Background: Sleep is an essential biological function vital for physiological rest, healing and emotional well-being. Sleep disruption, defined as alterations to the normal sleeping patterns, is commonly seen in patients and caregivers with lengthy hospital stays. Sleep disruption in caregivers can lead to increased stress and fatigue, decrease quality of life and ultimately affect the caregiver ability to support their loved one. Methods: We studied through a longitudinal observational cohort study, the quality and quantity of sleep in pediatric patients undergoing hematopoietic stem cell transplant (HSCT) and their caregivers; we identified a high level of sleep disturbance utilizing actigraphy and recounted poor sleep through qualitative assessments. We then performed a cross sectional focus group analysis of patients/caregivers and medical staff to identify the factors associated with poor sleep. The global aim of our quality improvement initiative was to improve sleep quality in HSCT patients and caregivers through a reduction of the nighttime noise (9pm-7am) in the bone marrow transplant unit, from 46 decibels (dB) (mean baseline data) to 38dB (WHO recommends night outside noise of less than 40dB) in a 6 month period. Results: We identified the factors associated with sleep disruption; noisy room entries, overnight trash pulls, loud hallway noise and hospital staff. A simplified failure mode analysis identified four main key drivers; reliable nighttime awareness system, quiet nighttime nursing system, unobtrusive nighttime cleaning process and awareness maintenance system. Several PDSA (plan, do, study, and act) interventions took place and were adopted. After four months the overnight mean dB have decreased to 42dB (9% reduction). Overnight noise spikes above 60dB have decreased from a mean of 271 spikes to a mean of 151 spikes (44% reduction). By September 2018 we expect further decrease in spikes and overnight dB and follow up quantitative and qualitative sleep assessments. Conclusions: With a quality improvement initiative, we identified factors that negatively impact sleep and performed interventions that successfully mitigate these factors, leading to improve quality of sleep in HSCT patients and caregivers.