Using Music to Promote Sleep for Hospitalized Adults

Abstract

A dequate sleep is a critical component of illness recovery. Inadequate sleep contributes to a myriad of physiological problems, including impaired immune response, decline in wound healing, greater insulin resistance, increased perceptions of pain, and an increase in mortality. Sleep problems exacerbate the healing process during hospitalization and can endure beyond hospitalization. [1][2][3] Researchers in one study 4 documented that sleep difficulties may endure beyond hospitalization: 50% of respondents reported moderate to severe sleep problems 1 week after discharge. Other studies have offered evidence that sleep problems experienced during hospitalization increase the risk for development of chronic insomnia. 3Acutely ill patients experience difficulty falling asleep, sleep fragmentation, decreased rapid-eye-movement (REM) sleep, and sleep perceived as poor quality. 2,5 In hospitals, many factors can interfere with patients' sleep. Environmental noise (eg, noisy equipment, alarms, staff interaction) is a pervasive problem. The Environmental Protection Agency recommends that noise levels not exceed 45 decibels during the day and 35 decibels at night. Numerous studies in acute and intensive care settings have documented noise levels regularly exceeding the recommendations.6,7 Other sleep disruption factors include lighting that interferes with sleep-wake cycles, pain, anxiety, and symptoms related to patients' underlying illness. 4 Many of these sleep-disrupting factors are amplified in intensive care units.Pharmacological interventions, such as sedatives, are often the first response to promoting sleep in hospitalized patients. However, use of sedatives has been linked to such adverse effects as memory loss, disorientation, increased fall risk, and daytime fatigue.3 In recent years, growing emphasis has been placed on exploring the effectiveness of nonpharmacological interventions to promote sleep, such as minimizing nighttime disruptions, decreasing noise and light, increasing meaningful daytime activity, and using relaxation techniques (eg, aromatherapy, massage, guided imagery, ear plugs, and eye masks).3 Music is another previously studied technique for promoting sleep. Music is hypothesized to have psychological and physiological effects on the body, including potentially sleep-promoting influences. 8 The PICO (patient/problem, intervention, comparison, outcomes) question that this review addresses is, What effect do interventions using music, compared with other methods, or usual care, have on promoting sleep in hospitalized adults? MethodsThe literature search strategy included searching Cochrane Library, Joanna Briggs Institute's Evidence-Based Practice (EBP) Database, PubMed, EMBASE, and CINAHL Plus. Key words included music, sleep, hospital*, lab*, and patient* (asterisks indicate that truncated versions of those words were used in the literature search). No limitations were placed on publication date so as to identify the largest number of relevant studies possible. Reference lists of identifie...

Ability of suvorexant to prevent delirium in patients in the intensive care unit: a randomized controlled trial

“…The pathophysiology of delirium is proposed to be related to sleep disturbances in critically ill patients. Sleep hygiene programs in ICUs improve sleep quality and quantity and can reduce delirium incidence and duration by >50% . Attention disturbances, a core delirium symptom, are among the most important symptoms and a critical item in the diagnostic criteria for delirium based on the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM‐5) .…”

Perceptions and Practices Regarding Sleep in the Intensive Care Unit. A Survey of 1,223 Critical Care Providers

“…The 2013 SCCM clinical practice guidelines for the management of pain, agitation, and delirium in the ICU recommend promoting sleep in adult ICU patients by using a multifaceted, bundled approach aimed at addressing modifiable disruptors of nighttime sleep in the inpatient setting (27,32), including environmental noise and light reduction via "quiet time" protocols (36-41); clustering of patient care activities (36); and consideration of earplugs, eye masks, or soothing music (36,(42)(43)(44)(45)(46).…”