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.
She slept very little in intensive care because of the lighting, medications and visits from...
The Thursday I didn't get any sleep, when they took me into that room because the fluorescent light was on ahead, on top of me, adjacent to me where the sluice room was, a fluorescent light was on. On the left hand side of me there was a door with a light shining right through and also I think with the effect of the morphine I wasn't getting any sleep; I couldn't like, you know, settle at all.
I was awake all throughout the day because I had so many people in and out, and also because I had my own visitors come in and out and they had to come in because they had to help me with my son. And the nurse, midwives come in and out so I didn't get any sleep throughout the day and I didn't get any sleep throughout the night and this was going on til Friday.
So she said, "what I want to do is I want to give you some sleeping tablets, and you can at least just have half an hour's sleep because you haven't slept and you're snappy at everybody and you're very anxious at everything." So I said, "ok". So she gave me a sleeping tablet.
And throughout that night a midwife, I think it was about three or four o'clock in the morning, one midwife walked in, and stood right up next to me and woke me up, said, "Hello, hello my name is [midwife's name] and I'm the midwife looking after you." So I opened my eyes and she was right in my face and she wore glasses, and I think my head was spinning because I had actually got a bit of sleep I think, but she woke me up before I had got enough and my head was very spinning. And she was right in front of me so I said to her, "Can you just go and stand over there and put the light on?"
I said to her, she might have thought I was a bit strange, but I couldn't focus on her cos she was very close to me. And she said, "Oh, I'm the midwife that's looking after you, she said, "it's three o'clock in the morning and I may be popping in and out." And I said, "Look I haven't had any sleep at all, and I just managed to get off and you've just woken me up so I don't need anything, if you could just let me sleep and then maybe in the morning you could talk to me." So she said to me "Um, well I do need to pop in and out." I said, "Ok, whatever."
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.
She felt disorientated and lay awake all night because of the medications and her own fears.
She stayed awake for four nights because she hallucinated whenever she tried to sleep, and felt...
I decided that, for two reasons. One, because particularly at night there was nobody there, or nobody I could see, you know. So I felt uncared for. So therefore I decided that I would therefore have to care for myself. And the only way that I could care for myself was by being awake and knowing what was happening. The second reason was that every time I closed my eyes I had this hallucination of this coming up, which was just too real.
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.
He had one nightmare but this was no worse than any other he might have had outside the hospital.
Interestingly, that was a question that was asked by the lady who came to see me from post-Intensive Care, from the post-Intensive Care team, fairly soon after I'd gone back down to the general ward. My answer then and now is I remember one appalling nightmare. I still remember it very vividly. But no more appalling than the nightmares that one can have, you know, off morphine or at any time, so I wouldn't say that that nightmare, which does not recur, was particularly linked to Intensive Care. I suppose it must trigger it to a certain extent but, no, I didn't have a lot of nightmares there.
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.
He dreamt he was a washing machine and slept poorly because of the noise of equipment.
Because I was on the life support system you had lines going into your arms which monitored your heart and there was one particular one that goes into your arm, or your finger, or your wrist and if your arm is lying in a certain way it blocks it. And then it sets off the, ding dong, ding dong, ding dong, and these kept on going off. And every time I went to sleep I moved and of course I moved in such a way that it set it off and woke me up. And I found that very annoying and I thought to myself well there's no real reason, they don't need to monitor my heart like that, you know I'm perfectly healthy [laughs]. Obviously I wasn't but I thought I was.
That was something I had to put up with and I was woken up several times because every time, you know, these things went off as soon as I went to sleep. And you can't really lie asleep and stay in a certain position I don't, you know, care what anybody says you can't, you're bound to move. And anyway I had to put up with being woken up a few times.
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.
Because of his near-death experience he now wants to help others who've been in intensive care.
And one of the times when I was sort of very, very semi-conscious I could hear Perry Como singing and he was singing, you see here we go again, the emotions come in and it's very difficult. He was singing 'Catch a Falling Star'. And as he was singing this, I had this vision, like in a tunnel of seeing people and people came into the tunnel, they went past holding a star, and it was all the different people in my life. And it was though I was on the brink of either coming back to the real world or going somewhere else. But there was no fear of it, there was a very deep cosiness and very deep sense of satisfaction, a very deep sense of well-being.
And eventually I went through all this and the time came when I was going to move again and it's very, very difficult to look at the, how can I put it? The sort of sequence of events. But I was eventually told that I was going to move to an ordinary ward and I thought this was a wonderful thing to happen because it meant that I was getting better. And by now one of the things that I'd realised is that I'd had a near death experience and because of that I had a very strong will or a very, very strong feeling that I had to try to remember what was happening because when I got better, by hook or by crook I was gonna get and do something about this, something for people who are patients in Intensive Care.
In his near-death experiences a sedate scene was always followed by a fight.
