Uses of Aromatherapy as a Treatment for Sleep Difficulties in the Intermediate Care Unit
Sleep difficulties are a common problem for patients who remain in the hospital for any significant amount of time. At the best of times hospitals are brightly lit and there is some level of noise at all hours of the day and night. Thus, insomnia becomes a critical issue for patients who are already ill or injured and distressed from being in the hospital. Insomnia can have a negative effect on the ability of a hospitalized patient to return to total wellness physically, psychologically, and spiritually. One of the central responsibilities of the nurse is to give patients the tools that they need to return to complete wellness. This includes proper medications and treatments, addressing food and hygiene needs and ensuring that patients can sleep. One of the means of doing this is by using alternative treatments to ensure patients can fall asleep and stay asleep. Aromatherapy is the use of scented natural oils to relax and calm individuals so that they can cope more effectively with stressors.
One central argument is that aromatherapy can be effectively used by nurses in helping patients overcome sleep difficulties and insomnia for patients on intermediate care units. This is specifically true if patients cannot use more traditional methods of addressing sleep issues such as, medication due to surgery or conflicts with other medications. While this may be effective for patients in intermediate care this cannot necessarily be applied to patients in acute care or intensive care units since they may have conditions that necessitate cleaner environments that prevent the use of aromatherapy or other heavily scented treatment options.
A literature search of CINAHL and PUBMED revealed four articles linked to the use of aromatherapy in treating patients with sleep difficulties. Two were research studies one of which was selected as the main article for this paper while the other two were informative articles, and article reviews. All were from peer reviewed journals. "Effect of lavender aromatherapy on vital signs and perceived quality of sleep in the intermediate care unit: a pilot study" by Lytle, Mwatha, & Davis and published in the American Journal of Critical Care will be the central article for this case study.
One major question when it comes to this issue is what effect aromatherapy will have on patients suffering from sleep difficulties. Lytle, Mwatha, & Davis hypothesize that using inhalation aromatherapy with lavender oil would increase sleep quality in a group of patients in an intermediate care ward in comparison to patients not receiving inhalation aromatherapy over the course of one night. The main problem being addressed is the issue of patient sleep difficulty. The proposed intervention is the use of aromatherapy to treat sleep difficulties. The main comparison in the case of this study is with a group of patients not using aromatherapy treatments. The expected outcome is that patients exposed to inhalation aromatherapy using lavender will have higher quality sleep. Finally the time duration of this study is one night.
Lytle, Mwatha, & Davis performed a pilot study using 50 patients hospitalized in the ICMU of a large teaching hospital. Patients were randomly selected from a pool of candidates that spoke English, and had been admitted to the ward for a stay of at a minimum two nights. The sample population had a median age of 52 years old. The majority of patients were female. Most patients were hospitalized with conditions ranging from endocrine conditions to cardiac problems. Patients were not on pain medications during the evening hours nor were they on oxygen for anything other than emergency treatment. This was an experimental action research study using both random sampling and randomized group assignment. Sixty eight percent of the participants were female while 32 percent were male. Eighty four percent of participants were receiving some type of pain medication while 80 percent were on oxygen. None were receiving these treatments at night.
Patients were randomly assigned to either the treatment or control group. Patients in the treatment group were treated using 3 ml of 100% pure lavender oil that was kept in a small jar at on their bedside table. Control patients were not exposed to the lavender oil. The treatment was conducted between 10 p.m. and 6 a.m. Nurses recorded patient heart rate, blood pressure, and respiration at 2 hour intervals throughout the night. The treatment was conducted over the course of a single night. The main reason indicated for this was that this was simply a pilot study and if the researchers found significant results this study would be re-implemented over a longer period of time.
After the completion of the treatment patients were asked to complete the Richard Campbell Sleep Questionnaire (RCSQ). This questionnaire uses visual analog questions in order to effectively assess the quality of a patient's sleep in a variety of areas including, depth of sleep, length of sleep, and periods of wakefulness during the night. This is an established instrument with a history of being used in sleep studies. Thus it is an established and reliable instrument of measurement that has seen numerous pretests and posttests.
The researchers used descriptive statistics including mean, mode, and median to analyze the data from the surveys as well as basic demographic patient information. The results of the study found that patients who received the aromatherapy treatment had lower blood pressure, than patients in the control group. There was no demonstrable difference in other vital statistics such as heart rate, pulse, or respiration between the treatment and control groups. The control group demonstrated a blood pressure rate of 87.7 while the control group had a blood pressure rate of 89.9. This was a difference of .03 which was not statistically significant.
In terms of the RCSQ patients in the control group were more likely to experience deep sleep with a score of 52.60 in comparison to reported scores of 41.44 from the control group (?=.24). Control group patients reported that they were less likely to fall asleep easily (36.92 percent) while people in the control group were more likely to fall asleep easily (47.76 percent). This indicates that while patients in the control group were more likely to show improved sleep in some areas in other areas they were less likely to show improved sleep. While the quality of sleep indicators included in the RCSQ were higher for patients assigned to the control group than they were for patients assigned to the control group. However; the difference was not determined to be significant. No significance was found for frequency of waking, return to sleep, or ease of getting to sleep. According to Lytle, Mwatha, & Davis, this demonstrated that while there was a difference between the control and treatment groups however, the difference was not statistically significant, a fact which would predicate further study.
