Intensive and Critical Care Nursing (2013) 29, 310—316

Available online at www.sciencedirect.com

journal homepage: www.elsevier.com/iccn

The experience of sleep deprivation in

intensive care patients: Findings from a
larger hermeneutic phenomenological study
Agness C. Tembo a,b,∗, Vicki Parker c,d, Isabel Higgins e,d

a
Casual Academic University of Newcastle, Newcastle, Australia
b
Registered Nurse Newcastle Private Hospital, New Lambton Heights, Australia
c
University of New England, Armidale, Australia
d
John Hunter Hospital, New Lambton Heights, Australia
e
University of Newcastle, Newcastle, Australia

Accepted 29 May 2013

KEYWORDS Summary Sleep deprivation in critically ill patients has been well documented for more than
Daily sedation 30 years. Despite the large body of literature, sleep deprivation remains a significant concern
interruption; in critically ill patients in intensive care unit (ICU). This paper discusses sleep deprivation in
Intensive care; critically ill patients as one of the main findings from a study that explored the lived experi-
Critical illness; ences of critically ill patients in ICU with daily sedation interruption (DSI). Twelve participants
Sleep; aged between 20 and 76 years with an ICU stay ranging from three to 36 days were recruited
Sleep deprivation from a 16 bed ICU in a large regional referral hospital in New South Wales (NSW), Australia. Par-
ticipants were intubated, mechanically ventilated and subjected to daily sedation interruption
during their critical illness in ICU. In-depth face to face interviews with the participants were
conducted at two weeks after discharge from ICU. A second interview was conducted with eight
participants six to eleven months later. Interviews were audio taped and transcribed. Data were
analysed thematically. ‘‘Longing for sleep’’ and ‘‘being tormented by nightmares’’ capture the
experiences and concerns of some of the participants. The findings suggest a need for models
of care that seek to support restful sleep and prevent or alleviate sleep deprivation and night-
mares. These models of care need to promote both quality and quantity of sleep in and beyond
ICU and identify patients suffering from sleep deprivation to make appropriate referrals for
treatment and support.
© 2013 Elsevier Ltd. All rights reserved.

∗ Corresponding author. Tel.: +61 4 03 5644125; fax: +61 2 49511592.

E-mail addresses: Agness.Tembo@gmail.com, Agness.Tembo@newcastle.edu.au (A.C. Tembo).

0964-3397/$ — see front matter © 2013 Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.iccn.2013.05.003
The experience of sleep deprivation in intensive care patients 311

Implications for Clinical Practice

• Clinicians need to recognise and promote the importance of sleep for patients in ICU.
• Practices that shield patients from witnessing death in ICU are needed.
• Models of care that seek to prevent and alleviate sleep disturbances in and beyond ICU are needed to promote both
quality and quantity of sleep in and beyond ICU.

