Physicians seek to improve the quality of sleep in ICU, researchers at UT Southwestern report

December 10, 2007

DALLAS - Dec. 10, 2007 - The sleep patterns of patients in the intensive care unit are so superficial that they barely spend any time in the restorative stages of sleep that aid in healing, UT Southwestern Medical Center physicians have found.

"Current clinical-care protocols routinely and severely deprive critically ill patients of sleep at a time when the need for adequate rest is perhaps most essential," said Dr. Randall Friese, assistant professor of burn/trauma/critical care at UT Southwestern and lead author of a study appearing in today's issue of The Journal of Trauma: Injury, Infection and Critical Care.

"We haven't recognized the importance of prescribing sleep," said Dr. Friese, whose study is one of the first to examine the sleep patterns of surgical and trauma patients. "Patients in the ICU may look like they are sleeping, but they're not sleeping well. They are not getting the restorative stages that are required."

Sleep typically occurs at night in successive cyclical stages. Sleep begins in very superficial stages. These stages are followed by deeper, more restorative states, including rapid eye movement (REM) sleep. Although researchers continue to investigate exactly what happens in the brain during REM sleep, they do know that it is critical for restorative sleep.

Dr. Friese monitored the sleep patterns of 16 patients in the ICU at Parkland Memorial Hospital who had suffered traumatic injuries or had undergone intra-abdominal surgical procedures. The patients had been in the ICU two to 10 days. Patients suffering brain injuries were excluded from the study because such injuries typically illicit abnormal sleep patterns.

After monitoring the patients' brain waves in a specially equipped bed for up to 24 hours, Dr. Friese found that patients in the ICU received an acceptable amount of sleep time, but that the sleep patterns were fragmented and significantly abnormal. Patients in the ICU spent 96 percent of their sleep cycle in superficial stages, compared to normal sleep, in which up to 50 percent is spent in the restorative stages.

The next step, Dr. Friese said, is to design a clinical trial that makes the ICU environment more conducive to sleep and then monitor the patients' outcomes. Some proposed steps to decrease disturbances in the ICU include adjusting monitoring machines so that alarms don't wake up sleeping patients, providing patients ear plugs and eye shields, dimming the lights, and using pharmacological sleeping aids.

"There are two major things contributing to abnormal sleep in these patients - the pathophysiology of the disease process itself and the stressful environment of the ICU," Dr. Friese said. "If we can neutralize the stressful environment, maybe we can shorten the hospital stay, lower infection risks and increase patient wound healing."

Dr. Ramon Diaz-Arrastia, professor of neurology and one of the study's authors, said the investigation demonstrated "that surgical patients in the ICU have essentially no restorative sleep.

"Restorative sleep is most abundant during the later part of sleep - it is sometime between 3 a.m. to 6 a.m. that the bulk of this stage of sleep occurs. It is likely that with some straightforward measures, such as changing the schedule of nursing intervention, we may help these patients attain the restorative sleep that could improve their outcomes."
-end-
Other UT Southwestern researchers involved in the study were senior author Dr. Larry Gentillelo, professor of surgery; Dr. Heidi Frankel, professor of surgery; and Dara McBride, senior research nurse.

Visit www.utsouthwestern.org/patientcare/medicalservices/sleep to learn more about clinical services at UT Southwestern in sleep and breathing disorders.

This news release is available on our World Wide Web home page at http://www.utsouthwestern.edu/utsw/cda/dept353744/files/430175.html

To automatically receive news releases from UT Southwestern via e-mail, subscribe at www.utsouthwestern.edu/receivenews

Dr. Randall Friese -- http://www.utsouthwestern.edu/findfac/professional/0,2356,51098,00.html

Dr. Ramon Diaz-Arrastia - http://www.utsouthwestern.edu/findfac/professional/0,2356,11807,00.html

UT Southwestern Medical Center

Related Sleep Articles from Brightsurf:

Size and sleep: New research reveals why little things sleep longer
Using data from humans and other mammals, a team of scientists including researchers from the Santa Fe Institute has developed one of the first quantitative models that explains why sleep times across species and during development decrease as brains get bigger.

Wind turbine noise affects dream sleep and perceived sleep restoration
Wind turbine noise (WTN) influences people's perception of the restorative effects of sleep, and also has a small but significant effect on dream sleep, otherwise known as REM (rapid eye movement) sleep, a study at the University of Gothenburg, Sweden, shows.

To sleep deeply: The brainstem neurons that regulate non-REM sleep
University of Tsukuba researchers identified neurons that promote non-REM sleep in the brainstem in mice.

Chronic opioid therapy can disrupt sleep, increase risk of sleep disorders
Patients and medical providers should be aware that chronic opioid use can interfere with sleep by reducing sleep efficiency and increasing the risk of sleep-disordered breathing, according to a position statement from the American Academy of Sleep Medicine.

'Short sleep' gene prevents memory deficits associated with sleep deprivation
The UCSF scientists who identified the two known human genes that promote 'natural short sleep' -- nightly sleep that lasts just four to six hours but leaves people feeling well-rested -- have now discovered a third, and it's also the first gene that's ever been shown to prevent the memory deficits that normally accompany sleep deprivation.

Short sleep duration and sleep variability blunt weight loss
High sleep variability and short sleep duration are associated with difficulties in losing weight and body fat.

Nurses have an increased risk of sleep disorders and sleep deprivation
According to preliminary results of a new study, there is a high prevalence of insufficient sleep and symptoms of common sleep disorders among medical center nurses.

Common sleep myths compromise good sleep and health
People often say they can get by on five or fewer hours of sleep, that snoring is harmless, and that having a drink helps you to fall asleep.

Sleep tight! Researchers identify the beneficial role of sleep
Why do animals sleep? Why do humans 'waste' a third of their lives sleeping?

Does extra sleep on the weekends repay your sleep debt? No, researchers say
Insufficient sleep and untreated sleep disorders put people at increased risk for metabolic problems, including obesity and diabetes.

Read More: Sleep News and Sleep Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.