Sleep in the Intensive Care Unit: Strategies for Improvement

Abstract

Sleep in the intensive care unit (ICU) is considered to be subjectively poor, highly fragmented, and sometimes referred to as “atypical.” Although sleep is felt to be crucial for patient recovery, little is known about the association of sleep with physiologic function among critically ill patients, or those with clinically important outcomes in the ICU. Research involving ICU-based sleep disturbance is challenging due to the lack of objective, practical, reliable, and scalable methods to measure sleep and the multifactorial etiologies of its disruption. Despite these challenges, research into sleep-promoting techniques is growing and has demonstrated a variety of causes leading to ICU-related sleep loss, thereby motivating multifaceted intervention efforts. Through a focused review of (1) sleep measurement in the ICU; (2) outcomes related to poor sleep in the ICU; and (3) ICU-based sleep promotion efforts including environmental, nonpharmacological, and pharmacological interventions, this paper examines research regarding sleep in the ICU and highlights the need for future investigation into this complex and dynamic field.

Delirium and sleep quality in the intensive care unit: the role of melatonin

“…( 7 ) Despite these efforts, sleep disturbances, such as sleep deprivation, are still reported by 66% of ICU patients ( 8 ) and are linked to neurocognitive dysfunction, which further increases the risk of delirium . ( 9 )…”

“…Strategies for improving sleep hygiene should be implemented in the ICU environment, including reducing noise (not exceeding 40 dB), adjusting syringe pump alarms, ensuring adequate light levels, avoiding procedures during nighttime, reviewing all current medication and the possibility of withdrawal (including nicotine or recreational addictive substances), optimizing ventilator settings, and even implementing alternative therapies for sleep promotion, including music, massage, or relaxation techniques. ( 9 ) Given the multifactorial nature of these conditions, a holistic approach encompassing both pharmacological and nonpharmacological interventions is essential.…”

Key elements of an evidence-based clinical psychology service within adult critical care

“…Disturbed sleep architecture in the ICU is associated with delirium and adverse pulmonary, cardiovascular and immunologic outcomes. 25 For example, REM sleep performs an important role in the processing of recent emotive experiences and when REM sleep is lacking the strength of affect within an autobiographical memory network persists, resulting in the potential for psychological sequalae. 26 Furthermore, sleep disturbance occurring in the aftermath of a traumatic experience is associated with an increased risk of PTSD.…”

Noise reduction in the ICU: a best practice implementation project

“… 10 , 11 According to the recommendation of the WHO, the average noise level in hospitals should not exceed 40 dB during both day and night time. 12 However, generally, noise levels in ICUs are beyond what is recommended. 13 , 14 …”