Guess what? Patients aren’t getting any. Sleep, that is.
Over time, studies have shown that sleep is important in the critically ill for healing and survival; yet there is consistent evidence that patients in the intensive care unit do not get enough sleep.
Sleep deprivation impinges on recovery and ability to resist infection. It brings about neurologic problems such as delirium and agitation, and respiratory problems because it weakens upper airway muscles, thus prolonging the duration of ventilation and intensive care unit stay. Sleep deprivation may provoke posttraumatic stress disorder, withdrawal symptoms, depression, and continued sleep disruption. Sleep deprivation may reduce pain tolerance; increase fatigue in sympathetic nerve centers; increase sympathetic activity, leading to nocturnal high blood pressure; and blunt chemoreceptor responses promoting ineffective gas exchange.
Sleep is one of those things we nurses love to talk about, but we don’t actually do anything to ensure it. Hospitals (and the sometimes clueless administrators that run them) are as equally as negligent. The Emergency Department is frankly the worst place for patients to sleep, and yet in our 1st Floor Med/Surg/ICU Emergency there are always admitted patients, sometimes as many as 20 or more, spending days in the emerg — a situation not like to change as long as hospital managers continue to treat the Emergency Department as the equivalent of a hospital ward. (This is a problem pretty general in all emergency departments.) There’s no privacy, and patients are tortured with narrow uncomfortable stretchers, bright lights, continuous noise, odd smells, the occasional scream, monitors beeping and an ambient temperature that ranges from frigid to tropical. Not exactly a place, you would think, conducive to sleep. And then we wonder when the patients get a little wonky — a phenomenon called ICU psychosis, or maybe when their recovery is unaccountably poor, or when mortality and morbidity rates start going up.
Florence Nightingale had some remarks about about noise and sleep:
There are certain patients, no doubt, especially where there is slight concussion or other disturbance of the brain, who are affected by mere noise. But intermittent noise, or sudden and sharp noise, in these as in all other cases, affects far more than continuous noise—noise with jar far more than noise without. Of one thing you may be certain, that anything which wakes a patient suddenly out of his sleep will invariably put him into a state of greater excitement, do him more serious, aye, and lasting mischief, than any continuous noise, however loud.
Never to allow a patient to be waked, intentionally or accidentally, is a sine qua non of all good nursing. If he is roused out of his first sleep, he is almost certain to have no more sleep. It is a curious but quite intelligible fact that, if a patient is waked after a few hours’ instead of a few minutes’ sleep, he is much more likely to sleep again. Because pain, like irritability of brain, perpetuates and intensifies itself. If you have gained a respite of either in sleep you have gained more than the mere respite. Both the probability of recurrence and of the same intensity will be diminished; whereas both will be terribly increased by want of sleep. This is the reason why sleep is so all-important. This is the reason why a patient waked in the early part of his sleep loses not only his sleep, but his power to sleep. A healthy person who allows himself to sleep during the day will lose his sleep at night. But it is exactly the reverse with the sick generally; the more they sleep, the better will they be able to sleep. (Notes on Nursing, V.)
Plus ça change, plus c’est la même chose. After 150 years, you’d think we would have learned something.