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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...

She slept very little in intensive care because of the lighting, medications and visits from...

Age at interview: 35
Sex: Female
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Throughout the Thursday I had so many people come in and out, while I was in ITU on the Wednesday when I just come round I didn't get any sleep at all because of, I don't know why, because the light was on I just didn't get any sleep.

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 felt disorientated and lay awake all night because of the medications and her own fears.

Age at interview: 35
Sex: Female
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The strongest kind of impression I had having been woken up was that I then couldn't go back to sleep. And part of that was I couldn't go back to sleep because you know, obviously I was just kind of pumped full of drugs and totally disorientated. And I had no idea whether it was morning or night or, you know, it was like kind of an extreme form of jetlag. But also I was utterly terrified to go back to sleep because I understood enough that there was a problem with my breathing. And I was convinced if I let myself fall asleep I'd stop breathing or I'd choke on all this gunk in my throat. And that went on for days. And so I'd have a kind of day pattern of people visiting me. And then they'd all go away and it would be night time and I would just stare at the clock and stare at the machines. And not, you know, not be able to sleep at all. And after a few days of that they started to give me some sleeping pills which didn't really work either. You kind of take this medication and expect to kind of just conk out within twenty minutes and it didn't really work like that.

 

She stayed awake for four nights because she hallucinated whenever she tried to sleep, and felt...

She stayed awake for four nights because she hallucinated whenever she tried to sleep, and felt...

Age at interview: 55
Sex: Female
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But one of the strangest things that happens to you physically and mentally, which apparently happens because of the sedation, and the type of drug that they use, I've been told subsequently it's a known effect, and that is hallucinations. And it's a common thing but until you've actually been through it you do not really realise the intensity of the experience. My particular hallucination was that every time I closed my eyes they would say, "You should go to sleep". Every time I closed my eyes something descended over my face. And the best way that I could describe it, initially I thought it was like a very soft kite shape, soft leather, that flaps, that flapped.  That was my initial thought, and then after that I thought it was more like a bat, you know, like a bat flying with these, again a sort of triangular shape. And in the middle of this triangular shape was something moving, pulsing, which made me think that it was alive, that therefore it was a bat. And it came over my face very slowly, very gently. And like when you put anything over your face, your eyes can still see. And I would be looking madly, intensely to see if there was any hole in this thing. Because if there was no hole in it, then I wouldn't be able to breathe through it. And because of that I didn't sleep for four nights.

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.

He had one nightmare but this was no worse than any other he might have had outside the hospital.

Age at interview: 63
Sex: Male
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In Intensive Care, did you have any dreams that you remember or...?

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.

He dreamt he was a washing machine and slept poorly because of the noise of equipment.

Age at interview: 60
Sex: Male
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Oh I dreamt and the dreams were as real as being awake and in the dreams I felt like I was something like a washing machine built into a shop or something. And I was just one plugged into the system and people every now and again came and twiddled my, made adjustments here and there and perhaps I was seeing something in my dream I don't know. But I didn't sleep very well the whole time I was there.

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.

Because of his near-death experience he now wants to help others who've been in intensive care.

Age at interview: 66
Sex: Male
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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.

In his near-death experiences a sedate scene was always followed by a fight.

Age at interview: 47
Sex: Male
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One of the journeys was, I was on a boat. We'd sold up our houses, or our house, I wish we did have houses, we'd sold up our house. We were on board a boat with some of the nurses, and it was, I think it was Malay nurses. And we were on this, and it was like a ferry type thing. So it wasn't just one boat, there was various boats all together. And I was going up this nice little sedate river and we were travelling along. And then I had a problem with one of the Malayan guys and we ended up in a struggle and a fight. And my wife intervened and then one of the other girls intervened. And then I was starting to sort of say, "No, no, no, no, no" and I started to actually throw up all over my wife, regurgitate. And I said, "No, no, no, no." And I remember that vividly. And that was, so it was very serene and then it was a fight. And I know what the fight was. It wasn't anything against the people that were there. It was a fight to say, "No, you're not having me."  

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.

He dreamt that he had to prove himself through games if he really wanted to survive.

Age at interview: 45
Sex: Male
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I had dreams, not nightmares. I had dreams, loads of dreams, all the time. I've since gone to a medium to find out what they meant. And the way I looked at them at the time is, it's a case of fighting and not dying. Willing to fight, willing to live. That's how I perceived it.

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.

He couldn't move or communicate his fears of a nurse trying to shoot him.

Age at interview: 46
Sex: Male
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I'm hallucinating then. I think people's trying to break in the ward to kill me, I don't know why and the nurse, she was a Thai woman, she's got a gun to my head trying to kill me and I'm saying to [my wife] and the daughter hit her, hit her but like they can't tell what I'm saying because I've got a tube in [makes noise] and I'm frightened because I think people are trying to kill me and then I think I'm in 1902 in Australia, watching WG Grace play cricket and I've put one old penny on it - weird.

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.

She was hallucinating that one of the doctors hated her and planned to kill her.

Age at interview: 47
Sex: Female
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After that I had a lot of hallucinations, with the drugs really. I remember one of the doctors that was on Intensive Care, who I really thought was trying to kill me. I don't think he actually did any treatment on me, but every time I saw him I was terrified. I remember him taking me up on the ceiling and whirling around like a Catherine wheel. We were holding hands like skydivers do and whirling round.

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...

She sometimes feared she'd been kidnapped and needed to escape because she drifted between...

Age at interview: 41
Sex: Female
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And then, from then on I was convinced that I'd been abducted by aliens and I was in some kind of spaceship and it wasn't really my Mum and my husband and my friends and colleagues that were with me. They were aliens and they were impersonating people that I knew. And all I could think of was that I had to go along with it and make them believe that I thought they were those people so that eventually when I was able to escape I could do that. And I think I must have been thinking that for days, but because I was trying to be nice to them they thought that I was just coming round in a normal way and was just a bit subdued, and a bit quiet, and a bit withdrawn. But I was watching everything they did, everybody that came near with a syringe or a drip, or anything, I was convinced that they were going to harm me, or they were going to try and kill me. And it was just very, very strange, I mean I'd worked in Intensive Care for thirteen years and you'd think you have an idea of how patients feel, but really when I look back now you have no idea that patients went through this kind of experience really.

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...

He felt stronger after having heart surgery but was tired and hallucinating when he first came...

Age at interview: 43
Sex: Male
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I vaguely remember my wife coming, well you know being with me. I remember a nurse giving me a bed wash, which was brilliant because I felt like I was sweating. And then I remember being tired. We've got to remember everybody was speaking English around me, and I was speaking Welsh to my wife. But every time I closed my eyes, everybody was speaking English, then turned to speaking Welsh, which they didn't but it was just the anaesthetic or whatever. Then once I opened my eyes, they reverted back to English and when I closed my eyes, they reverted back to Welsh, which I couldn't understand. I remember telling my wife, they're playing a joke on me because everybody here speaks Welsh but they're refusing to speak Welsh to me.

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...

He recommended discussing dreams with family rather than nurses, and appreciated family members...

Age at interview: 47
Sex: Male
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And if anybody experiences something [dreams and hallucinations] and they say, "God knows where that's come from" then just talk to someone about it, your wife, your kids, doesn't matter, just talk to someone. I wouldn't say talk to the nurses and the doctors, because they say, "Oh, yes, that's natural." The people that you're talking to say, "You're having a laugh." And the thing is you're not having a laugh, but you are having a laugh. And they take it on board and say, "Cor, blimey, what sort of life have you lived to coming to that sort of dream?"

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.
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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