TUCSON, Ariz. – Sleep is essential for recovery from an illness or injury. Yet, acutely ill patients in hospital intensive care units (ICUs) who need the most rest are getting the least.
Trauma critical care surgeon Randall S. Friese, MD, associate professor in the Department of Surgery at the University of Arizona College of Medicine, is conducting a study investigating sleep promotion during critical illness and injury to help ICU patients get the rest they need to heal.
“Beeping monitors and round-the-clock treatments make getting restful sleep nearly impossible in the ICU,” Dr. Friese says. “Patients may look like they are sleeping, but they’re not sleeping well. They are not getting to the restorative stages that are required.”
Previous research conducted by Dr. Friese, one of the first doctors to examine sleep patterns of surgical and trauma patients, revealed that while patients in the ICU received an acceptable amount of sleep, most of it was not a deep sleep. He found that patients in the ICU spent 96 percent of their sleep cycle in superficial stages, compared to normal sleep, which is as much as 50 percent of the sleep cycle in the deep, restorative stages.
The current study at the University of Arizona and University Medical Center is funded by an Arizona Biomedical Research Commission grant of $375,000 over three years.
Sleep is divided into two distinct states: rapid eye movement (REM) and non-rapid eye movement (NREM) sleep. REM sleep normally accounts for about 25 percent of sleep time during an episode of restful sleep.
Several researchers have described highly abnormal sleep patterns in patients in the ICU. These patients spend only 1-3 percent of sleep time in REM sleep. Prior research also has shown that sleep deprivation suppresses the immune system in normal subjects. While there is little research describing the effects of sleep deprivation coupled with acute or chronic illnesses, critically ill patients may be more vulnerable to sleep deprivation, and poor sleep quality may adversely impact their outcomes.
“Our current research will demonstrate whether a strategy to promote sleep in patients in an ICU setting during recovery from a critical illness or injury results in improved sleep,” Dr. Friese explains. “We will approach the study in three phases: develop a manual for sleep promotion and staff training; implement and test the protocol; and conduct a pilot trial to determine its effectiveness.”
Some proposed steps to decrease disturbances in the ICU include adjusting monitors so that alarms don’t wake up patients, providing ear plugs and eye shields, dimming the lights and using pharmacological sleeping aids.
“If doctors and ICU directors develop and put into practice protocols for promoting sleep, I believe that outcomes, including infection rates, ICU and hospital lengths of stay, overall complication rates and most importantly, mortality rates, will improve.”