Introduction also found that the intervention group had a shorter length
of stay (LOS) in ICU as compared to the control group.
However, there was no significant difference in the health
Sleep deprivation is characterised by continued lack of
related quality of life between the two groups. This study
restorative sleep over time that results in physical and cog-
however, was a single centre study with a small number of
nitive sequlae (Fulke and Vauqhan, 2009). Sleep deprivation
patients. The impact of DSI on sleep however, was also not
in critically ill patients has been well documented for more
established.
than 30 years (Hardin, 2009) and contributing factors and
Sleep deprivation is renowned for causing disorders
therapeutic approaches to alleviate sleep deprivation have
of the mind (Germain and Zadra, 2009; Ramful, 2006;
been researched extensively (Friese, 2008; Hardin, 2009;
Simon, 2009), including delirium (Friese, 2008; Tembo
Tembo and Parker, 2009).
and Parker, 2009). The consequences of sleep depri-
Noise, pain and discomfort (Hardin, 2009; Pandharipande
vation include impaired immunity, protein catabolism,
and Ely, 2006; Reishtein, 2005) as well as modes of ventila-
deranged host defenses and death (Friese et al.,
tion, and many drugs used in ICU are among the possible
2009; Pandharipande and Ely, 2006; Parthasarathy and
causes of sleep deprivation in critically ill patients (Friese,
Tobin, 2004). Of concern in ICU is that sleep depriva-
2008; Parthasarathy and Tobin, 2004; Tembo and Parker,
tion weakens upper airway muscles causing respiratory
2009). The administration of sedatives and analgesics by a
problems including a prolonged need for ventilator
continuous infusion has been the mainstay of drug treat-
support, ICU stay and it complicates the post extu-
ment for managing patients requiring mechanical ventilation
bation period (Friese, 2008; Parthasarathy and Tobin,
in ICU for many years (Kress et al., 2002; Ogundele and
2004).
Yende, 2010). Continuous sedation and analgesia are used
Unfortunately, the many causes of sleep deprivation
largely for the patient’s comfort, to improve patient and
pose a challenge to its treatment, prevention and allevi-
ventilator interactions, decrease pain and anxiety, and
ation (Tembo and Parker, 2009). Whilst measures such as
self-injury (Ogundele and Yende, 2010). The cumulative
diurnal lighting (Honkus, 2003), noise reduction (Stracham
effects of sedation and analgesia however, may delay the
and Brown, 2004), careful choice of mechanical ventilation
patient’s withdrawal from mechanical ventilation support
modes (Friese, 2008; Tembo and Parker, 2009) and clus-
(Kress et al., 2002). The effects of continuous sedation for
tering of nursing care (Tamburi, 2004; Tembo and Parker,
ventilation is known to extend ICU stay, and increase the risk
2009), have been recommended to prevent and/or allevi-
of complications associated with ventilation, delirium and
ate sleep deprivation in ICU, patients continue to suffer.
post-traumatic stress disorder (PTSD) (Ogundele and Yende,
It is argued that the causes may be the critical illness
2010). Daily sedation interruption (DSI), whereby patients
itself (Tembo and Parker, 2009) and/or the medications
are administered intermittent boluses of sedatives, seeks to
used for sedation and analgesia (Pandharipande and Ely,
alleviate these problems (Kress et al., 2003), however its
2006).
long term effects and the impact on the patient are largely
Whilst it is well known that sleep is essential for
unexplored. Debate over the use of one mode over the other
healing, recovery and surviving critical illness (Richardson
in terms of the benefits to patients, is unresolved (Kress
et al., 2007; Stracham and Brown, 2004; Tamburri et al.,
et al., 2002).
2004) sleep deprivation in critical illness survivors contin-
A study by Kress et al. (2003) however, provides some
ues to be a problem. Of concern, is that the experiences
insight. Kress et al. (2003) conducted a comparative study
of sleep deprivation for the sufferers have not been
of DSI and continuous infusion in order to establish whether
explored. This paper shares the experiences of people with
DSI was associated with long term psychological harm and
sleep deprivation who were participants in a study that
to measure outcomes such as post traumatic stress disorder
explored the experiences of being critically ill in ICU with
(PTSD). The researchers compared psychological outcomes
DSI.
of ICU patients (n = 13) undergoing DSI (intervention) to
those (n = 19) who underwent continuous sedation infusion
(controls). Participants included patients who were admit-
ted to ICU for sedation and mechanical ventilation. A range
of measures were used including those for PTSD, health sta-
tus, anxiety, depression and psychological adjustment to Aim of the study
illness. Participants were interviewed at least six months
after discharge from ICU. Findings suggested that DSI did The aim of the study was to describe the experience of
not result in psychological harm. Patients in the interven- critical illness in ICU with DSI and how this impacted the
tion group fared better for PTSD than the controls. They participants’ continued existence.
312 A.C. Tembo et al.

Research question Setting description

The research question was: What is the experience of critical
illness in the context of DSI and how does it affect people’s
lives after discharge?
The following questions guided the inquiry; what does it
mean to have been critically ill in ICU with DSI, what is it
like to be critically ill and mechanically ventilated with DSI,
what is it like to wake up from a state of unconsciousness
in ICU and what is the impact of critical illness and ICU on
continued existence?
Methods
The study was conducted in a 22 bed ICU of a tertiary refer-
ral teaching hospital in the state of New South Wales (NSW)
in Australia, which treats a variety of patients ranging from
infants to older people. It is a multidisciplinary unit that
treats all types of injuries and illnesses, and provides post-
operative care to patients following major surgery including
head and neurosurgery. It has a helicopter retrieval service
that transports critically ill patients from smaller hospitals
within the radius of 500Km and also transports patients
to specialist treatment in the metropolitan hospitals of
Sydney. Mechanically ventilated patients are nursed on a
ratio of one to one with other less critical patients nursed
on a one to two ratio.

