leep is an essential component of health and is related to physical and psychologi- cal well-being.Inadequate quality and quantity of sleep in hospitalized patients are common problems,particularly in intensive care or intermediate care units (IMCUs)and can have serious detrimental effects on health and recovery from ill- ness.The association between the severity of illness and sleep disturbance in patients in the intensive care unit has been evaluated.?Sleep disruption was greater in patients who died and in patients who had a higher disease severity score than in patients who survived and had lower scores.In addition,sleep deprivation has a adverse effect on the immune sys- tem and is associated with increased morbidity in critically ill patients.Among patients who received an influenza vaccine,patients who were sleep deprived produced less than half the level of antibodies produced by patients who had normal sleep times.3 Also,sleep deprivation is one of the most frequent complaints of patients after hospital stays.? A systematic review of nursing interventions done to establish effects of lavender aromatherapy indicated that little research is available on use of on sleep in an acute care hospital setting. aromatherapy to improve sleep in the hospital. Investigating ways to promote and provide a Aromatherapy is the use of pure essential oils from restful night of sleep for hospitalized patients is fragrant plants to help relieve health problems and important.Vital signs can be a measure of the body's improve quality of life in general.s Aromatherapy response to stress,illness,and relaxation.A decrease has been used in a variety of settings to assist in in blood pressure,heart rate,and relaxation and aid in sleep.In a study of 122 patients respiratory rate correlates with a Patients who die in an intensive care unit by Dunn et al,patients greater relaxation state."Our aim exposed to aromatherapy had significantly greater was to evaluate the effectiveness of and those with improvements in mood and perceived levels of inhalation of 100%lavender oil on higher disease anxiety than did patients not exposed.In a random- the vital signs and perceived quality ized controlled study'in a hospice,the use of laven- of sleep of IMCU patients.We severity scores der and massage resulted in improved sleep scores, hypothesized that patients who have greater but the results were not significant because of the received the aromatherapy would small number of patients in the sample.Several experience a decrease in blood pres- sleep disruption. studies have indicated that lavender aromatherapy sure,heart rate,and respiratory rate affects the autonomic nervous system,reducing anx- during the night and would report higher quality of iety in patients in different settings,such as inpa- sleep than would patients who did not receive the tients and outpatients.Sleep deprivation leads to aromatherapy markedly impaired glucose tolerance and reduc- tions in acute insulin responses to glucose.Glucose Methods control is an important marker in healing for criti- Study Design and Sample cally ill patients.'Lavender aromatherapy can also This randomized controlled pilot study was reduce mild insomnia in patients in their home set- conducted in the IMCU of a large academic teach- ting.1 We chose lavender rather than another ing hospital between August 2,2011,and Decem- essential oil because of the studies that support ber 2,2011.Patients were eligible if they were older using lavender to promote rest and relaxation in than 21 years and admitted to the IMCU for at least different settings.Little scientific research has been 2 nights.Patients were excluded if they could not speak English,were confused,had respiratory prob- lems requiring mechanical ventilation or continu- About the Authors ous positive airway pressure,were receiving oxygen Jamie Lytle and Catherine Mwatha are nurse clinicians via mask,had an allergy or sensitivity to oils or fra- and Karen K.Davis is director of nursing,Department of Medicine,Johns Hopkins Hospital,Baltimore,Maryland. grances,or had received a new blood pressure med- Corresponding author:Karen K.Davis,RN,PhD,Johns ication or a sleeping pill on the night of the study. Hopkins Hospital,1830 E Monument St,9th Floor,Room Potential patients were referred to the study team 9061,Baltimore,MD 21287 (e-mail:Kdavis4@jhmi.edu). by the nursing staff.Any time after the first night in www.ajcconline.org AJCC AMERICAN JOURNAL OF CRITICAL CARE,January 2014,Volume 23,No.1 25 Downloaded from ajcc.aacnjournals.org by guest on April 27,2015A systematic review4 of