Lynchburg Journal of Medical Science

Lynchburg Journal of Medical Science


Critical Care


Dr. Nancy Reid



Objective:To prove that implementing a sleep hygiene bundle will decrease delirium in critically ill patients as well as improve mortality and morbidity.

Data Sources:I searched PubMed, Cochrane Library and Google Scholar for relevant literature.

Study Selection:Articles on delirium in the ICU, sleep hygiene practices, and non-medicine sleep aids like melatonin, earplugs and eye masks were selected.

Data Extraction:Three different meta-analysis and systematic reviews that were published from 2015-2018 were used to extract data for this scholarly project. Studies included earplugs, eye masks, melatonin, reduced noise, decreased activity at night and reduced medications to evaluate the effect on delirium.

Data Synthesis:One systematic review and two randomized controlled trials were evaluated with subjects using earplugs, eye masks, and/or melatonin to help implement sleep. Earplugs were found to have a significant reduction on delirium. Melatonin compared to a placebo did not show a vast difference. However, melatonin compared to just earplugs and eye masks against ICU noise and light showed a major improvement in sleep quality.

Conclusions:A sleep hygiene bundle has shown significant improvement in the decreased risk of delirium in ICU. Decreasing delirium in critically ill patients has shown benefits in mortality and morbidity. The ideal approach for improving sleep hygiene and the associated effect on patient-centered outcomes remains uncertain.

Keywords: delirium, sleep, intensive care, sleep hygiene, agitation, sedation, melatonin, earplugs, eye masks, critical ill patients, CAM-ICU


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