Ian 10 2026 ICU delirium sleep

Delirium

Sleep Cycles

  • N3 the most important. Memory consolidation

  • no deep sleep in ICU. People persistently stay in N1 and N2

Sleep and Delirium

  • poor sleep shows increased risk of delirium

Delirium Pharm Treatment

  • works, doesn’t work, no difference
  • Melatonin should be dosed 1.5 to 2 hours before desired sleep time

  • low dose can help with delirium resolution, fewer delirium active days

  • new drug, smoother sleep effect, less side effects
  • can work for insomnia
  • don’t continue Ambien/Lunesta inpatient => can increase delirium risks
  • needs to fail melatonin, trazodone, ambien before approval

  • increased mortality
  • maybe short term benefit
  • no longterm benefit
  • stop when leaving icu

Delirium Non-Pharm Treatment

  • change bed to face window
  • use weather channel

Devices

Case 1

  • check gas in 30 min - 1 hour after change

  • autopeep

  • higher cycle sensitivity = breath cut off sooner
  • e.g. 60% of peak flow is sooner than 20% of peak flow
  • Ti min: 0.6
  • Ti long: 1.5

  • higher trigger sensitivity: sometimes autopeep can trigger a breath => keep trigger in middle
  • COPD: shorten rise time can feel they can get the breath quicker

Case 2

  • more restrictive than obstructive compared to case 1
  • slower, bigger breaths => longer i time, decrease sensitivity

Solutions

  • Zilo Melts: zilo sorbitol. Slowly melts throughout night. Good for dry mouth

AVAPS

  • NMS: may be only take one big breath and then small breaths after that

Clinician working nightshift

  • have longer sleep the night before. Don’t try to stay up all night the night before.
  • flip back: sleep 3-4 hours after shift, stay awake rest of day