Written by Greg Arnold, DC, CSCS. Of the 40 patients in this study, those in a quiet environment who took melatonin had 33.9% more sleep and 50% less awakenings than the placebo group.
For extremely sick patients who are admitted to a hospital’s intensive care unit, “a major health concern” is sleep deprivation (1) due to frequent arousals and awakenings (2). This may result in “many adverse consequences” that include impaired immune function, delirium and severe declines in health (3).
Aside from the patient’s’ primary diseases and medication side effects, the noise and light in intensive care units create a very disturbing environment (4, 5) and is estimated to cause 30% of the arousals and awakenings in patients (6). Now a new study (7) suggests that melatonin supplementation may help offset the harms of the light and noise in an intensive care unit environment.
The study involved 40 healthy subjects (20 males, 20 females) aged 28 to 54. In the first part of the study, they were acclimated to the sleeping environments of the study by sleeping one night under a “quiet” night environment where noise levels were below 15 decibels and light levels below 5 lux. The next night, all subjects slept under a standard intensive care unit environment where noise levels of at least 47.3 decibels and 100 lux lighting intensities were maintained.
In the second part of the study, groups of 10 patients each were assigned to one of four groups for four nights:
- Control group: Normal intensive care unit environment
- Intensive care unit plus placebo
- Intensive care unit with patients using earplugs and eye masks
- Intensive care unit with patients taking 1 milligram of melatonin at 9 pm.
After four nights, the following results were observed:
| What was Measured | Standard ICU | Placebo | Ear plugs / Eye Mask | Melatonin | p value |
|---|---|---|---|---|---|
| Sleep latency (minutes) | 71.4 | 61.3 | 46.6 (24% less than placebo) | 33.7 (45.1% less than placebo) | 0.004 |
| REM (% total sleep) | 16 | 15 | 18.4 (22.6% greater than placebo) | 20.9 (33.9% greater than placebo) | 0.011 |
| # awakenings | 15.1 | 13 | 10.5 (19.3% less than placebo) | 6.5 (50% less than placebo) | 0.001 |
In addition, those in the melatonin group experienced significant improvements in both anxiety and sleep quality (8):
| What was Measured | Standard ICU | Placebo | Ear plugs / Eye Mask | Melatonin | p value |
|---|---|---|---|---|---|
| Anxiety | 46 | 45.2 | 33.5(25.9% less than placebo) | 23.8(47.4% less than placebo) | 0.001 |
| Sleep Quality | 6.1 | 4.3 | 3.4 (21% less than placebo) | 2.2 (48.9% less than placebo) | 0.001 |
For the researchers, “Our pilot study provides a reasonable basis for promoting the use of oral melatonin, and earplugs and eye masks for ICU patients” but admit that “compared to earplugs and eye masks, melatonin showed better performance in effectiveness and patient tolerability.”
Source: Huang, Hua-Wei, et al. “Effect of oral melatonin and wearing earplugs and eye masks on nocturnal sleep in healthy subjects in a simulated intensive care unit environment: which might be a more promising strategy for ICU sleep deprivation?.” Critical Care 19.1 (2015): 124.
© 2015 Huang et al.; licensee BioMed Central. Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0),
Click here to read the full text study.
Posted May 11, 2015.
Greg Arnold is a Chiropractic Physician practicing in Hauppauge, NY. You can contact Dr. Arnold directly by emailing him at PitchingDoc@msn.com or visiting his website at www.PitchingDoc.com.
References:
- Huang H, Jiang L, Shen L, Zhang G, Zhu B, Cheng J. Impact of oral melatonin on critically ill adult patients with ICU sleep deprivation: study protocol for a randomized controlled trial. Trials. 2014;15:327
- Elliott R, McKinley S, Cistulli P, Fien M. Characterisation of sleep in intensive care using 24-hour polysomnography: an observational study. Crit Care. 2013;17:R46
- Boyko Y, Ording H, Jennum P. Sleep disturbances in critically ill patients in ICU: how much do we know? Acta Anaesthesiol Scand. 2012;56:950–8
- Esquinas AM, Papadakos PJ, Schwartz AR. Sleep patterns during long-term mechanical ventilation in tracheostomized patients in the ICU: do they matter? Crit Care Med. 2014;42:e82–3
- Day A, Haj-Bakri S, Lubchansky S, Mehta S. Sleep, anxiety and fatigue in family members of patients admitted to the intensive care unit: a questionnaire study. Crit Care. 2013;17:R91
- Gabor JY, Cooper AB, Crombach SA, Lee B, Kadikar N, Bettger HE, et al. Contribution of the intensive care unit environment to sleep disruption in mechanically ventilated patients and healthy subjects. Am J Respir Crit Care Med. 2003;167:708–15.
- Huang HW. Effect of oral melatonin and wearing earplugs and eye masks on nocturnal sleep in healthy subjects in a simulated intensive care unit environment: which might be a more promising strategy for ICU sleep deprivation? Crit Care 2015 Dec;19(1):842. doi: 10.1186/s13054-015-0842-8. Epub 2015 Mar 19
- Richardson SJ. A comparison of tools for the assessment of sleep pattern disturbance in critically ill adults. Dimens Crit Care Nurs. 1997;16:226–39. Quiz 240–242.
