The effectiveness of valerian acupressure on the sleep of ICU patients: A randomized clinical trial

Abstract

Background

Severely ill patients often experience problems with sleep. Either acupressure or valerian aromatherapy are reported as helpful in promoting sleep.

Objectives

The purpose of this study was to explore the effectiveness of valerian acupressure on the sleep of patients in the intensive care unit (ICU).

Design

A randomized clinical trial.

Setting

A 42-bed adult intensive care unit.

Participants

Forty-one subjects in the experimental group and 44 subjects in the control group.

Methods

The measurement included observation, and actigraphy measures during 10 pm–6 am, and the Stanford Sleepiness Scale (SSS) measures on the next morning. Experimental groups received valerian acupressure on the Shenmen, Neiguan, and Yongquan acupoints between 7 pm and 10 pm of the second day while control groups received regular treatment. Heart rate was measured for 5 min before and after valerian acupressure present for HR variability analysis to measure relaxation response.

Results

The results indicated that after receiving valerian acupressure, patients’ sleeping hours increased, wake frequency reduced and SSS grades declined. The HR variability data indicated relaxation response immediately after valerian acupressure.

Conclusion

This study supports the hypothesis that valerian acupressure on the Shenmen, Neiguan, and Yongquan acupoints could improve the sleeping time and quality of ICU patients.

Introduction

Severely ill patients residing in hospital frequently experience sleep problems. Factors such as the noise of physiological monitoring systems, warning alerts, lights, and frequent or complex treatments disrupt patients’ sleep. These disruptions can result in sleep deprivation, which negatively influences patient recovery (Tamburri et al., 2004). Celik et al. (2005) and Tamburri et al. (2004) found that in intensive care units (ICUs), nurses and medical staff visit patients rooms over 40 times every night. Additionally, only 6% of patients have 2–3 h of uninterrupted sleep. When critically ill patients are deprived of sleep, their immune systems are weakened, and their ability to recover is reduced. Steroid secretions in the body increase and interfere with regular healing properties and disease resistance. Furthermore, respiratory muscle can become flaccid, affecting breathing and causing high carbon dioxide and low oxygen levels in the blood. This prolongs patient dependency on respirators and other medical equipment (Richards et al., 2003). Therefore, the sleep quality of severely ill patients is a serious issue for medical and nursing staff.

In ancient China, the sedative and pain-relieving properties of valerian, and its ability to promote healthy blood circulation effectively, were used to treat neurasthenia, insomnia, mania, and other illnesses (Kao, 1989). In Europe and the U.S., valerian is generally considered to be beneficial to sleep (Taibi et al., 2007). Bent et al. (2006) systemically reviewed valerian-related studies and reported that valerian can improve the sleep quality of insomniacs, with few side effects. The possible side effects of valerian, such as dizziness, drowsiness, and headaches, are not severe and occur rarely. Another systematic review conducted by Taibi et al. (2007) found that when refined valerian is absorbed by the human body, the activity of the gamma-aminobutyric acid (GABA) receptor is increased but its absorption is inhibited. The medicinal effects of valerian are similar to those of benzodiazepine (BZD), but the side effects are milder. Valerian influences the nerve receptors that regulate sleep, specifically the adenosine and serotonin receptors. A more recent systematic literature review (Fernandez-San-Martin et al., 2010), emphasizing well-designed studies and ignoring smaller or poorly designed clinical trials, concluded that valerian subjectively improved sleep quality; however, this was not demonstrated with objective measurements. Their study reported that although valerian is safe and has few side effects, its effectiveness in improving sleep quality required further clinical investigations.

According to the theories of traditional Chinese medicine, the function of organs depends on the channels through which life energy flows. These channels are known as “meridians.” Meridians connect the internal with the external, transmitting qi (the life energy that is believed in traditional Chinese culture and medicine to sustain all living things) and blood to various organs, and enabling the body to function as a harmonious whole. Acupoints are points located along the meridians for infusing qi, reacting to pain or disease, and receiving treatment. Practitioners of acupressure use traditional Chinese medical theory to determine along which meridian, or in which organ, the disease has occurred. They then employ acupuncture to locate the acupoints. Gentle pressure is manually applied (usually with the fingertips) to these acupoints to stimulate the flow of qi through the meridians and prevent/treat illness or disease (Ma, 2005, Hwang, 2004).

Ancient Chinese medical literature identified over 54 acupoints that are related to sleep disorders (Peng et al., 2007). Kim et al. (2004) reported that performing acupuncture on the Neiguan and Shenmen points improved the sleep conditions of people experiencing insomnia after a stroke. Tsay et al. (2003) applied acupressure to the Shenmen and Yongquan points of people with end-stage renal disease. Their results showed that acupressure can increase people's sleep quality and number of hours of sleep. Sun et al. (2005) and Xu et al. (2006) applied acupressure to the Yongquan and Shenmen points of nursing home residents. They found that applying acupressure to these points improved the residents’ sleep quality. These studies showed that acupressure or acupuncture on the Shenmen, Yongquan, and Neiguan acupoints can improve sleep quality.

Acupressure and valerian aromatherapy are complementary non-invasive therapies. However, no data exists regarding how effective the combined application of these therapeutic methods are to improving the sleep quality of critically ill patients. Considering the critically ill status of the participants, we conducted this clinical trial by applying acupressure with valerian oil, instead of acupuncture, on the Neiguan, Shenmen, and Yongquan acupoints. This study investigates the effectiveness of valerian acupressure on the sleep quality of ICU patients.