How to get a good night's sleep: Earplugs in the intensive care unit ward off confusion

Patients in an intensive care unit (ICU) often become confused or delirious soon after, or within a few days of, admittance to the ICU. New research published in BioMed Central's open access journal Critical Care shows that use of earplugs can result in better sleep (as reported by the patients), lower the incidence of confusion, and delay the onset of cognitive disturbances.

Patients in the ICU are thought to suffer confusion and delirium due to sensory overload. Part of this is due to the physical injuries and sensations of the patients and part due to their environment.

Sound in the ICU has been a subject of research for several years. There is contestant noise due to equipment and people coming and going. However, patients complain that it's not so much the level of noise but the interruptions due to phones ringing and people talking which is the most disturbing. Not surprisingly studies have shown that the sleep of patients in ICU is severely fragmented with a corresponding lack of slow wave and REM sleep.

While it is not practicable to have silent equipment (and patients need checking at regular intervals), researchers from the University of Antwerp and Antwerp University Hospital investigated the use of earplugs to reduce the amount of noise experienced by the patients as they slept.

As a result of this simple solution the researchers found that starting to use earplugs within the first 24 hours of entering ICU decreased the patient's risk for delirium or confusion by over 50%. They also noticed that patients sleeping with earplugs developed confusion and delirium later than patients without. After the first night more of the patients with earplugs reported a better night's sleep.

Prof Bart van Rompaey, who led this study, explained, "The greatest improvement was observed in the risk of confusion, and seems to be strongest within the first 48 hours of admittance to the ICU. Delirium is a multifactorial process and, in our study, was also influenced by age, smoking, and severity of disease. Nevertheless the beneficial effect of earplugs in the ICU, especially in the first few days, clearly demonstrates the advantage of using them. Earplugs are a cheap and easy to use means of improving a patients sleep and preventing confusion."

1. The effect of earplugs during the night on the onset of delirium and sleep perception: a randomized controlled trial in intensive care patients
Bart Van Rompaey, Monique M Elseviers, Wim Van Drom, Veronique Fromont and Philippe G Jorens
Critical Care (in press)

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2. Critical Care is a high quality, peer-reviewed, international clinical medical journal. Critical Care aims to improve the care of critically ill patients by acquiring, discussing, distributing, and promoting evidence-based information relevant to intensivists..

3. BioMed Central (http://www.biomedcentral.com/) is an STM (Science, Technology and Medicine) publisher which has pioneered the open access publishing model. All peer-reviewed research articles published by BioMed Central are made immediately and freely accessible online, and are licensed to allow redistribution and reuse. BioMed Central is part of Springer Science+Business Media, a leading global publisher in the STM sector.