Authors: Shaw R.

Reference: Am J Crit Care. 2016 Mar;25(2):181-4.

Adequate 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.13 Researchers in one study4 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.3

Acutely 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 non-pharmacological 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).3Music 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?

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Pubmed ID: 26932923