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Table 2 Suggested chronobiological approaches to preserve circadian rhythms on the intensive care unit (ICU)

From: Clinical chronobiology: a timely consideration in critical care medicine

Zeitgeber Ideal ICU environment
Light • Bright-light daylight hours (> 1000 lx)
• Minimise light pollution at night (< 1 lx, consider)
• Eye masks at night
Feeding • Intermittent daytime feeding aligned to usual meal times
• Avoid continuous and overnight feeding
Temperature • Warmer environment during the day and cooler at night
Exercise rehabilitation • Similar time each day
• Take patient chronotype into consideration when planning schedule
Noise • Minimise noise during the night time
• Ear plugs at night
Medical and nursing interventions • Minimise at night and cohort together
• For non-sedated patients, allow patients to sleep according to their natural schedule, rather than a staff-based schedule
Sedative drugs • Minimise use through regular review and avoid “sleeping tablets”
• Consider melatonin (up to 5 mg) at 0900 h as circadian preserving sleep aide
• When possible, give drugs at the time of day least disturbing to circadian rhythms