Sleep in the ICU
By: Margaret Pisani, MD, MS, FCCP
July 18, 2017
“Sleep that knits up the ravell’d sleave of care, the death of each day’s life, sore labour’s bath, balm of hurt minds, great nature’s second course, chief nourisher in life’s feast,” William Shakespeare,
Macbeth.
As ICU physicians, we need to consider the importance of sleep in our critically ill patients. Often, we focus on the acute care considerations and forget about the basic importance of promoting sleep that corresponds to a normal circadian pattern. Research has documented that ICUs are too loud, often above the OSHA-recommended sound levels.
ICUs’ light levels are too intense at the wrong time of day and not bright enough during periods when normal circadian rhythm maintenance requires increased lux. Patient care activities such as lab draws and bathing often occur during sleep time.
In addition, there is increasing interest in the link between sleep and circadian rhythm disruption, delirium, and other persistent cognitive and functional impairment. Not only do studies in ICU patients demonstrate lack of sleep, alteration in sleep stages, and circadian misalignment, ICU survivors also report sleep disturbances post discharge. In a recent survey of over 1,200 ICU caregivers, greater than 83% recognized the importance of sleep but only 32% had a sleep protocol in place.
Providing dedicated time for patients to sleep is something ICU caregivers can achieve, but it takes a village. It means restructuring workflows and changing culture. Stakeholders that need to be included when developing an ICU sleep protocol include hospital administration, medical staff, nursing, pharmacy, respiratory care, radiology, environmental services, and importantly— patients and families.
Providing time for patients to sleep at a low-cost, low-tech intervention has the ability to improve outcomes in critically ill patients. For as Shakespeare noted in his play Macbeth, sleep is a key component to well-being.
Dr. Margaret Pisani is an Associate Professor at Yale School of Medicine where she is the Fellowship Program Director. Her research focuses on outcomes in older ICU patients, ICU delirium and sleep in critical illness, and the intersection of all three.