From the Guidelines
Dexmedetomidine is a recommended sleep aid for ICU patients, as it may improve sleep architecture, particularly in hemodynamically stable patients requiring a sedative infusion overnight 1.
Key Points
- Non-pharmacologic interventions are also recommended to promote sleep in adult ICU patients, including optimizing patients' environments, controlling light and noise, clustering patient care activities, and decreasing stimuli at night to protect patients' sleep cycles 1.
- A sleep-promoting protocol may be used to improve sleep in critically ill adults, which can include multiple interventions such as offering earplugs and eyeshades, and using relaxing music 1.
- Pharmacologic interventions should be considered with caution, as they may increase the risk of polypharmacy and delirium, and their safety and efficacy in ICU patients are not well established 1.
- Minimizing external factors such as light, alarms, and human voices, and maintaining a normal day-night rhythm can also help improve sleep quality in ICU patients 1.
- Melatonin is mentioned as a potential pharmacologic intervention to improve sleep, but its use is not specifically recommended in the provided evidence.
From the Research
Sleep Aids for ICU Patients
- The following sleep aids have been studied for use in ICU patients:
- Melatonin: evidence for its use as a sleep aid in the ICU is mixed and largely not supportive for improving sleep 2
- Ramelteon: evidence is too limited to offer definitive recommendations 2
- Suvorexant: evidence is too limited to offer definitive recommendations 2
- Propofol: evidence is too limited to offer definitive recommendations 2
- Dexmedetomidine: supported by both objective and subjective data as an effective sleep aid in the ICU, with improved sleep duration and efficiency, and decreased arousal index 2, 3, 4
Non-Pharmacological Interventions
- Non-pharmacological interventions have also been studied for use in ICU patients, including:
- Eye masks and earplugs: shown to improve subjective and objective sleep quality 3, 5
- Bundles to reduce noise and lighting: shown to improve subjective and objective sleep quality 3
- Organization of patient care: shown to improve subjective and objective sleep quality 3
- Assist-control ventilation: associated with greater objective sleep quality than spontaneous modes 3
- White noise, music, aromatherapy, massage, acupressure, and sleep hygiene protocols: reported to improve sleep quality in some studies 5
Safety and Efficacy
- Dexmedetomidine has been reported to have mild side effects, including bradycardia and hypotension 2
- Other medications have been reported to be safe, but evidence is limited 2
- Non-pharmacological interventions are generally considered safe and may be effective in improving sleep quality in ICU patients 3, 5