nursing interventions indicated that little research is available on use of aromatherapy to improve sleep in the hospital. Aromatherapy is the use of pure essential oils from fragrant plants to help relieve health problems and improve quality of life in general.5 Aromatherapy has been used in a variety of settings to assist in relaxation and aid in sleep. In a study of 122 patients in an intensive care unit by Dunn et al,6 patients exposed to aromatherapy had significantly greater improvements in mood and perceived levels of anxiety than did patients not exposed. In a random￾ized controlled study7 in a hospice, the use of laven￾der and massage resulted in improved sleep scores, but the results were not significant because of the small number of patients in the sample. Several studies have indicated that lavender aromatherapy affects the autonomic nervous system, reducing anx￾iety in patients in different settings, such as inpa￾tients and outpatients.8 Sleep deprivation leads to markedly impaired glucose tolerance and reduc￾tions in acute insulin responses to glucose. Glucose control is an important marker in healing for criti￾cally ill patients.9 Lavender aromatherapy can also reduce mild insomnia in patients in their home set￾ting.10 We chose lavender rather than another essential oil because of the studies that support using lavender to promote rest and relaxation in different settings. Little scientific research has been done to establish effects of lavender aromatherapy on sleep in an acute care hospital setting. Investigating ways to promote and provide a restful night of sleep for hospitalized patients is important. Vital signs can be a measure of the body’s response to stress, illness, and relaxation. A decrease in blood pressure, heart rate, and respiratory rate correlates with a greater relaxation state.11 Our aim was to evaluate the effectiveness of inhalation of 100% lavender oil on the vital signs and perceived quality of sleep of IMCU patients. We hypothesized that patients who received the aromatherapy would experience a decrease in blood pres￾sure, heart rate, and respiratory rate during the night and would report higher quality of sleep than would patients who did not receive the aromatherapy. Methods Study Design and Sample This randomized controlled pilot study was conducted in the IMCU of a large academic teach￾ing hospital between August 2, 2011, and Decem￾ber 2, 2011. Patients were eligible if they were older than 21 years and admitted to the IMCU for at least 2 nights. Patients were excluded if they could not speak English, were confused, had respiratory prob￾lems requiring mechanical ventilation or continu￾ous positive airway pressure, were receiving oxygen via mask, had an allergy or sensitivity to oils or fra￾grances, or had received a new blood pressure med￾ication or a sleeping pill on the night of the study. Potential patients were referred to the study team by the nursing staff. Any time after the first night in S leep is an essential component of health and is related to physical and psychologi￾cal well-being. Inadequate quality and quantity of sleep in hospitalized patients are common problems, particularly in intensive care or intermediate care units (IMCUs) and can have serious detrimental effects on health and recovery from ill￾ness.1 The association between the severity of illness and sleep disturbance in patients in the intensive care unit has been evaluated.2 Sleep disruption was greater in patients who died and in patients who had a higher disease severity score than in patients who survived and had lower scores. In addition, sleep deprivation has a adverse effect on the immune sys￾tem and is associated with increased morbidity in critically ill patients. Among patients who received an influenza vaccine, patients who were sleep deprived produced less than half the level of antibodies produced by patients who had normal sleep times.3 Also, sleep deprivation is one of the most frequent complaints of patients after hospital stays.2 About the Authors Jamie Lytle and Catherine Mwatha are nurse clinicians and Karen K. Davis is director of nursing, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland. Corresponding author: Karen K. Davis, RN, PhD, Johns Hopkins Hospital, 1830 E Monument St, 9th Floor, Room 9061, Baltimore, MD 21287 (e-mail: Kdavis4@jhmi.edu). www.ajcconline.org AJCC AMERICAN JOURNAL OF CRITICAL CARE, January 2014, Volume 23, No. 1 25 Patients who die and those with higher disease severity scores have greater sleep disruption. Downloaded from ajcc.aacnjournals.org by guest on April 27, 2015