The first patient I am going to see today wrote on his Kite: “I need something to help me sleep.” Over the course of my career in correctional medicine, I have seen literally hundreds of such requests. I have empathy for the patient who submitted this kite. There is no question that it is hard to sleep in a jail.
First, there are the physical impediments to sleep. They never turn the lights all the way off! If you are someone who likes it to be really dark when you go to bed, too bad for you. And it is loud! Most inmates are housed in large dorms with 40-60 (or more) inmates who are talking, snoring, yelling. There are no carpets or drapes to absorb noise, which bounces and echoes in the cavernous concrete space. The large metal doors clang loudly when they close. Even footsteps on the concrete floor are surprisingly loud.
The mattresses and pillows are not designed to be comfortable. They are designed to be secure, i.e. hard to hide contraband in. That means the mattresses and pillows are thin with little padding. Jails are cold, even in the summer, but the blankets are also often thin and may itch to boot. Inmates are not issued two blankets.
Finally (and most importantly for many inmates), there is the mental anguish that prevents sleep. This is an alien and frightening environment. You are sleeping in the same room with 50 other inmates, some of whom can be quite scary. You worry about being away from your family, what will your family and neighbors think, will you lose your job, how will you make bail, what about court, what if I get convicted?
For all of these reasons and more, complaints of insomnia are common in a jail. Jail medical providers need to have a policy or guideline on how to deal with complaints of insomnia. But before I see my first patient who wants a sleeping aid, I need to review the following guiding principles in my mind:Continue reading