Sleep disruption in critically ill patients--pharmacological considerations.
Sleep disturbances are common in critically ill patients and contribute to morbidity. Environmental factors, patient care activities and acute illness are all potential causes of disrupted sleep. Additionally, it is important to consider drug therapy as a contributing factor to this adverse experience, which patients perceive as particularly stressful. Sedative and analgesic combinations used to facilitate mechanical ventilation are among the most sleep disruptive drugs. Cardiovascular, gastric protection, anti-asthma, anti-infective, antidepressant and anticonvulsant drugs have also been reported to cause a variety of sleep disorders. Withdrawal reactions to prescribed and occasionally recreational drugs should also be considered as possible triggers for sleep disruption. Tricyclic antidepressants and benzodiazepines are commonly prescribed in the treatment of sleep disorders, but have problems with decreasing slow wave and rapid eye movement sleep phases. Newer non-benzodiazepine hypnotics offer little practical advantage. Melatonin and atypical antipsychotics require further investigation before their routine use can be recommended.
Bourne
R S
RS
Intensive Care Unit, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK. richard.bourne@sth.nhs.uk
Mills
G H
GH
D003422:Critical Care / Q000523:psychology*; D016638:Critical Illness / Q000523:psychology* / Q000628:therapy; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects; D012893:Sleep Wake Disorders / Q000188:drug therapy* / Q000209:etiology; D013375:Substance Withdrawal Syndrome
D006993:Hypnotics and Sedatives