Research design Recruitment of participants

This study used a qualitative design guided by phenomen-
ology as the research methodology. Phenomenology aims
to gain deep understanding of the meaning of everyday
experiences (Van Manen, 1990). Unlike other sciences, phen-
omenology seeks to garner insightful descriptions of the
way the world is experienced pre-reflectively without tax-
onomising, abstracting or classifying it (Van Manen, 1990).
Phenomenological research aims at describing and under-
standing human experience (Van Manen, 1990) and allows
researchers to explore the depths of experience and the
associated meanings.
To understand people’s experience we . . . need to get
really close to them so that their hopes become our
hopes, their pain becomes our pain—we . . . need to
listen and speak, read and write in a manner that is
attentive to the things of the world that are ultimately
unnamable.
Manen (1999, p. 19)
Participants were purposively recruited on the basis of hav-
ing had the experience of being critically ill in ICU. To be
eligible to participate in the study participants had to have
been ventilated for at least 48 hours and to have undergone
DSI. They had to be 18 years and over, English speaking,
without any cognitive impairment and able to give informed
consent. Participants were initially approached by a third
party who informed them of the study and gave them the
researcher’s contact details. Twelve people agreed to be
interviewed. Table 1 below shows the description and demo-
graphic data of the participants. Pseudonyms were used to
protect the participants’ identity.
Data collection
Data collection included in-depth face to face interviews
with participants. An interview guide was used with open
ended questions designed to explore experiences. For exam-
ple, participants were asked ‘‘Can you tell me about what
it was like for you when you were in ICU’’? Participants

Table 1 Summary of demographic and other relevant data.

Participant Age Reason for admission LOS in ICU (days) Period of

mechanical
ventilation (Days)

