Enf.ª Isabel Pires

Specialist in Medical-Surgical Nursing
Master's in Nursing Responsible Nurse

Enf.ª Cláudia Ribeiro

Intensive Care Unit

 

Sleep promotion in the Intensive Care Unit

HPA Magazine 23 // 2025

Promoting sleep in intensive care units (ICU) is a challenge that requires increased attention from healthcare teams. Hospitalized patients are constantly subjected to stimuli, such as noise, intense light, and frequent interruptions, which make rest difficult and can delay their recovery 1,2. In this context, the implementation of simple, non-pharmacological strategies has shown effective results in improving the quality of sleep and the general well-being of patients

Sleep plays an essential role in physical and emotional recovery. However, ICU conditions, such as constant alarms, the noise of medical equipment, and nighttime interventions, can lead to sleep deprivation, increasing the risk of complications such as delirium, cardiovascular changes, and emotional imbalances 3,4. Therefore, it is essential to adopt measures that minimize this impact and allow the patient to rest adequately 1,3.
One of the most effective approaches is reducing noise, adjusting alarms to less disturbing levels, avoiding unnecessary conversations in the vicinity of patients, and using devices such as earplugs or white noise. These simple steps can make a big difference 5. Lighting should also be adjusted to respect the circadian rhythm: decreasing light intensity at night and allowing natural light to enter during the day helps regulate the sleep and wake cycle 5,6.
Another important aspect is to carry out rigorous planning of the care to be provided to the patient. Whenever possible, procedures should be grouped and carried out during the day, avoiding unnecessary interruptions at night, which contributes to improving sleep quality 6.
Patients in critical situations often experience feelings of anxiety, anguish, and fear, which can make it difficult to relax.
To promote greater relaxation, techniques such as massage, relaxation, and music therapy can be used, as these are strategies that help reduce stress and facilitate effective rest for patients 3,5. Furthermore, emotional support is crucial. The nurse, due to their proximity and direct contact with the patient, plays a fundamental role through communication and the relationship of trust they establish with the patient, helping the patient feel safer 3,5,7,8.
The success of these measures depends, however, on teamwork.
Raising awareness among all ICU professionals about the importance of sleep and the strategies that promote it is essential 1. It is up to nursing professionals, as they are closer to patients, to lead this effort, educating their peers and ensuring that the practices adopted respect the needs of each patient 3,5,7.
Promoting sleep in the ICU is more than a matter of comfort; it is a fundamental component of the recovery process. With simple adjustments to the environment, organization of care, and emotional support, it is possible to create conditions that promote restful sleep, improving not only physical health but also the quality of life of patients. The role of the nurse, in this context, is essential, ensuring that each intervention aims at the well-being and full recovery of those under their care 3,5,7-9.

Referências/References
1. Locihová, H., Axmann, K., & Žiaková, K. (2021). Sleep-disrupting effects of nocturnal nursing interventions in intensive care unit patients: A systematic review. Journal of Sleep Research, 30(4). https://doi.org/10.1111/jsr.13223
2. Ong, K. K., Khoo, L. M., Zhou, Y., & Toh, P. C. (2022). Improving critical care patients’ sleep quality in a surgical high-dependency unit: An evidence-based practice project. Worldviews on Evidence-Based Nursing, 19(2), 166–168. https://doi.org/10.1111/wvn.12558 
3. Beck Edvardsen, J., & Hetmann, F. (2020). Promoting Sleep in the Intensive Care Unit. SAGE Open Nursing, 6. https://doi.org/10.1177/2377960820930209 
4. Peršolja, M., & Rožnik, A. (2024). Strategies to Improve Sleep Quality in Intensive Care Unit Patients. Critical Care Nurse, 44(4), 47–56. https://doi.org/10.4037/ccn2024368 
5. Sá, F., Miranda, F., Morais, I., Almeida, M., & Afonso, M. (2021). Comprometimento e promoção do sono em unidades de terapia intensiva: revisão integrativa.
https://doi.org/http://dx.doi.org/10.37689/acta-ape/2021AR0002
6. Beltrami, F. G., John, Â. B., De Macedo, B. R., Corrêa Júnior, V., Nguyen, X. L., Pichereau, C., Maury, E., Fleury, B., Gus, M., & Fagondes, S. C. (2022). A multi-intervention protocol to improve sleep quality in a coronary care unit. European Journal of Cardiovascular Nursing, 21(5), 464–472. https://doi.org/10.1093/eurjcn/zvab099 
7. Gonçalves, M., Mão De Ferro, M., & Veludo, F. (2023). Eficácia das intervenções não farmacológicas promotoras do sono na pessoa em situação crítica: uma revisão sistemática. Cadernos de Saúde , 15, 4–14. https://doi.org/10.34632/cadernosdesaude.2023
8. Habibi Nezhad, M., Sadeghi, N. K., & Yaghoubinia, F. (2024). Comparison of the Effect of Swedish Massage and Earplugs/Eye Masks on Sleep Quality of Patients Admitted to ICUs. Medical-Surgical Nursing Journal, 12(2). https://doi.org/10.5812/msnj-144370 
9. Fang, C. S., Wang, H. H., Wang, R. H., Chou, F. H., Chang, S. L., & Fang, C. J. (2021). Effect of earplugs and eye masks on the sleep quality of intensive care unit patients: A systematic review and meta-analysis. In Journal of Advanced Nursing (Vol. 77, Issue 11, pp. 4321–4331). John Wiley and Sons Inc. https://doi.org/10.1111/jan.14914