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Learn more: PMC Disclaimer | PMC Copyright Notice J Educ Health Promot . 2026 Mar 31;15:101. doi: 10.4103/jehp.jehp_369_25 Search in PMC Search in PubMed View in NLM Catalog Add to search Quality of sleep among nurses working in critical care units: A cross-sectional study Pooja Yadav Pooja Yadav 1 Department of Endocrinology, Charing Cross Hospital, Imperial College Healthcare, NHS Hammersmith, London, United Kingdom Find articles by Pooja Yadav 1 , Suresh K Sharma Suresh K Sharma 1 College of Nursing, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India Find articles by Suresh K Sharma 1, ✉ , Nimarta Rana Nimarta Rana 1 College of Nursing, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India Find articles by Nimarta Rana 1 , Nikhil Kothari Nikhil Kothari 2 Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India Find articles by Nikhil Kothari 2 , Natwar Patidar Natwar Patidar 1 College of Nursing, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India Find articles by Natwar Patidar 1 , Ritu Rani Ritu Rani 3 College of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India Find articles by Ritu Rani 3 Author information Article notes Copyright and License information 1 Department of Endocrinology, Charing Cross Hospital, Imperial College Healthcare, NHS Hammersmith, London, United Kingdom 1 College of Nursing, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India 2 Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India 3 College of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India ✉ Address for correspondence: Prof. Suresh K. Sharma, College of Nursing, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India. E-mail: [email protected] Received 2025 Feb 26; Accepted 2025 Jul 22; Collection date 2026. Copyright: © 2026 Journal of Education and Health Promotion This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License (CC BY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. PMC Copyright notice PMCID: PMC13094890 PMID: 42016406 Abstract BACKGROUND: Critical care nurses often face sleep deprivation and circadian rhythm disturbances, affecting their well-being and patient safety. Although global research highlights this issue, Indian data remain scarce. Globally, the literature has shreds of evidence about the poor quality of sleep in critical care nurses but there is a paucity of data regarding this issue in the Indian scenario. Therefore, this study was conducted to assess the quality of sleep among nurses working in critical care units and to find its association with the sociodemographic variable. MATERIALS AND METHODS: A cross-sectional descriptive study was conducted from April 2021 to January 2022 among 251 critical care nurses in adult, pediatric, neonatal, and neurology ICUs of a tertiary care hospital. Nurses with at least 3 months of ICU experience were included. Nurses who were not willing to participate and had psychiatric, chronic respiratory, cardiac illness, obesity, or pregnancy were excluded. Total enumerative sampling was used. The data were collected using Sociodemographic Information Performa and Pittsburgh Sleep Quality Index (PSQI). Data were analyzed using descriptive and inferential statistics using SPSS version 20.0. RESULTS: The mean score of PSQI was 6.23 ± 2.92 and 62% of critical care nurses had poor quality of sleep. A significant association was found between the quality of sleep with marital status ( P = 0.02) and history of smoking ( P = 0.04). CONCLUSION: Most (62%) critical care nurses reported poor sleep quality, significantly associated with marital and smoking status. Implementing sleep hygiene education and lifestyle-focused wellness programs can enhance nurses’ well-being and promote safer, more effective patient care. Keywords: Critical care, health, nurses, sleep quality Introduction Sleep is a cyclic phenomenon that alternates with intervals of awakeness.[ 1 ] It is a complex biophysiologic circadian process, which is pertinent to many day-to-day physical and mental functions of humans.[ 2 ] Rest is one of the fundamental and physiological needs of humans which has a noteworthy impact on physical and mental well-being.[ 3 ] Sleep disorders are the cause of morbidity and mortality and can diminish the utilitarian capacity and quality of life.[ 4 ] The lack of sleep among nursing personnel is a major area of concern for the healthcare sector. Critical care nurses are exposed to a relatively high level of stress and embrace numerous job-related errands while giving patient care. Worldwide, the incidence of sleep disturbance among critical care nurses ranges from 55% to 88%.