Sleep in ICU

Todd Fraser on 19-10-2011

This is a topic I've been mulling over for some time. I know how important sleep is to me. A busy night on call with a few phone calls really takes the wind out of my sails, and the older I get, the harder it is to cope. Is this sounding familiar? So try recovering from a critical illness some day. The obstacles to a decent sleep must be insurmountable. Noisy staff, doors banging, machines going 'bing', frequent nursing observations, lying in one position all the time and the delirious millieu of pharmacology must make having a decent night's sleep impossible. I wonder if there is a better way. Do you have policies in your units for this? Do you have decibel monitors for instance? Do night staff "really" get it? What sedative options are there? Is melatonin the bees knees? How do you get someone to sleep in ICU?

7 Comments

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Jo Butler wrote 10-21-2011 01:24:46 pm
I have no doubt that the noise level in ICU has a major impact. I think we pay little attention to this as night staff, and I think we need to give the patients a bit more respect.

I've used soft ear plugs before and that seems to subjectively improve sleep - not sure if there is anything in the literature to support this.

Sue Farrell wrote 10-23-2011 11:55:04 am
I think there is much we can do from a nursing perspective. Clustering cares to avoid waking the patient unnecessarily, paying attention to environmental factors such as noise and lighting, reassurance and minimising stress are all important. I suspect if we paid attention to whole of patient care (massage, spiritual etc), this would make some difference.

James O'Connor wrote 10-23-2011 02:20:13 pm
There have been a couple of studies looking at mode of ventilation and its effects on sleep. One looked at proportional assist vrs pressure support and found fewer 'awakenings', while another compared assist control with pressure support finding the same thing.

I thought I read that there was a study using NAVA which seemed to improve outcomes too.

Li Huey Tan wrote 10-24-2011 01:39:15 pm
This is something which I have brought up with my nursing colleagues recently. There is without a doubt, including recently published data, that noise levels are higher during the night time. Some people get quite defensive, stating that we are not beside the patient for 12 hours and therefore, staff need to interact to keep themselves from falling asleep. It is difficult having to stay awake when our natural body clock is telling us to go to bed. I have gotten into a habit of prescribing ear plugs for our HDU type patients or bed blocked patients. The compliance for something simple like that is poor I have to say...

Matthew Keys wrote 11-24-2011 02:42:23 pm
Prescribing earplugs... Interesting. I'll try it!

Alex McKenzie wrote 01-15-2012 12:09:30 pm
Interesting paper in the Journal Club this month I note.

Todd Fraser wrote 10-07-2012 10:44:15 am
I had the chance to chat to a world leader in this field late in 2011. Check out my interview with Roz Elliot on Sleep in the ICU - http://crit-iq.com/index.php/Podcast