What Happens to Patients When the Lights Go Out
August 22, 2014
I found the term “nocturnal rumination” in a recent study on insomnia in palliative care patients in the ICU. Basically, it’s obsessive thinking when the lights go out.
The study noted that many factors have been studied about ICU patients. However, insomnia has not been suspected or diagnosed.
Environmental Factors Are Major Cause
Nonetheless, the fact that patients struggle with sleep deprivation is well known. What happens to patients whose cognition is sufficient to know their own diagnosis, know their own prognosis, and dream up what dying will be like?
The study points to environmental disturbances that led to interrupted sleep. Environmental factors were primary for 76% of the participants.
And, we know that noise is at the top of causes of sleep deprivation. However, the one that got my attention was nocturnal rumination — thinking, contemplating one’s situation when the lights go out and no one else is around to interrupt disturbing thoughts.
By far, this is the real suffering of patients.
Nocturnal Ruminations Prevent Restful Sleep
Many of us suffer from nighttime loneliness and chatter. And, our lives are probably not in as much turmoil as our thinking. The terrifying thoughts — these nocturnal ruminations — are like reruns of fear that plague us emotionally and keep us from a restful sleep.
Perhaps this is at the core of what is being asked in the sole question about noise on the HCHAPS survey addressing “quiet at night.” Neuroscience has long shown that thought is auditory — that the volume of our internal screams can be intolerable to us but quiet to everyone else.
When I was in the hospital last year, well enough to think, nights were the most dreaded part of each 24-hour day. They were long, lonely, and scary. Memorable for all the wrong reasons.
Antidote to Silence
The C.A.R.E. Channel, from its inception, was designed to offer an environmental antidote to the silence that feeds patients’ internal chaos over the 24-hour cycle. The kind of silence that leaves patients with nothing to do but think because they have nothing else to focus on but the dark and unknown.
With a midnight starfield that is engaging to the eye and music to calm the mind and attract the ear, The C.A.R.E. Channel can help ease nocturnal rumination. It can also help improve HCHAPS scores, as reported in this case study from Tuality Health.
Other ways to ease suffering in the nighttime hours are human in nature. Nurses and others who do nighttime rounds need to pay attention to the patients who are clearly in a state of unrest. Speak to them, cut through the isolation — and offer them the security of knowing that they are not alone.
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