Promoting Sleep in Acute and Critically Ill Adults: Enhancing Recovery Through Evidence-based Practices

Scope and Impact of the Problem

Achieving high-quality sleep of sufficient duration is essential for acute and critical illness recovery. High-quality sleep is characterized as continuous, efficient, appropri­ately timed, and adequate in physiologic stages and dura­tion.^1,2 Insufficient and poor-quality sleep is associated with numerous short- and long-term negative health outcomes including impaired cognitive function, car­diometabolic disease, increased symptom burden, inci­dent dementia and increased all-cause mortality risk.^3-9 Even a single night of insufficient sleep (< 6 hours) can induce physiologic alterations such as inflammatory activation, increased blood pressure, insulin resistance and impaired levels of alertness.^10-13 In the intensive care unit (ICU), patients are at high risk for negative health outcomes and impaired recovery from poor and disrupted sleep that present as:^14,15

• Abnormal sleep architecture (referring to the organizational structure and stages of sleep)
• Reduced sleep efficiency (less total amount of sleep out of the total time attempting to sleep)
• Sleep fragmentation (repeated short interruptions of sleep)
• Poor self-reported sleep quality^16,17

Causes of sleep disruption are multifactorial and include the environment, pharmacologic agents and pathophys­iologic conditions (see Figure).¹⁵ Critical care nurses play a central role in the assessment and promotion of high-quality, well-timed sleep. This AACN Practice Alert outlines evidence-based strategies and considerations for sleep promotion in the ICU, focusing specifically on nonphar­macologic interventions for adult patients. Opportunities for interprofessional involvement are also highlighted.