Sleep is defined as a periodic, temporary unconscious state of cognitive, and sensory disconnection from the external stimuli. Sleep peririod has its unique behavioral, electroencephalography, and physiological properties that it consists of four to six 90 to 100 minutes period which is alternative fashion cyclic during NREM and REM sleep periods which is taken 7 to 8 total sleep hours(1). Human being existence is impossible without sleep at all the life. Maslow defined the sleep state in his Hierarchy model as basic need sleep is a natural rest of the physiological activity to reserve the energy. In this sense sleep is an essential parts of the 24 hours cycle to restore the normal sleep state(2).
Intensive care units (ICU) are a highly complex area where critically ill patients are managed by Intensive care monitors and invasive devices(3). Difficult sleep is a subjective complaint of dissatisfaction with the quantity, timing of sleep that sleep discomfort is estimated to occur in approximately one-tenth of the general population(4). Delirium is acommon acute confusional state that is familiar for critically ill patients, affecting up to 80% of patients with intensive care unit patients especially on mechanical ventilation(5).
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A commonly complication of ICU patients are not having adequate profound sleep. In critical ill-patients the happening of sleep deficit has been shown to be more than 50 % (6). Sleep in the intensive care unit (ICU) is characterized by repeated wakefulness and lack of the restorative sleep stages that are needed for the healing process(7). Sleep disruption during intensive care unit admission is frequent. It has been practiced in critical illness patients even after transfer out of the ICU. Sleep disturbances can widely influence patients’ recovery from critical illness(8,9). The sleep disturbance affect the body function that is essential for recovery from the illness that is respiratory systems effect muscle weakness, immunological effects reduce defense against infection, cardiovascular effects that result hypertension, heart failure and stroke, hormonal alteration that results insulin resistance diabetics. Generally sleep disorder potentially cause long-term consciences hypertension, diabetics mellitus, stroke and cardiovascular disease(10) Several factors are accountable for sleep disturbances n ICU.
A general approach to the patients regarding their night rest is a necessary(11). Factors are mentioned as the main cause of sleep disorder in the intensive care unit admitted patients sleep. From Environmental factors are take the main role of the sleep disturbing(12). Study revealed that are another medical activity and none environmental were mentioned as causes of the sleep disturbance in the ICU(13).
Numerous factors are contributed to sleep disturbance in ICU in different medical services. Environments together with none environments determined procedures employed in ICU make it not easy to recognize the causes of sleep deprivation. Evidence suggested that sleep disruption is mainly due to a combination of internal and external factors. Individual patient sickness and prior experiences, together with variable severity of illness impact on the potential to achieve effective sleep. Particular causes included discomfort, procedures, mechanical ventilation, medication administration and severity of underlying disease are contributed to sleep deprivation.(14–17) As the great nurse Florence Nightingale herself once said that “never to allow patient awake from sleep intentionally or accidentally”(18).
The importance of sleep for patient healing can be deprioritized in ICU due to the need to meet progressively more complex care needed. Sleep interruption has emerged as an indicator of adverse medical outcomes(19). Disrupted sleep is related with impairment of immune system, impaired resistance to infection, therefore, impaired wound healing, and cardio-respiratory consequences(20).
Measurements tool to assess level of sleep quality and related factors of intensive care unit patients are classified into objective and subjective assessment instruments which are Polysomnography is the golden standards that able to identify the stage of the sleep by recording electromyogram and electro-oculogram that are reliable recording sleep stages. Another objective method helping to assess sleep status of the patient is actinography which is worn at wrist and ankle by recording the movements of the body. The subjective measurements are self reporting questionnaire, Richards Campbell Sleep Questionnaire, Pittsburgh Sleep Quality Index and Modified Freedman sleep quality questionnaire(21). This study aims to identify the factors affecting sleep under the freedman sleep questionnaire which is answering the question of what are the factors disturbing sleep of the ICU patients the study area. The finding of this study will enable to minimize the factors by recommending stakeholders the possible resolution strategies.
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