Sleep and the ICU

Abstract

Disturbed sleep is common in critical illness, not only during early phases of treatment in an intensive care unit (ICU) but also during later stages of recovery after ICU discharge. While sleep quality during critical illness is usually not a primary concern of intensivists, disrupted sleep can impede recovery and has been associated with immune system dysfunction, impaired wound healing, and adverse neurological and psychological outcomes (1). The noise and lighting of the ICU environment, frequent patient-provider interactions, and critical care procedures all profoundly impact sleep quality and continuity in critically ill patients. Various sedative medications and various modes of mechanical ventilation can also affect sleep. This article will review (1) sleep disruption and its clinical manifestations in the ICU patient, (2) the effects of the ICU environment and routine critical care on sleep disturbances, (3) the biological consequences of critical illness on sleep and circadian rhythms, and how sleep deprivation (SD) affects the immune system, (4) iatrogenic disturbances of sleep in the ICU patient (e.g. commonly used sedatives, mechanical ventilation), and (5) sleep during recovery after critical illness.