[ 5 , 6 , 7 , 8 ] Furthermore, in India, research conducted in Pune and Rajasthan found that 88% and 61.90% of critical care nurses had poor quality of sleep.[ 9 , 10 ] The perception of sleep quality is multifaceted, and in addition to objective sleep quality, it is influenced by multiple subjective variables. These factors have a huge impact on nurses’ quality of sleep, affecting their health and ability to provide proper patient care. Researchers in China and Istanbul found that variables such as age, years of experience, department, job title, number of nights worked per month, anxiety, and frequency of exercise affect nurses’ sleep.[ 5 , 11 ] Critical care nurses are vulnerable to many diseases due to inadequate sleep which often remains unreported and unnoticed. Poor sleep quality can lead to a range of negative effects, such as impaired cognition, mood swings, depression, irritability, reduced productivity, low motivation, higher risk of accidents, and physiological imbalances. Exploring sleep quality among nurses is essential to identify influencing factors and emphasize the need for deeper insights. Such research can guide the development of effective interventions to enhance sleep quality and support nurses’ health and job performance.[ 12 ] In addition, there is very little literature available on the quality of sleep of critical care nurses in India. Therefore, this study was undertaken to assess the sleep quality of nurses working in critical care and find its association with sociodemographic variables. Material and Methods Study design and setting A cross-sectional descriptive study was conducted among critical care nurses working in adult ICU, pediatric ICU, neonatal ICU, and neurology ICU of a tertiary care hospital, from April 2021 to January 2022. Nurses working in the critical care units for the last three (03) months were included in the study. The exclusion criteria included nurses not willing to participate, having a history of psychiatric illness (anxiety, depression, attention deficit hyperactive disorder, bipolar disorders), chronic respiratory and cardiac illness (COPD, asthma, heart failure), obesity BMI >25 kg/m 2 (Asian Pacific Classification), and Pregnancy. Study participants and sampling The sample size was calculated by using the Prevalence formula, n = {( Z 1- α /2 ) 2 ( P )( q )}/ d 2 , the prevalence rate for the assessment of sleep quality among critical care nurses was considered 62% as reported in the earlier study[ 7 ] and 5% level of significance. Hence the sample size came out to be 251. The critical care nurses were selected using total enumerative sampling technique. Ethical approval was obtained from the institutional ethical committee vide Certificate reference number: AIIMS/IEC/2021/3467; dated 30/04/21. All the participants were informed about their participation in the research, objectives of the study, duration of their involvement, and probable use of findings of the study. A written informed consent was taken from them and confidentiality of data was maintained. Data collection and tools Sociodemographic Information Performa and Pittsburgh Sleep Quality Index (PSQI) was used for data collection. Sociodemographic Information Performa contains 15 items (age, gender, marital status, qualification, duration of professional experience, designation, history of smoking, history of alcohol consumption, history of tea/coffee consumption at night, regular exercise, family history of sleep disturbance, history of any illness, use of medications affecting sleep, screen time, and sleep promotion bedtime rituals). PSQI is a standardized self-report questionnaire that assesses sleep quality in adults over 1 month. It consists of 19 self-rated questions and five questions rated by bed partner or roommate. The items are grouped into seven component scores. Each component is weighted equally 0-3 scale, where 0 = no difficulty, 1 = mild difficulty, 2 = moderate difficulty, and 3 = severe difficulty. The seven component (Subjective Sleep Quality, Sleep latency, Sleep Duration, Habitual Sleep Efficiency, Sleep Disturbances, Use of Sleeping Medications, and Daytime Dysfunction) scores are then summoned to yield a global PSQI score, which had a range of 0–21; the higher the score indicates worse sleep quality. A global score >5 is typically used to differentiate between good and poor sleepers. Permission to use the PSQI was taken from the author of the tool. It has also been validated in various countries, including India, with consistent psychometric properties. Cronbach alpha reliability of PSQI was 0.85.