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Views And Reviews

The intensive care unit was so noisy I couldn’t sleep

BMJ 2016; 353 doi: (Published 18 April 2016) Cite this as: BMJ 2016;353:i2150
  1. Lisa Hinton,
  2. senior qualitative researcher,
  3. Health Experiences Research Group
  1. Nuffield Department of Primary Care Health Sciences, University of Oxford
  1. lisa.hinton{at}

Now researching the issue, Lisa Hinton experienced the pandemonium at first hand

Patients may imagine that intensive care units (ICUs), where lifesaving high tech care is delivered to very sick people, are as quiet as a chapel. But they’re not. The World Health Organization says that noise levels in the average ICU should be no higher than in a library, at 35 dB. In reality, ICUs are as loud as a main road or a busy restaurant: one UK study recorded noise peaks above 85 dB—equivalent to a road drill—as many as 16 times an hour in an ICU.1

Several years ago I spent many weeks in one of those ICU beds. I wasn’t your typical ICU patient, who tends to be older or to be admitted after a planned procedure or an accident. In my early 30s I developed pneumonia, then sepsis, and was critically ill for several weeks. Like many such patients, when I was woken up I didn’t understand where I was. A combination of severe illness, sedation, and a tracheostomy left me unable to talk or move. I felt completely trapped and vulnerable. The loud noises and activity around me were confusing and threatening.

Constant and unpredictable

I could hear chatter and activity from the staff, crashing bin lids, and disturbing noises from other patients. But the constant and unpredictable alarms were the worst. The beeping of life support systems communicates to staff that all is well or that something is wrong and needs their urgent attention. As a patient, you can’t distinguish between these. So, when the alarms went off, it was terrifying: it might have been me or my machine failing. As I could neither move nor call out, I feared that I’d die before anyone noticed. The machines run 24/7. The noise and consequent anxiety were constant.

At first, being awake after spending weeks “asleep” was good news—it meant that I was on the mend. But being awake soon became a nightmare. I couldn’t get back to sleep because my surroundings were too noisy and I was too scared. Sleeping pills, which I eventually managed to communicate that I needed, did no good. I knew that this elusive sleep was important for my recovery and getting home. Staring at the clock on the wall as it spun slowly through its 12 hour shifts was torturous. It wasn’t until I was discharged to the general ward that I got some decent sleep. This must have slowed my recovery, and it made my experience of an ICU all the more traumatic.

This is common. A recent quality improvement study led by colleagues at the University of Oxford and King’s College, London tackled the disruption caused by noise and light. This, in turn, drew on a secondary analysis of interviews with patients and carers about intensive care, many of whom talked about noise—particularly from equipment, other patients, and their visitors. The 24 hour activity and bustle in ICUs was often challenging for patients and caused distress.2 3 4

Disturbed sleep patterns

Many patients who are treated for more than a couple of days in an ICU have disturbed sleep patterns, hallucinations, and periods of delirium. These are due to environmental factors (loss of day and night, continuous background noise), as well as their acute illness and associated treatments.5 6 7 8 9 Patients who become confused stay longer in hospital and often have more health problems after they go home.10 So, tackling noise levels is a clinical and economic priority.

A decade on from my ICU experience, I’m collaborating with clinical and research colleagues at Oxford to reduce noise levels, to see how we can improve sleep and reduce confusion. If we can reduce noise levels in ICUs we could improve patients’ experiences and outcomes. Our mixed method study seeks to identify the common sources of noise and find ways to reduce them. Although we’re never likely to achieve the recommended WHO limits, there’s room for considerable improvement.11


  • doi: 10.1136/bmj.i1956
  • Competing interests: I have read and understood BMJ policy on declaration of interests and have no relevant interests to declare.

  • Provenance and peer review: Commissioned; not externally peer reviewed.


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