28 March 2023

The KHP Mind & Body Programme spoke to Katie Susser [pictured], Critical Care Recovery Nurse Lead at Guy’s and St Thomas’ NHS FT, and a Mind & Body Champion, about the importance of sleep for some of the most physically unwell patients across the partnership.

What do you think the biggest challenges to patient sleep in critical care?  

The biggest challenges are the nature of the setting and the acuity of the patients’ needs. Due to the nature of being critically ill, things don’t ‘stop’ at night-time and critical care units are 24-hour settings.

There is the need for constant monitoring and care delivery throughout the night, so for example a patient may need their blood taken in preparation for blood transfusions, a canula inserted, or there might be alarms sounding. Even something as straightforward as opening and closing the bins, which are in use constantly, disrupts patients’ sleep.

Each patient in critical care has a detailed schedule of activities that need to take place, and these include everything from monitoring, administration of drugs and antibiotics, changing the bedsheets or washing the patient. Sometimes, some of these things will be taken over by other needs or priorities, so a patient wash or bed change might not have taken place and you can easily find yourself needing to wash a patient at midnight.

Or the patient may be due IV antibiotics at 8am, but the doctor on shift is available to cannulate the patient at 2am. You then have to weigh up, do I get the doctor to cannulate the patient now, or do I let them sleep and push it back, unsure of when the doctor will next be available? 

You need to consider whether the decision you make will be best for the patient. I think we can all sometimes be more task focused than we think. It’s hard to be mindful of this when you’re feeling tired, anxious, stressed, or overworked. It is also quite challenging for staff receiving feedback from patients that say that they found their time in critical care very difficult, especially when you’ve been working so hard to keep them alive. 

What do staff in critical care do to support patient sleep?

There are things we do for patients all the time. For example, for patients who are being dialysed, we need to break open the boxes every two hours which is noisy, so we break open the bags at a different time to prevent disturbing patients in the middle of the night when they’re sleeping. It is important that we are mindful to speak to colleagues quietly, not talk over patients, and remember that they can hear us or might be asleep. We try reducing the noise and light during the night by using backlights against our computers or dimming the lights whenever possible.  

We also try to maintain and support the sleep-wake cycle by opening the blinds or windows on the ward during the day so that the patients are aware of when it is daytime. Not all our units have this, but in those that do, patients have said it’s been helpful. If we can, even turning the patient bed to face the window can make a significant difference. 

Other ways we try to support patient sleep is by providing ear plugs and eye masks, but also encouraging them to apply what works for them in their home life to their time in critical care. For some patients, they like to listen to readings of the Qur’an, or use music, relaxation, or book apps if they can and find it helpful. The Sleepio app is also a good recommendation. 

Why do you think sleep is so important for these patients?

I think it’s difficult to over emphasise how important sleep is for everything and everyone. For patients in critical care, good sleep helps them engage better with rehabilitation, reduce fatigue, increase their energy levels, and support their recovery.

To learn more about the KHP Mind & Body programme and how to become a Mind & Body Champion, visit their webpages here.