[ 6 ] Statistical analysis After the data were collected, it was coded and entered into an excel sheet. Descriptive (mean, median, standard deviation) and inferential statistics (Kruskal Wallis and Mann–Whitney U test) were used for data analysis using SPSS version 20.0. Results Sociodemographic profile of critical care nurses Out of the 251, critical care nurses, 141 (56.2%) were male and 110 (43.0%) were female. Half of them were unmarried 127 (50.6%). Nursing officers formed the major proportion (245; 97.5%), and the remaining 6 (2.4%) were senior nursing officers. More than half of the participants, 189 (75.3%), were nonsmokers, followed by 33 (13.1%), 29 (11.6%) exsmokers, and smokers, respectively. There were 153 (61.0%) nurses doing regular exercise, while 98 (39.0%) nurses were not doing regular exercise [ Table 1 ]. Table 1. Demographic profile of the nurses working in critical care units Demographic profile f (%) PSQI score [Mean±SD] P $ Age in years <24 07 (2.8) 6.71 0.546 25-28 161 (64.1) 6.16 29-32 83 (33.1) 6.31 Gender Male 141 (56.2) 6.06 0.320 Female 110 (43.8) 6.44 Marital status Unmarried 127 (50.6) 6.68 0.02 Married 123 (49.0) 5.75 Divorced 01 (0.4) - Qualification B.Sc. Nursing/Post Basic 185 (73.7) 6.06 0.587 GNM 47 (18.7) 6.34 M.Sc. Nursing 19 (7.6) 5.53 Professional experience (in years) 1-3 142 (56.6) 6.39 0.443 4-6 69 (27.5) 6.16 >7 40 (15.9) 6.59 Position Nursing Officer 245 (97.6) 6.21 0.399 Senior Nursing Officer 06 (2.4) 6.23 History of smoking Nonsmoking 189 (75.3) 6.37 0.04 Exsmoking 33 (13.1) 5.09 Smoker 29 (11.6) 6.59 History of alcohol consumption Never 148 (59.0) 6.24 0.719 Rarely 54 (21.5) 6.02 Sometime 46 (18.3) 6.46 Daily 03 (1.2) 4.67 Tea/Coffee consumption at night Never 100 (39.8) 6.19 0.983 Sometime 54 (21.5) 6.13 Rarely 60 (23.9) 6.40 Daily 37 (14.7) 6.19 Regular exercise Yes 153 (61.0) 5.89 0.071 No 98 (39.0) 6.23 Screen time 1-4 hours 131 (52.2) 6.27 0.735 5-8 hours 109 (43.4) 6.06 9-12 hours 11 (4.4) 7.36 Open in a new tab $ Kruskal Wallis test and Mann Whitney U -test A maximum of 245 (97.6%) had no history of any illness, but there were around 6 (2.4%) who had a history of illness. A little less than half of 109 (42.2%) critical care nurses were following sleep promotion bedtime rituals, among which 72 (28.7%) were listening to music and 45 (17.9%) were practicing stretch, breathing, and relax. Most of the nurses, 249 (98.9%), had no use of medications affecting sleep. The quality of sleep of critical care nurses was assessed with PSQI, and it was found that the total PSQI score had a mean with SD, 6.23 ± 2.92. Sleep latency had the highest mean score of 1.57 ± 0.94 [ Table 2 ]. Table 2. Mean score for different domains of Pittsburgh sleep quality index ( n =251) PSQI domain PSQI index score (mean±SD) Range Mean±SD Duration of sleep 0-3 0.67±0.85 Sleep disturbance 0-3 1.16±0.75 Sleep latency 0-3 1.57±0.94 Day dysfunction due to sleepiness 0-3 0.91±0.76 Sleep efficiency 0-3 0.59±0.86 Overall quality of sleep 0-3 1.37±0.99 Needs medications to sleep 0-3 0.04±0.24 Total PSQI score 0-21 6.23±2.92 Open in a new tab Each domain score ranged between 0 no difficulty (better)- 3 severe difficulty (worse) sleep quality. Total PSQI ranged between 0-21; where PSQI score ≥5 was interpreted as poor quality of sleep Marital status and history of smoking were significantly associated with the quality of sleep of critical care nurses P- value of 0.02 and 0.04, respectively [ Table 1 ]. Discussion This study examined the quality of sleep of critical care nurses and its association with sociodemographic variables. The principal result that 62% of critical care nurses suffered from poor sleep quality [ Figure 1 ] has also been reported by other parts of the world.[ 9 , 7 , 13 ] Compared with the reports from Iran and India (Hyderabad); however, our results appear to be lower than some.[ 5 , 8 ] We believe that variations in staffing levels and qualifications, patient profiles in various organizations, and policies and procedures can all contribute to disparities in sleep quality. Figure 1. Open in a new tab Quality of sleep among critical care nurses In this study, approximately half of the participants were between the age group of 25 and 28, and more than half of them were men. Similar findings have been reported by other related studies, which found that most of the nurses belonged to the 25–30 years of age group.[ 8 , 10 , 14 ] The possible reason for most of them to be males can be that male nurses like high-action settings over general care. They feel greater professional satisfaction when working in the trenches of trauma care and high-stress situations than they do in general care settings, for reasons ranging from communication problems with the opposite gender to better career role fulfilment. As a result, they gravitate toward the positions where they must move quickly and make decisions with little opportunity for thought or reflection. In this study, 29% of the participants were smokers and 6% were senior nursing officers. A study conducted by Tarhan et al .[ 11 ] concluded that approximately 27% of the participants were smokers and 86.2% held a managerial position, which is consistent with the results of our current study. It has been observed that many nurses are taking medications to assist them. These findings contradict the findings of this study.[ 14 ] The mean PSQI score was found to be 6.23 ± 2.92 in this study. A study conducted among 126 nurses in Bikaner, Rajasthan found that the PSQI score was 5.317 ± 1.899, and our research results corroborate with what they found.[ 9 ] It has been well documented in the literature that sleep duration had the highest mean PSQI score (1.31 ± 0.95), which contrasted with our research findings that sleep latency had the highest mean PSQI score (1.57 ± 0.94).[ 11 ] Numerous factors influence sleep quality; therefore, it is critical to focus on and comprehend sleep-related factors. Tarhan et al .,[ 11 ] in their work, concluded that age, working shifts works, duration of professional experience, and smoking status have an association with sleep quality which was partially congruent with the findings of our study in which smoking had significant association with sleep quality. The possible reasons for these could be that cigarette contains nicotine which is a stimulant and if taken too close to sleeping time affects falling asleep. Patients admitted to critical care units are either postoperative patients or are critically ill. Hence, their health conditions change suddenly, and emergencies often occur. Therefore, the nurses need to be adaptable and should be able to cope with that stress. In this study, a significant association was found between marital status and sleep quality among nurses. Some studies suggest that single nurses may experience better sleep quality than their divorced or separated. For instance, one study reported that a higher percentage of married nurses (86.4%) had poor sleep quality compared with single nurses (73.9%), although the difference was not statistically significant.[ 15 , 16 ] Marriage brings time and financial resources to one another. In contrast to single, married people spend more time engaging in activities like eating, and relaxing, which tends to increase their financial security and sense of camaraderie. The improved marital circumstances of married people lessen their exposure to various hazards and stresses and improve their capacity to handle them.[ 17 ] Our study findings are unique as we have assessed the quality of sleep among critical care nurses in India, with an adequate sample size. The limitation of the study was that it was a single-center study. The study recommends that the hospital administration can implement some sleep health changes such as arranging regular yoga and aerobic sessions for the critical care nurses, maintaining the optimum nurse patient ratio in the ICU, and regular rotation of the staff from the critical care unit to other areas. Future research could use objective tools such as actigraphy or polysomnography to enhance the accuracy of sleep assessments. Longitudinal studies may help uncover causal relationship and track changes in sleep quality over time. Comparing sleep quality across different hospital departments, types of ICUs, or public vs. private institutions could highlight contextual factors that influence nurses’ sleep. Expanding the sample across diverse regions in India would improve generalizability, while mixed-methods approaches could offer deeper insights into nurses’ perceptions, coping strategies, and barriers to quality sleep. Conclusion This study highlighted that a significant number of nurses (62%) reported poor quality of sleep, with an overall PSQI of 6.23 ± 2.52. Most of the participants were male, married, and not doing any exercise. Few of them also reported habits of smoking and alcohol use. A significant association was found between sociodemographic variables (marital status, smoking status) with quality of sleep. Nurses should be oriented for sleep hygiene practices to promote quality of sleep among them. Conflict of interest The authors declare that they have no known conflict of interest. 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