Effect of Sleep on the Recovery of Patients Admitted to the ICU
Condition: Critical Illness; Circadian Dysregulation; Delirium
MeSH terms: Chronobiology Disorders; Critical Illness
Study type: Interventional

Summary: 
      The investigators plan to create several sleep/circadian rhythm friendly rooms within the
      medical intensive care unit to determine if decreasing sleep fragmentation effects recovery
      in patients hospitalized in the ICU.
    

Detailed description: 
      Critically ill patients are known to suffer from severely fragmented sleep with a
      predominance of stage I sleep and a paucity of slow wave and REM sleep. The causes of this
      sleep disruption include the intensive care unit (ICU) environment, medical illness,
      psychological stress, and many of the medications and other treatments used to help those who
      are critically ill. Surveys have identified poor sleep as one of the most frequent complaints
      among patients who have survived a critical illness. Patients in medical, cardiac, and
      surgical ICUs almost uniformly have fragmented sleep.

      Although illness, pain, and medications contribute to sleep disruption in ICU patients, the
      primary factor causing sleep disruption had been thought to be the ICU environment. Noise
      from various sources, including ventilators, alarms, television, phones, beepers, and
      conversation, have all been purported to disturb sleep in the ICU. Patients have reported
      that noise, specifically talking, is a frequent cause of sleep disruption in the ICU. Several
      studies have confirmed that peak noise levels in ICUs are far in excess of 45 dB during the
      day and 35 dB at night, which are the recommendations of the Environmental Protection Agency
      for peak noise levels in the ICU.

      The clinical importance of this type of sleep disruption in critically ill patients, however,
      is not known. The investigators hope to determine if placing patients in sleep/circadian
      rhythm friendly rooms will enable them to achieve better sleep, suffer from decreased
      delirium, and have improved recovery from their critical illness.
    

Intervention name(s): Sleep/Circadian Friendly
Intervention type(s): Behavioral
Intervention description(s): This intervention attempts to improve sleep and prevent circadian rhythm dysregulation among patients admitted to the medical intensive care unit (MICU). Patients within his arm will be asked to try to keep their TV off and limit their telephone use from 10pm-7am, as well as limit the amount of visitors in their room as much as possible between those hours. Patients will also be offered ear plugs and eye masks if they wish to use at night to aid in helping them sleep, if deemed medically safe to do so. Additionally nurses will be asked to bathe patients either before 10pm or after 7am, to limit their conversations in the patient's room at night, and try as much as possible to limit blood draws and waking patients during those hours as is medically safe. Nurses will also be instructed to lower the blinds in the room at 10 pm and raise them up at 7am to help with patients sleep/wake cycle.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention