Can We Improve Sleep Quality by Changing the Way We Ventilate Patients?

Sleep Loss and Circadian Rhythm Disruption in the Intensive Care Unit

“…In addition to causing pain and anxiety, MV is believed to disrupt sleep via patient-ventilator asynchrony, overventilation leading to apneas Sleep Loss and Circadian Rhythm Disruption and subsequent arousals, and inadequate ventilatory support leading to increased respiratory effort and subsequent arousals. 78 Although extensively studied, there is no strong evidence to support improved patient sleep with one ventilator mode over another. 79 A PSG study of 11 patients comparing assist control (AC) and pressure support ventilation (PSV) demonstrated less sleep fragmentation during PSV; this difference was attributed to diminished patient control of PCO 2 in the AC mode.…”

Sleep Disturbances and Critical Illness

“…These sources include alarms from monitoring devices infusion pumps, ventilators and normal function of the ventilator, telephones, beepers, overhead paging and health care providers having conversations at patients' bedsides [7][8][9]12,[15][16].…”

“…Light: Exposure to artificial light in the ICU 24 h a day can lead to altered sleep patterns [1,8,9,11,12,[15][16][17]. Exposure to artificial light is reported to stifle secretion of melatonin, which controls circadian rhythms.…”

“…Mechanical ventilation and high levels of pressure support can lead to patient/ventilator dyssynchrony, increased ventilatory effort, alterations in gas exchange, and air trapping. All of these can impact sleep quality [1,9,11,15,17,[19][20][21].…”

“…emptying trash) and keeping the room at an appropriate temperature for sleep (too warm and too cool interferes with sleep). Clustering of activities and performing only those activities that are clinically indicated and evidence-based versus based on routine is also recommended [1,[7][8][9][10][11]13,15,[17][18][19]24,25]. Lights should be kept dim during sleep hours so as not to trigger arousal through melatonin suppression and disruption of circadian rhythms [11].…”