Quieting the ICU: Pathway to Recovery, by Enhancing Sleep through Non Pharmacological Intervention: A Comparative Analysis

INTRODUCTION: Quality sleep is essential for overall well-being and recovery, particularly in critically ill patients in intensive care units (ICUs).(2) Studies show that sleep deprivation in ICUs can impair cognition, weaken immune function, and affect the metabolism of life-saving treatments.(4) Factors like sedatives and the ICU environment disrupt the circadian system and neural networks regulating sleep.(4) Sleep disruption is a common issue reported by ICU survivors.(1) To improve sleep quality, it's important to assess the quality of sleep and identify modifiable factors.(1) Interventions, both pharmacological and non pharmacological, have been attempted with uncertain results.(4) More research is needed to develop effective solutions. OBJECTIVES: Primary objective – To assess the impact of non pharmacological interventions on improving ICU sleep quality Secondary Objective – To evaluate sleep quality in ICU and to identify modifiable factors disrupting sleep in ICU patients. MATERIALS AND METHODS: Patients who meet the study's inclusion criteria will be screened for arousal levels. Mental capacity to participate in the study will be determined by assessing Richmond Agitation-Sedation Scale (RASS) scores. Participants were randomly assigned to either the interventional group or the control group. Informed consent was obtained. Patients in the interventional group received eye pads and earplugs to minimize sensory disturbances. Nursing interventions, patient care, administration of medications and blood sampling were limited during night time hours (10:00 p.m. to 6:00 a.m.) to reduce disturbances.(1) Additionally, the patient environment was optimized by maintaining noise levels below 35 dB, noise is monitored using decibel meter and ensuring the room is kept as dark as possible during these hours. Patient in control group were given standard ICU care. Sleep quality was assessed using the Richards Campbell Sleep Questionnaire,(2) while factors influencing sleep was evaluated using the Modified Freeman Scale.(1) Both interventional and control group participants completed the questionnaires at the time of ICU discharge. Responses were collected and analysed statistically. Patient with RCSQ score less than 50 was considered to have a poor sleep.(2) RESULTS: A total of 80 patients will be included in the study. So far, 50 patients have been analysed, including 34 males and 16 females. Sepsis was the main indication for ICU admission. The mean ICU stay was similar between the control (4.8 days) and intervention (4.7 days) groups. Sleep quality, assessed using the RCSQ score, significantly improved in the intervention group (75.00 ± 10.88) compared to the control group (52.92 ± 14.26) (p < 0.0001). Awakening from sleep was significantly reduced (p < 0.0001), and the ability to return to sleep improved (p = 0.0023) with the intervention. Light, nursing interventions, diagnostic testing, and vital measurements were found to be the main factors causing poor sleep quality in the ICU. With the non-pharmacological measures, these factors were minimized, and sleep quality improved in the intervention group. DISCUSSIONS: Poor sleep quality is common among ICU patients. Our study identifies factors causing sleep disturbances, and suggests that non-pharmacological interventions can improve sleep quality. It's important to raise awareness among ICU staff about significance of sleep and the factors that disrupt it.