Keith 76 Cardiac event 36 27

Jason 69 Haemothorax 4 3
George 58 Chest infection 4 3
Rosie 34 severe metabolic 3 2
acidosis
Ian 56 Metabolic diabetic keto 6 5
acidosis
Moira 76 Triple Vessel CABG 10 8
Alex 65 Aortic bifemoral bypass 9 5
Kate 60 Cardiac arrest. 13 11
Aspiration pneumonitis
Eric 20 Traumatic chest injury 6 5
Maggie 23 Status epilepticus 6 4
Liam 71 Major abdominal surgery 3 2
Monika 41 Motor vehicle accident 6 4
The experience of sleep deprivation in intensive care patients
were interviewed two weeks after they had been discharged
from ICU and again six to eleven months later. A total
of 24 interviews were conducted. Four participants were
interviewed once; two of them declined the subsequent
interview, one could not be interviewed because of ill health
and one could not be contacted. The remaining partici-
pants were interviewed twice. Interviews were conducted
in participants’ homes or place of preference where pri-
vacy, safety and comfort were ensured. Interviews were
between 30 to an hour and 45 minutes. During interviews the
researcher recorded notes of the participants’ non-verbal
cues observed. Data saturation was deemed when no new
information was obtained from interviews. All interviews
were audio recorded and later transcribed for analysis.
Data analysis
A selective highlighting approach was used to analyse the
transcribed interviews (Van Manen, 1990). This approach
meant that the researcher looked for phrases and sentences
that were exemplars of the lived experience of critical ill-
ness in ICU. Data analysis began as soon as data collection
commenced. The process of analysing individual transcripts
helped the researcher to guide the subsequent interviews
while keeping in mind the original research questions.
Significant phrases and sentences relating to the study ques-
tions were highlighted, clustered, categorised and emergent
themes identified. Having conducted the interviews and the
preliminary data analysis of each transcript, the researcher
then used a ‘‘parts and whole’’ process whereby highlighted
phrases and sentences were compared and contrasted across
all of the transcripts and identifying recurrent ideas and
themes from individual transcripts. Emergent themes and
subthemes allowed the researcher to demonstrate and bring
to light the various differences, contradictions and tensions
that characterised the participants’ experiences. Linguistic
data was then transformed into phenomenological sensitive
text through the process of writing, reflection and rewriting.
Constructing linguistic transformation of data is a challeng-
ing creative hermeneutic process (Van Manen, 1990) that
involved generating text and forming paragraphs from the
data and the researcher’s notes of non-verbal cues obser-
vations of the participants. During the analysis, consistent
with the study aims and research questions, attention was
given not only to the participants’ experiences more broadly
within the context of ICU, DSI and beyond but also to the
impact on the participants lives. Sleep deprivations emerged
as a major concern for many (n = 8) of the participants as
described in the findings below.
Credibility and rigour
Phenomenology attends to matters of credibility by
describing the study population, selection procedures for
participants and ensuring an accurate representation of
the participants’ experiences, opinions and perspectives
(Gerrish and Lacey, 2010; Moustakas, 1994). Phenomeno-
logical research is also judged by the evocativeness and
transferability of the experience, and the accuracy of rep-
resentation (Van Manen, 1990). In relation to the findings
reported here the study population has been described
313
along with the process of recruitment. The experiences,
opinions and perspectives of participants in this study
are represented by the exemplars provided to support
their descriptions of disturbed sleep. Only people who had
experienced critical illness with DSI were approached to par-
ticipate in the study. Purposive sampling ensured there was
representation of the experience under study. In depth face
to face interviews were held with all of the participants in
order to ensure thick description of experiences. Preliminary
data analysis was conducted by the lead author and verified
by authors one and two who have experience in ICU and
qualitative research. Consistent with qualitative research,
the researchers used a process of reflexivity throughout;
assumptions, preconceptions, and beliefs relating to the
study were identified, monitored throughout, recorded and
discussed as the data were analysed. Sleep deprivation was
a major concern of 8 of the 12 participants in this study
Ethical Considerations
Ethical approval was sought and granted in December, 2007
by the Research Ethics Committee where the study was
undertaken. Potential participants were given both written
and verbal information about the study. Written consent was
obtained from participants.
Findings
The experience of being critically ill in ICU in the context of
DSI was depicted in this study as ‘‘being in limbo’’. Being
in limbo, the essential feature of the experience of the
participants in this study, exemplifies the uncertainties the
participants faced during this time. In this paper we present
selected findings from the study to highlight the concerns
of participants in relation to sleep captured in the themes
‘‘Longing for normal sleep’’ and ‘Being tormented by night-
mares’. Here they described not being able to sleep and
having nightmares reminiscent of their stay in ICU and that
kept them awake throughout the night. They longed for
the return of peaceful sleep. The findings relating to other
themes in this study will be reported elsewhere.
Longing for normal sleep
‘‘You just doze on and off if you’re lucky. And back then
ah I’d sleep for a couple of hours and wake up. Once I
woke up, I knew that was the end of the night’s sleep.
It might be 11 o’clock, 12 o’clock or whatever, I knew
I wasn’t going to get anymore sleep that night. And you
