudge Theory” might enhance the impact of our sleep intervention and shorten the lag time until patients appreciate the benefits is interesting.2 Our study aimed to assess the effect of a sleep-promoting intervention on sleep quality and duration among hospitalized patients within a quasi-experimental prospective study design. As is the case at the University of Chicago hospital described in Machado’s letter, nocturnal disruptions are also the “default” in order sets in our electronic medical records (EMR). Because the EMR team at our hospital is stretched thin with more requests than it can fulfill, it was not feasible or possible to incorporate any sleep supporting changes when designing the pilot.
Complementing sleep-promoting procedures for hospitalized patients with “nudge” principles, such as the use of choice architecture with appropriate EMR defaults or even incentives and mappings, seems like a wise recommendation.3 Regular nudges may be helpful for sustaining any multicomponent interventions in healthcare delivery that rely on cooperation by multiple parties. It appears as if evidence is growing that “nudge principles” can augment behavior change attributable to interventions.4,5 Sleep-promoting nudges, namely “anti-nudges” by members of the healthcare team, should help patients to sleep better during their hospitalizations, when sleep is critically important to recovery and health restitution.