There are several difficulties with this study. First, is the fact that this study is just a pilot study? This means that it is of short duration. The statistical methods used to analyze the results of the study are not as rigorous as in a more extended study. The treatment is also of short duration meaning that the long term effects of inhalation aromatherapy using lavender oil on the sleep of patients with sleep difficulties is not known. There seem to be few issues with internal validity issues such as, researcher bias since Lytle, Mwatha, & Davis found the opposite of what they hypothesized they would find. The sample size for this study was small and it is not clear whether the researchers accounted for issues such as, environmental allergies that would mean that the results of the study cannot be generalized. This study would have to be conducted on a much more extensive level in order to results to be applicable to larger patient populations.
Allard &Katseres argue that while aromatherapy has historically been used to assist patients suffering sleep difficulties it is not recommended for use on its own. It is commonly used in combination with other therapies meant to assist patients gain high quality sleep. There are two primary types of aromatherapy that are used with hospital patients, inhalation therapy and massage therapy. Inhalation therapy can be administered in hospital rooms directly by nursing staff, the patient themselves, or the patient's family members. Massage aromatherapy is typically conducted by either the physical therapist or a licensed massage therapist.
Hwang & Shin indicate that previous studies have revealed that inhalation aromatherapy was more effective in inducing sleep and assisting participants in remaining in a state of deep sleep than massage aromatherapy. However; an analysis of 258 studies on the use of aromatherapy revealed that aromatherapy did not have a significant impact on quality of sleep in hospital settings in any previous study. This indicates that while aromatherapy is effective it is perhaps more useful when used in combination with other sleep therapies such as, sleep medications, oxygen therapy, and cognitive behavioral therapy.
Dyer, Cleary, McNeill, Ragsdale-Lowe & Osland conducted a study of 65 patients receiving treatment in a cancer care unit in the UK. Patients were given aromasticks and asked to use them over a 13 week period. The results of the study indicated that the inhalation based aromatherapy sticks helped patients sleep improver over the course of the study. Patient's indicated that it was helpful enough that they would continue using the aromasticks in combination with other sleep therapies.
The literature indicates that patients demonstrate improvement in the quality of sleep overall although this improvement is not significant when compared to control groups. This demonstrates that while aromatherapy is an effective therapeutic method it is not particularly effective on its own. The study by Lytle, Mwatha, & Davis demonstrated the most significant results in comparison to the other articles however; one must take into account type of research study, and the size of the sample population. Also the fact that the study by Hwang & Shin was a literature analysis rather than a quantitative research study did have an influence on the comparison. Lytle, Mwatha, & Davis were also one of two researchers to conduct their research in a controlled hospital setting. While the study by Dyer, Cleary, McNeill, Ragsdale-Lowe & Osland was a legitimate research study little information was available on whether this study was randomized in any way, or if the researchers utilized reliable instruments, or a control group.
Overall the research suggests that aromatherapy may have limited usefulness on its own as a sleep aid. The other critical issue that is not addressed in the literature is what effect it may have on other patients in the unit who may have environmental sensitivities or allergies. Given that scenario it is likely that the only time this treatment would be useful would be in a setting where a patient had a private room. Furthermore, variables such as, smaller sample sizes indicate that this therapy may not be useful for all patients having sleep difficulties.
The primary recommendation is that this therapy should not be used as the sole means of assisting patients with sleep difficulties. While results indicate that patients have lower blood pressure, and higher quality sleep with the use of aromatherapy as a sleep aid the difference between the treatment and control groups was not significant enough to warrant use on its own. It is perhaps better that this therapy be used in combination with other therapies such as, cognitive behavioral therapy or sleeping pills.
Second, it is recommended that due caution be taken to ensure that aromatherapy methods are not used in the same hospital rooms with patients who may have allergies, asthma, COPD, or other respiratory problems such as pneumonia. The primary reason for this is that patients with respiratory problems may not be able to handle the heavy scents of aromatherapy essential oils. There may also be issues in terms of patients being allergic to the oils themselves since many people are allergic to the scent of lavender.
Thirdly, it is recommended that if aromatherapy of any type is used that essential oils not be left unsupervised by patient bedsides and that massage aromatherapy only be conducted by physical therapist or licensed massage therapists. The reason being that leaving aromatherapy oils unsupervised by patients specifically those with mental health issues, or dementia issues may result in patients ingesting potentially poisonous substances. Furthermore, massage aromatherapy should not be used without consulting the other people on the patient's medical team. Finally, the research seems to indicate that further study and perhaps larger studies are necessarily in order to ensure that this is in fact, a useful tool to use in helping patients in improving sleep while hospitalized.
In conclusion, while aromatherapy can be effective in helping patients with sleep difficulties the results of research studies were not significant enough for this treatment to be effective on its own. There are also significant issues surrounding the use of aromatherapy treatments in a hospital setting due to the risk of the patient ingesting the oils, or other patients having allergic reactions to the essential oils.
Allard, M. E., & Katseres, J. CE: Using Essential Oils to Enhance Nursing Practice and for Self-Care. AJN The American Journal of Nursing, 116(2), 42-49.
Dyer, J., Cleary, L., McNeill, S., Ragsdale-Lowe, M., & Osland, C. The use of aromasticks to help with sleep problems: A patient experience survey. Complementary therapies in clinical practice, 22, 51-58.
Hwang, E., & Shin, S. The effects of aromatherapy on sleep improvement: a systematic literature review and meta-analysis. The Journal of Alternative and Complementary Medicine, 21(2), 61-68.
Lytle, J., Mwatha, C., & Davis, K. K. Effect of lavender aromatherapy on vital signs and perceived quality of sleep in the intermediate care unit: a pilot study. American Journal of Critical Care, 23(1), 24-29.