just lay there all night—for the rest of the night. You knew
what was going on around you all the time and think ‘oh
1 o’clock, 2 o’clock, 3 o’clock, 4 o’clock all awake, all
the time I just couldn’t sleep of a night time. I lay awake
all night—hour after hour. Ah, it was—oh, I was getting
desperate to get a night’s sleep. I don’t know why. I’m
still the same here. I wake up at 11 or 12 o’clock, that’s
it.’’
(Keith 1st Int.)
Participants were desperate for sleep. So desperate were
they that some took sleeping tablets against advice. The
314
sleeping tablets proved to be futile in achieving a good
night’s sleep. Most of the participants attributed their
inability to sleep to the medications they had in ICU and the
medications they were using at home. Participants searched
for reasons for their inability to sleep.
‘‘No reason why [the lack of sleep] whether it was the
medication or the surroundings or what it was, I just
couldn’t get back to sleep. I just couldn’t.//. Like last
night I think I woke up about half past 12 or something like
that.//. Same thing, even when I took sleeping tablets. . .
I was told I shouldn’t be taking them.//. I so desperately
want to sleep. It becomes annoying. And you don’t know
why. You can’t understand it..//. One day I’ll get back to
a normal nice sleep.’’
(Keith 1st Int.)
Jason reasoned that he ‘‘had his eyes closed for five
days’’.
‘‘I can’t sleep.’.//. I don’t know why? I just can’t go to
sleep. I don’t know whether it was that I probably did
close my eyes and I had my eyes closed for five days.’’
(Jason, 1st Int.)
George said:
‘‘I can’t sleep. I don’t know why I just can’t go to sleep. I
want to but I don’t know whether it is that I did close my
eyes and I had my eyes closed for five days..but I hope I
will be able to sleep like I used to again.’’
Some participants could not sleep because people were
dying and they thought they were also at risk. They were
frightened to go to sleep in a place where death was per-
vasive, as Ian said; ‘‘I couldn’t sleep because the people
around me were basically dying’’. For Ian sleeping reminded
him of being ‘‘blacked out’’ with DSI in ICU and where death
may have taken him. Seeing others dying made him sense his
own death more profoundly. Yet when he thought he had left
death behind in ICU and he was in the comfort of his own
home and bed, he found that he still could not sleep. The
only means of survival was to stay awake and keep vigil so
that death did not claim them. This was also described by
Kate:
‘‘There was one night a doctor’s husband died. He had a
heart attack, they rushed him in. The whole place was
erratic, you know and I hardly slept at all that night. I
slept for a few hours and then I’d wake up.//. I couldn’t
sleep in that place because everybody around me was
dying.’’
(Kate, 1st Int.)
Being tormented by nightmares
Rosie’s sleep times were filled with nightmares about her
ICU experience and often she would wake up with beads
of perspiration, unsure where she was. She would ask her
partner to clarify the nightmares as to whether or not they
really happened. Rosie’s world changed between night and
day. At night during sleep, nightmares returned her to the
dark and horrifying world of ICU. During the day she was
safe and in control with a hold on the world and things that
mattered to her. Rosie explains:
A.C. Tembo et al.
‘‘I wake up distressed in the middle of the night and a lot
of that’s got to do with, I don’t know what’s real and what
isn’t. So I have to ask Joseph, did that really happen? Did
they really do those things to me or am I imagining it? And
he’ll either confirm or deny what actually happened to
me because I’m not sure. So, it is left you know, I don’t
sleep well yet.//. I expect that it will get better.’’
(Rosie 1st Int.)
Six months after ICU, Eric was still traumatised by his
ICU experiences relived every night through nightmares Eric,
like Rosie, hovered between the world of ICU and the famil-
iar world of home and mainstream life. Eric also depended
on his wife to put things in perspective — regaining his orien-
tation to the real world of that time. The silence of the night
was relentless and frightening for Eric. It took him back to
the sounds of the monitors he endured when he was in ICU.
For Eric there may be no moving on from ICU:
‘‘They come in the dreams and I’m waking up with the
tubes and being tied to the bed. That’s lack of sleep, I
don’t sleep much, I keep waking up, tossing and turning
and getting up through the night.//. I’ll feel like I’m tied
down and they’ve got tubes in my mouth and just could
be waking up out of a dream and it just freaks me out. I
still remember hearing noises. I’ll be asleep and when it’s
real quiet I can hear the sounds of the monitors going off,
beep and beep beep. That sort of starts to freak me out a
bit, ‘because I have the feeling of back in hospital.//. My
Mrs. being next to me, she’s had to calm me down saying,
‘You’re right. You’re at home. You’re not in hospital.’ I
just freak right out.//. I don’t know when all this will
end.’’
(Eric 2nd Int.)
As the experiences of sleep deprivation continued the
participants became desperate for sleep as Keith said:
‘‘I am so desperately wanting to sleep and you can’t and
the more you try, the less chance you’ve got. It becomes
annoying. Ah, you’d be dead tired but you can’t get to
sleep. And you don’t know why. You can’t understand it.’’
(Keith, 1st Int.)
Moira could not sleep because she continued to experi-
ence nightmares;
‘‘I still can’t sleep because I still have bad nightmares
after all this time and I don’t think I should.’’
The participants in this study described living without
sleep as punctuated with nightmares and the troubling expe-
riences of their critical illness and ICU stay. Life in ICU was
characterised by the expectation that one day, they would
be able to sleep restfully. As Kate said;
‘‘So, it is left you know, I don’t sleep well yet.//. I expect
that it will get better. But at the moment, I don’t sleep
very well. I have a lot of night sweats and wake up not
