Exogenous Melatonin to Improve Sleep in Critically Ill Patients

Melatonin is a hormone produced naturally in the pineal gland at the base of the brain. It is important in regulating sleep. Usually melatonin levels in the body are high overnight and drop during the day to maintain the sleep-wake cycle. However, in critically ill patients there is evidence to suggest the normal secretion of melatonin is lost or diminished. This may contribute to sleep disruption in critically ill patients. This study will be conducted as a randomised double blind placebo controlled trial. Sixty patients with a tracheostomy in the intensive care unit (ICU) with poor sleep will be recruited. Participants will receive temazepam, a sleep medication, plus either placebo or melatonin at night for 7 nights. Hours of sleep during the day and the night will be documented through nursing observation and actigraphy (a wrist-watch which records wrist movements and translates it into sleep periods). Quality of sleep will be assessed with the use of the Richards Campbell Sleep Questionnaire. The study will help determine if there is a role for the addition of melatonin to usual sedative-hypnotic medication for the management of sleep disruption in ICU patients.