And then the next time it was the Kylie Minogue syndrome which, I'd actually managed to catch her. And we won't go into the state of dress and the state of, how can we say, whatever, attitudes. But there was a sense there, because of the state, and again it was a very serene build-up to it, very, very serene. And it was a chase, and it was a chase into a building. And she was dressed in, excuse the term, stockings, suspenders and not a lot else. And her boyfriend, husband, whatever he was, that's the vague area, stepped in front of me and said like, "Sorry". And, and I said, "No, no". And that's where we went into the, "No, no" and the fight back again. And there were some other things that I won't talk on about video, because it's a bit rude, but before, you know. But that was the other time. But it was very serene, a fight, and then back to serenity, normality.
He dreamt that he had to prove himself through games if he really wanted to survive.
Your dreams were about being willing to live?
Yes, all the time.
I tell you one of them was, you know like these video games you get where you've got to get, like kids have in a game station, you've got to get up to higher levels. There's one I had to get from A to B to C to D before I could get out and carry on. And every time I was just getting A and B. But it was a race, a racetrack. And I had two mechanics. One was Michael J Fox and the other was Sylvester Stallone. No word of a lie, it's true. I tell people this and they think, "Yes, he's lost it." No, but it's true. I had these two all the time. They kept on saying, "You've got to keep going, you've got to keep going." So that to me was a way of fighting, you know. I've had another one where I've been underwater all the time. I'm not drowning, I can see people and I'm trying to get up to the top.
You know the people?
I know the people, yes. And I'm trying to get out of the water and get to the top to see them. But I'm not drowning. There's lots of other little ones which are a little bit vague. I can't recall them too much. But those are the two main ones I can recall.
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.
He couldn't move or communicate his fears of a nurse trying to shoot him.
Thinking all these things and then and I and the nurse who's looking after me, I've one to one in intensive care, I'm telling [my wife] get up hit her, hit her but whether she can understand me I don't know. I think this nurse is trying to kill me, I'm hallucinating. I don't know at the time but they put that many drugs in to me that I'm tripping, like hallucinating things and I don't know what's what. So for a few days I don't remember. The days I can't remember how many days it were, the Mrs will probably know and the nurses, anyway, whether the drugs were wearing off I don't, I could like not talk but communicate you know they had books there and she's telling me I'm in intensive care, you nearly died twice.
Well I've gone "what?" But like not talking [makes noise] like that and I just didn't believe I said no but I realise I can't move. I've got tubes in me leg, mouth, head wherever there's anywhere to put tubes, there's tubes. I can't go toilet, I've a catheter, whatever. And then I'm frightened, thinking oh what's happening here am I going to be alright?
She was hallucinating that one of the doctors hated her and planned to kill her.
There were bright colours, loud music, he was laughing, and I knew he was going to kill me. And every time I sort of came round when I was in Intensive Care, if he came anywhere near me, I thought he was trying to switch the tubes off that were feeding me or helping me to breathe or whatever. And I couldn't make anybody understand. I couldn't make my family understand. I tried to tell them. I couldn't talk. And I tried to explain to them as best I could.
I had a tracheotomy and so I couldn't speak. And I couldn't move because they'd paralysed my muscles. So it was really difficult to communicate.
And my husband was there and he kept saying to me, "Don't try and talk." And I sort of tried to make him see that this was really important. And what I was trying to say to him was, "Will you please apologise to this doctor so that he will not kill me." And I thought, "If he goes and apologises, it will be okay." Because I thought I'd said something to him about, "I don't want to be in this hospital. This is not a good hospital". I don't whether I really said that, but I thought I had and that's why he hated me so much.
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.
She sometimes feared she'd been kidnapped and needed to escape because she drifted between...
So this must have gone on for about three or four days that I was in this kind of twilight zone, and then gradually things would happen. The nurses would come and take bloods from the drips and things and say, "We're just doing, taking this blood to check your drug levels." Or, "We're just taking this blood to check your oxygen levels and then I'd think, "Well why would aliens want to check my oxygen levels? And why would aliens want to check my drug levels?" And I think I then started, that must have been at a time when I was becoming more orientated myself, when all the drugs were wearing out of my system and everything else. So then I started to think, "Well maybe it's not aliens, maybe I really am in the Intensive Care Unit".
And the other thing that was strange was one minute I would remember what had happened and why I was in there, I'd remember about the baby and I'd remember about everything that had happened leading up to me being poorly, but then the next minute I'd be back to thinking that I was in this spaceship, so they were very contradicting thoughts.
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.
He felt stronger after having heart surgery but was tired and hallucinating when he first came...
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.'
He recommended discussing dreams with family rather than nurses, and appreciated family members...
And you say, "Well, that's just it. I'm just a normal person." Who on earth would dream that somebody's going to be a fish and be closed down and be released? You know, I had a dream where I was on the Richard and Judy show, but I was an undercover party to that. And it's just absolutely surreal. And there's no rhyme or reason to any of it. So you need to get it all off your chest. If you've got a really, really good wife that listens or a good husband that listens, take them for a lovely meal afterwards, [laughs] because like they're going to, bend their ears first, but then take them out and like treat them like they are God's gift. Because if they've stood by you for all of that, they are.
"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.
- National Institute for Health and Care Excellence (NICE) CG83 (2009)
Last reviewed August 2018.
Last updated May 2015.