quite sure where I am.’ One day I’ll get back to a normal
nice sleep..//.Till then I remain in limbo not knowing
when all this will end.’’
(Kate, 1st Int.)
The experience of sleep deprivation in intensive care patients
Discussion
For the participants in this study there were some who
did not report concerns about sleep, however there were
several others who were clearly troubled by their inability
to sleep. They could not understand why sleep eluded them
and were desperate to overcome this. Others experienced
disrupted sleep with terrifying dreams and nightmares.
These participants shared a longing for peaceful sleep.
Sleep was seen to some extent as both a means to and a
symbol of their recovery. Without sleep they were unable
to resume their lives. Some were afraid to sleep because
of recurring nightmares; they were constantly tired, often
depressed and unable to feel safe in the world. That they
could not sleep and experienced ongoing nightmares that
depicted scenes of their ICU experiences disallowed their
ability to move on with their lives. In the absence of
peaceful sleep they were living life in limbo.
The participants’ descriptions of sleep deprivation have
revealed the negative effects of critical illness in ICU with
DSI and the struggle participants engaged in to regain
restorative sleep. The findings presented here show that the
absence of sleep was distressing for participants and that
nightmares impacted the ability and quality of their sleep.
Some participants described a heightened sense of death as
a reason not to sleep in ICU and on return to home: they felt
the proximity of their own death, they feared not waking
from sleep, and they were witness to the death of others in
ICU. This finding has been reported by others (Parker, 1997;
Rattray et al., 2004; Zeilani and Seymour, 2010). That night-
mares constantly took participants back to their ICU expe-
riences has also been found in other studies (Ringdal et al.,
2006; Roberts et al., 2006; Roberts and Chaboyer, 2004).
Although other studies have described the effects of criti-
cal illness and ICU hospitalisation for patients, these descrip-
tions have been interpreted largely as PTSD arising from the
trauma associated with being ventilated and receiving seda-
tion. Accounts of nightmares and sleepless nights after ICU
have been described since the early days of ICU (Blachly and
Starr, 1964; Kornfeld et al., 1969). The findings of this study,
however, provide insight into the impact of the experience
for survivors highlighting both uncertainty and vulnerability
and the need to reconsider models of care that address the
problem of sleep across the critical illness trajectory.
Models of care might include follow-up pathways with
attention to psychological support for nightmares, promot-
ing sleep hygiene or rehabilitation and sleep clinics. These
models of care need to promote both quality and quantity
of sleep in and beyond ICU and might be achieved through
post ICU follow-up clinics designed to help identify patients
suffering from sleep deprivation. Additionally community
programmes such as support groups for critical illness sur-
vivors may also help survivors to overcome and deal with a
range of issues and concern such as sleep deprivation and
ongoing nightmares from their ICU experiences.
Limitations of the study
Because the focus of phenomenological research is on
the subjective nature of lived experience, the researcher
becomes integral part of the research through the data
315
collection and it analysis. The findings, therefore, represent
the researcher’s account and interpretation of the raw data.
There may be other interpretations that are equally valid.
The themes identified are the researchers’ interpretation
of the participants’ experiences and guided by their under-
standing of phenomenology. Therefore throughout the study,
the researchers endeavoured to maintain trustworthiness
of the findings by emphasising the individuality of the par-
ticipants’ situation through which they revealed the varied
experiences of each one of them. Emphasising the individu-
ality and situations resonate with Merleau-Ponty’s argument
that man is ‘always situated and individuated’ (Merleau-
Ponty, 1964, p. 51). It is also a limitation in that what is
understood is based only on the individual’s perception at
that particular time. Whatever follows is not known.
Conclusion
The study demonstrates patients continue to experience
sleep deprivation at various stages of their trajectory of crit-
ical illness in and beyond ICU. The findings suggest a need for
models of care that seek to support restful sleep and pre-
vent or alleviate sleep deprivation and nightmares. These
models of care need to promote both quality and quantity
of sleep in and beyond ICU and identify patients suffering
from sleep deprivation. Clinicians need to be mindful of
the role of comfort in promoting sleep, including the use
of comfortable beds, judicious repositioning procedures and
communicating with patients regarding their comfort needs
and preferences for sleep and rest. Practices that shield
patients from witnessing death in ICU are needed.
Both nurses and students need to be educated about the
importance of sleep, factors that impact on it and the com-
plications that arise from sleep deprivation in ICU patients
with the aim that they can observe policies that could sup-
port and improve patients’ sleep in and beyond ICU. In
service for new nursing staff and other medical personnel
could shed insight and understanding that would result in
better sleep patterns for the patients.
Future research needs to address ways of promoting rest-
ful sleep amongst critically ill patients. A range of strategies
need to be explored with a particular focus on those that
promote quality/depth and length of sleep both during and
after ICU. Research into drugs that that do not interfere with
patients’ quality and quantity of sleep and those that help
patients to sleep as naturally as possible could be helpful.
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