Intensive care: Patients' experiences

Sleep, dreams and hallucinations in ICU

People in intensive care are given many separate medicines, including sedatives and painkillers, and all of these can affect them in different ways. Policies instructing doctors on how much sedative to give a patient vary greatly - some units keep people in as light a sleep as possible, other units keep people much deeper. Here men and women talk about their experiences of sleep, dreams and hallucinations while they were in the intensive care unit.

While some people said they 'drifted on and off', many others found it difficult to sleep well in intensive care. Being attached to lots of equipment and being unable to move often caused discomfort. The ICU environment itself - the lighting, frequent medical interventions, visitors and noise - prevented sleep in some. Others found the environment frightening, hot or busy.

Some ICUs have no windows and, along with disrupted sleep patterns, this can cause loss of normal day / night pattern of wakefulness and sleep. One man said the nurses made him stay awake all day so that he would gradually adopt a normal pattern. Some people were afraid to sleep in case they pulled out breathing tubes. Others were put off sleeping by nightmares. 

Sleeping tablets helped some people to get some sleep while they were in ICU. One woman praised a nurse who gave her a lavender wash especially to help her sleep.

Dreams and hallucinations
Serious illness may cause problems with a person's ability to stay conscious and cause hallucinations. People in intensive care also receive many medicines and some of these can cause nightmares and auditory or visual hallucinations (e.g. opiates and less commonly benzodiazepines). A few people experienced no nightmares or hallucinations while they were in intensive care. Others remembered nothing of their entire time in ICU, including any dreams and hallucinations.

Although some people had no dreams or hallucinations, for others these were an important part of their whole experience. Sometimes dreams and hallucinations caused anxiety, confusion or disorientation and some people found it difficult to distinguish between dreams, nightmares and hallucinations, particularly when they first came round (see 'Coming round and regaining consciousness'). Dreams could be unpleasant, pleasant or just strange - experiences vary greatly.

Some people reported vivid and powerful dreams in which they were given a choice between living and dying, or encountered situations in which they fought fiercely to stay alive. For some, these dreams profoundly affected how they now perceived their lives. One man went to see a spirtual medium to help him make sense of his dreams.

Some people were very frightened in intensive care because their dreams merged with their hallucinations, and were so intense and real that it became difficult to distinguish between dreams and hallucinations, and work out what had really happened. Some of these people hallucinated that they'd been kidnapped, imprisoned or that people were trying to kill them. 

Many said they felt 'lucid' (clear) and then disorientated. It was a few days after coming round, when the medications were wearing off, that they started feeling clearer.

Some found it important to discuss their dreams and hallucinations while they were in intensive care to clarify what was really happening. One man was hallucinating and thought he was on a boat. He insisted on talking to his wife, who confirmed that he was in hospital. A woman wondered if police had taken her son, and her sister assured her that this wasn't true. Others believed they were on planes, in other countries or in the jungle. A few people, who watched television while they were in intensive care, said their dreams and hallucinations merged with what they'd been watching earlier. 

One woman remembered waking up every morning after a nightmare and feeling distressed to find she'd removed her gown. Some said they spoke out loud to other people, only to realise moments later that no one was actually there. This man from north Wales recalled speaking to everybody in Welsh.

Because of its hallucinogenic side effects some people who were receiving morphine (not commonly used now), a potent painkiller, chose to be weaned off it (see 'Intensive care treatments').

Some people wanted to discuss dreams, nightmares and hallucinations after leaving hospital because it was when they were back home that they wanted to make sense of all that had happened to them (see 'Making sense of what happened'). They recommended talking with nurses, family or friends. They stressed the need to find out what was real, what had actually been happening and of getting the vivid, intense dreams and hallucinations 'off your chest.' 

"Patients who have been admitted to critical care should be given a health check, called a short clinical assessment, to identify:
  • Any physical or psychological problems
  • The likelihood of any problems developing in the future, and
  • Their current rehabilitation needs
  • If the health check shows that a patient could benefit from more structured support, he or she should be given a more detailed health check (called a comprehensive clinical assessment) to identify their rehabilitation needs.
The healthcare team should talk to each patient about their rehabilitation goals, involving the family and/or carer if the patient is unconscious or unable to give formal consent."

 - National Institute for Health and Care Excellence (NICE) CG83 (2009)

Last reviewed August 2018.

Last updated May 2015.


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