Post Intensive Care Syndrome, PICS
Post Intensive Care Syndrome, PICS
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Information for Patients – Sleep

 

During a stay in the ICU, your sleep is negatively affected. The lights, noises and frequent tests promote increased nighttime awakenings and poor quality of sleep. This alteration in your sleep schedule may continue after you leave the hospital.  In one study, more than half of ICU survivors reported worse sleep after an ICU stay than they had prior to their hospitalization. Even one year after discharge, over one-quarter of survivors met the criteria for insomnia.

 

What is Insomnia? Insomnia is trouble falling asleep, trouble staying asleep, or waking up too early without feeling rested. If you have insomnia, you have trouble sleeping even if you have a good setting in which to rest. If you are concerned that you may be experiencing insomnia, you should make an appointment to discuss your symptoms with your doctor.

 

What causes insomnia? ICU survivors have multiple risk factors for insomnia.   

  1. The ICU routine – The altered sleep and activity schedule in the ICU, such as being awake in the middle of the night for tests, predispose patients to difficulty sleeping after discharge. Sleeping in the hospital is not easy!

  2. Mood problems – This category includes but is not limited to anxiety, depression, and ICU PTSD.

  3. New or worsening sleep disorders – Restless leg syndrome and sleep apnea are common culprits. Patients with sleep apnea have pauses in breathing overnight that disrupt a normal sleep pattern and those with restless leg syndrome have an urge to move their legs at night that make it hard to sleep. Both of these disorders provoke daytime fatigue.

  4. New or worsening chronic pain

  5. Medications - Certain medications frequently prescribed in the ICU cause insomnia. (And you may be on a medication from your ICU stay that you do not need anymore.)

  6. Polypharmacy – Taking too many medications increases your risk of drug interactions and side effects that worsen sleep.

 

What happens to me if I have insomnia? Insomnia creates a multitude of issues. Daytime fatigue or sleepiness prevents patients from participating in their usual day-to-day activities. The lack of sleep at night can lead to increased confusion, difficulty concentrating, and increased risk of accidents, such as car crashes. Pain is intensified, and patients with insomnia become increasingly irritable. Also, insomnia usually worsens existing anxiety, depression, and other mood disorders.

 

You may be stuck in a vicious insomnia cycle. For example, anxiety leads to insomnia and then that insomnia worsens the anxiety.

 

What is the treatment for insomnia? Some of the treatments for insomnia require testing or prescriptions from your physician, but good sleep hygiene is also important.  Sleep hygiene is a set of practices or habits that promote the proper environment for sleep. Good sleep hygiene may be enough to stop the insomnia!

 

When it comes to sleep hygiene, keep a regular sleep schedule. Go to bed at the same time each night and wake up at the same time every morning. Do not take naps! Avoid watching television or looking at your phone prior to sleep, and no brooding in bed.  

 

Here is a more complete list of sleep hygiene tips to try at home: https://www.sleepassociation.org/wp-content/uploads/2014/08/Top-Sleep-Hygiene-Tips-Handout.pdf

 

Consider keeping a sleep diary. A sleep diary is a self-reported record that helps track your sleep habits so you can make changes and improvements. You can use the following: http://sleepcenter.ucla.edu/workfiles/forms/sleep-diary.pdf

 

Remember, sleep is VITAL. Your body requires sleep for mental and physical restoration.  Sleep is important for normal daily functioning and for your physical and mental well-being. Insomnia decreases the overall quality of your life! So if good sleep hygiene does not improve your symptoms, consider seeking a professional opinion.

 

Resources:

1. Kelly MA, McKinley S. Patients' recovery after critical illness at early follow-up. J Clin Nurs. 2010;19(5–6):691–700. [PubMed]


2. Parsons EC, et all. Insomnia is associated with quality of life impairment in medical-surgical intensive care unit survivors. Heart Lung. 2015; 44(2): 89-94. [PubMed]