Julie JOSEPH
Florence Nightingale Journal of Nursing - 2026;34(1):1-8
Sleep disturbances affect 47-60% of intensive care unit (ICU) patients and often persist after discharge, contributing to adverse outcomes such as prolonged recovery, increased delirium risk, and higher mortality. Sleep assessment in ICU settings is complex; although polysomnography is the gold standard, its practical limitations restrict its use. Consequently, subjective tools like the Richards-Campbell Sleep Questionnaire are widely used for bedside evaluation, while objective methods such as actigraphy and bispectral index monitoring are gaining acceptance. Interventions to improve sleep quality include nonpharmacological approaches such as eye masks, earplugs, massage, and environmental modifications, as well as pharmacological treatments, with dexmedetomidine showing potential benefits in specific ICU populations. Multicomponent sleep-hygiene bundles combining environmental, behavioral, and pharmacological strategies demonstrate the greatest effectiveness. Implementation often follows a phased approach that addresses both ventilated and non-ventilated patients, with nursing staff playing a central role. Evaluation metrics encompass subjective assessments (RCSQ), objective monitoring (BIS), and clinical outcomes, including delirium incidence, mechanical ventilation duration, and ICU length of stay. Evidence indicates that sleep-hygiene bundles can reduce delirium incidence by 30-50% and shorten ICU stays by approximately 1.2 days. Nevertheless, challenges such as staff resistance and resource limitations impede widespread adoption, underscoring the need for tailored implementation strategies to optimize sleep management in critical care environments.
