Sleep disruption in inpatient palliative settings reflects the interaction of symptoms, patient vulnerability, ward conditions, clinical surveillance, medication, alarms, equipment, and unpredictable care. This conceptual article proposes a night-time nursing framework based on three judgments: susceptibility to disturbance, cumulative nocturnal burden, and the necessity and modifiability of each interruption. It distinguishes care that is immediately necessary, care that is required overnight but can be coordinated, and disturbance that can be reduced without compromising safety. Nursing may therefore fragment or protect sleep according to timing, coordination, symptom responsiveness, and patient priorities. Sleep protection should intensify when vulnerability and modifiable disturbance are high while preserving clinically necessary surveillance and symptom relief.
