Catching Z’s in Intensive Care
Who would be more in need of a good night’s sleep than someone in the coronary ICU (Intensive Care Unit)? Coronary ICU patients may have recently survived heart attacks and probable open-heart surgeries. We can imagine how stressed they must feel, especially if they are not sleeping well.
Can’t you just hear the anxiety-filled and sleep-deprived patients begging for a little help? “I need to sleep! And while you’re at it, Doc, could you help calm me down from the stress and worries of my condition?”
We had to chuckle at the statement made in a July 2015 study from two universities in Gaziantep and Izmir, Turkey. “In intensive care units (ICUs), patients cannot sleep well.”1 (Does anyone sleep well in a hospital?)
We have to hand it to this group of researchers for turning away from the easy use of a prescription pad. Instead, they summoned Mother Nature. “This study aimed to investigate the effect of lavender essential oil on the sleep quality and anxiety level of patients in coronary ICU.”2
Sixty coronary ICU patients from a province in southeast Turkey participated in the study. After dividing the patients into intervention and control groups, patients in both groups were administered a questionnaire, the Pittsburgh Sleep Quality Index (PSQI) and the Beck Anxiety Inventory (IAI) scale.
“The patients in the intervention group were given 2 percent lavender essential oil via inhalation for 15 days after which they were administered the same scales again to evaluate the sleep quality and anxiety. As the for the control group, they were administered the same scales again after 15 days without the inhalation of lavender essential oil.”2
Before we spill the beans on the results of this 15-day test of lavender’s sleep-enhancing and anxiety-relieving benefits, we have to tell you about our own small research project. We headed over to PubMed (the website of the U.S. National Library of Medicine www.pubmed.gov) to do a search for “lavender” and “sleep.” We quickly found 24 studies.
We will review five of these lavender/sleep studies starting with an Israeli study from 2010. This was conducted at the Department of Neurobiology, The Weizmann Institute of Science in Rehovot, Israel. In this case, the researchers were looking at odors as a potential mechanism for treating sleep apnea. Their hypothesis was that odorants delivered during sleep would modify respiratory patterns but not cause arousal (starting to wake up) or waking in healthy sleepers.
The researchers used two mildly trigeminal odorants, the pleasant lavender and unpleasant vetiver oil. The trigeminal nerve has three branches the ophthalmic (V1, sensory), maxillary (V2, sensory) and mandibular (V3, motor and sensory), so these odorants could stimulate physical responses. Two pure olfactory odorants were also used, the pleasant vanillin and unpleasant ammonium sulfide. An olfactometer delivered up to 37 odorant presentations a night for the 36 subjects who were tested for one night with one of the four different odorants. The odorants did not waken the subjects but did influence rates of respiration. The study concluded that “These results suggest that the olfactory system may provide a path to manipulate respiration in sleep.”3 Other studies would build on this research.
A 2013 Norwegian study tested aromatherapy in nursing homes for any benefit for patients suffering from dementia, anxiety, and disturbed sleep patterns. Lavandula angustifolia was diffused nightly for 24 patients in four nursing homes. The lavender was “perceived as an effective care modality reducing insomnia and anxiety in this patient cohort.”4 The very sad part of this study is that “Nurses experienced some negative attitudes among colleagues because they considered aromatherapy as not evidenced based. Nurses required greater access to evidence based use of Aromatherapy.”5 We refer those naysayers to PubMed!
German researchers looked at using a commercial lavender oil capsule (Lasea®) for major depression and insomnia. The 2014 study stated that “Symptoms of agitation, anxiety and insomnia are frequent among patients with major depressive disorder (MDD) during the first weeks of psychiatric care. But a substantial number of patients decline taking pharmaceutical medication to avoid side effects. Therefore, an alternative herbal medication is needed.”6 The conclusion is “The results demonstrate that Lasea and an additional antidepressant resulted in a reduction of MDD. Lasea also reduced agitation in 6 cases.”7
Minneapolis researchers from the School of Nursing, University of Minneapolis, turned to lavender in two studies published in 2014 and 2015. The earlier review study states, “Inhalation of essential oils may be a safe alternative to pharmaceutical interventions for mild to moderate sleep disturbances.”8 After reviewing 15 qualitative human sleep studies (11 of which were randomized), the Minnesota study reports, “A majority of the study findings suggested a positive effect of essential oils on sleep. Lavender was the most frequently studied essential oil. No adverse effects were reported.”9 The conclusion is that “Inhalation of essential oils may be considered for people with mild sleep disturbances.”10
The Minnesota University researchers’ 2015 study was randomized, controlled, with investigator blinding, and steps taken to blind the participants! You can see the care taken, so that this study should not be dismissed by the naysayers desperate to promote pharmaceutical solutions.
As a result of their prior study, the researchers chose lavender (Lavandula angustifolia) as the essential oil to test. The control and intervention groups of 79 college students with self-reported sleep issues were taught “sleep hygiene.” The abstract does not discuss what constitutes sleep hygiene, but we can imagine that keeping the bedroom for sleeping (not for TV watching or perusing the Internet), blocking light and noise sources, etc., might be part of the protocol.
Both study groups practiced good sleep hygiene and wore an inhalation patch. “One group wore a patch with 55 μl of lavender essential oil and the other group wore a blank patch. Sleep quantity was measured using a Fitbit® tracker and a sleep diary, and sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI) and the NIH Patient-Reported Outcomes Measurement Information System (PROMIS) sleep disturbance short form.”11
The conclusion: “Lavender and sleep hygiene together, and sleep hygiene alone to a lesser degree, improved sleep quality for college students with self-reported sleep issues, with an effect remaining at follow-up.”12 Were you surprised? Of course not! Lavender rules!
So you have already guessed the outcome of our original Turkish University study. We could not sum up our feelings about lavender essential oil any better than the researchers from Turkey. “As a non-invasive, cheap, easily applicable, cost-effective, independent nursing intervention and appropriate for cardiac patients, lavender essential oil could be applied in ICUs.”13
- Karadag E, et al. Effects of aromatherapy on sleep quality and anxiety of patients. Nurs Crit Care. 2015 Jul 27. [Epub ahead of print]
- Arzi A, et al. The influence of odorants on respiratory patterns in sleep. Chem Senses. 2010 Jan;35(1):31-40.
- Johannesen B. Nurses experience of aromatherapy use with dementia patients experiencing disturbed sleep patterns. An action research project. Complement Ther Clin Pract. 2013 Nov;19(4):209-13.
- Fißler M, Quante A. A case series on the use of Lavandula oil capsules in patients suffering from major depressive disorder and symptoms of psychomotor agitation, insomnia and anxiety. Complement Ther Med. 2014 Feb;22(1):63-9.
- Lillehei AS, Halcon LL. A systematic review of the effect of inhaled essential oils on sleep. J Altern Complement Med. 2014 Jun;20(6):4451-51.
- Lellehei AS, Halcon LL. Effect of Inhaled Lavender and Sleep Hygiene on Self-Reported Sleep Issues: A Randomized Controlled Trial. J Altern Complement Med. 2015 Jul;21(7):430-8.
- Karadag, op cit.