Mechanical Ventilation and Sleep

Critically ill patients supported by invasive or non-invasive mechanical ventilation sleep poorly. Beyond the usual challenges posed by the ICU environment and medical illness itself, the application and management strategy applied to mechanical ventilation (which includes variables such as sedation, analgesia, and mobilization among others) can also have an impact on sleep quality. There are few high quality studies evaluating the effects of mechanical ventilation itself on sleep and even fewer that consider the potential effects of sleep disturbances on aspects of mechanical ventilation but the relationship is likely bidirectional. In this chapter we highlight intervention studies over observational ones, review studies comparing the effects of specific modes of ventilation on sleep and the difference between spontaneous and timed modes, and review physiology pertinent to the potential effects of sleep disturbance on mechanical ventilation and monitoring.