EARPLUGS: a simple way to improve our patients sleep hygiene.

A systematic review / meta-analysis published in Critical Care Medicine looked at the simple intervention of using ear plugs to both reduce the risks of delirium and sleep deprivation in the ICU setting.

Poor sleep hygiene leading to delirium is not only a misery for the patient but it is also associated with increased ICU length of stay, increased mortality and significant additional cost.

The study:

After an electronic search of the literature, 48 studies were examined of which 9 met eligibility criteria for the analysis. These included randomised controlled trials (n=6) and interventional studies (n=3) all of which were conducted in the ICU setting.

Some of studies also included a mix of other sleep hygiene strategies including eye masks, music therapy and stimulus reduction.


The use of earplugs in these ICU patients was associated with a significant reduction in risk of delirium.

Interestingly, there was found to be little difference in the reduction of delirium between the earplugs alone, and earplugs bundled with other sleep hygiene interventions.

Compliance with earplug use was high and no safety issues were reported.

The authors concluded:

Placement of earplugs in patients admitted to the ICU, either in isolation or as part of a bundle of sleep hygiene improvement, is associated with a significant reduction in risk of delirium. The potential effect of cointerventions and the optimal strategy for improving sleep hygiene and associated effect on patient-centered outcomes remains uncertain.

So this is a simple, low risk,  intervention that may have a significant improvement in the quality of care delivered to ICU patients.

Not just for ICU:

These benefits of using earplugs to reduce delirium (and I imagine improve overall sleep quality) can easily be transposed to other clinical areas such as the emergency department, CCU and ward areas. And not just during the night time. Patients could be offered earplugs during the day as well to help them get some extra rest.

Although more studies are needed to develop an optimal strategy for using earplugs +/- other interventions, disposable earplugs are cheap, safe and offer a potential large reduction in cost due to adverse clinical outcomes.

Something many units should consider incorporating into their unit practices.



Litton, Edward, Vanessa Carnegie, Rosalind Elliott, and Steve A. R. Webb. “The Efficacy of Earplugs as a Sleep Hygiene Strategy for Reducing Delirium in the ICU.” Critical Care Medicine 44, no. 5 (2016): 992-99. doi:10.1097/ccm.0000000000001557.

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