most physicians , if not all , readily support the notion that achieving an adequate amount of quality sleep is essential for speedy recovery from acute illness , and promptly send their patients home with a prescription for adequate rest .
however , when these acute illnesses require hospital admission , the importance of attaining adequate rest takes a back seat secondary to the necessities of running a hospital ward .
the practice of active sleep disruption is no more apparent than in the intensive care unit ( icu ) setting , where lighting , noise , and frequent nocturnal assessments / treatments prevent acutely ill patients from attaining sleep of adequate quality .
the time has come for critical care providers to give credence to the significance of ' prescribing ' sleep in the inpatient setting , just as we prescribe antibiotics , nutrition support , deep venous ulcer prophylaxis , mechanical ventilation , gastric ulcer prophylaxis , and physical therapy . in a previous issue of critical care ,
bourne and coworkers   reported the results of a small randomized clinical trail in which they investigated the use of melatonin as a means to promote sleep in the critical care environment .
although the demonstrated effect of melatonin on sleep efficiency ( as measured by bispectral index ) was small , the study is extremely important .
most literature on sleep and recovery from illness provides either a description of the abnormal sleep patterns that occur in the icu setting [ 2 - 4 ] or a review of the deleterious effects of sleep deprivation , with suggestions on ways to improve sleep in icu patients [ 5 - 7 ] .
few authors have scientifically evaluated a potential way to promote sleep , as have bourne and colleagues .
research into the effects of active sleep promotion in the icu is lacking . as we continue to improve the quality of critical care interventions
, we must not overlook the importance of supporting the body 's basic needs , namely nutrients , exercise , and sleep .
. therefore , research into sleep promotion should utilize a tool that is multifaceted , addressing sleep promotion at several different levels simultaneously .
this tool must address noise and lighting issues , minimize nocturnal assessments and treatments , utilize pharmacologic interventions to enhance time in restorative sleep stages , and consider behavioral interventions that enhance sleep quality ( for instance , relaxation techniques , massage , biofeedback , and music therapy ) . finally ,
if sleep promotion is to be effective in the icu setting , then a paradigm shift must occur at all levels of the health care team .
when we fully recognize the importance of good quality sleep during recovery from acute illness and begin actively to promote sleep in the icu setting , i believe that outcomes - including infection rates , icu and hospital lengths of stay , overall complication rates , and ( most importantly ) mortality rates  will improve .
 the role of sleep during recovery from acute illness has been overlooked for decades . 
 advances in the support of critically ill patients have been made in mechanical ventilation , specialized nutrition support , highly specific antibiotic therapy , and early rehabilitation . 
 however , the promotion of sleep  a basic tenet for survival  has been actively ignored by critical care providers . bourne and coworkers recently conducted a small clinical trial that describes improved sleep efficiency with oral melatonin use in critically ill patients . 
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