BACKGROUND: Critically ill patients are deprived of sleep and its potential healing qualities, although many receive medications to promote sleep. No one has adequately evaluated holistic nonpharmacological techniques designed to promote sleep in critical care practice. OBJECTIVES: To determine the effects of (1) a back massage and (2) combined muscle relaxation, mental imagery, and a music audiotape on the sleep of older men with a cardiovascular illness who were hospitalized in a critical care unit. METHODS: Sixty-nine subjects were randomly assigned to a 6-minute back massage (n=24); a teaching session on relaxation and a 7.5-minute audiotape at bedtime consisting of muscle relaxation, mental imagery, and relaxing background music (n=28); or the usual nursing care (controls, n=17). Polysomnography was used to measure 1 night of sleep for each patients. Sleep efficiency index was the primary variable of interest. One-way analysis of variance was used to test for difference in the index among the 3 groups. RESULTS: Descriptive statistics showed improved quality of sleep among the back-massage group. Initial analysis showed a significant difference among the 3 groups in sleep efficiency index. Post hoc testing with the Duncan procedure indicated a significant difference between the back-massage group and the control group; patients in the back-massage group slept more than 1 hour long than patients in the control group. However, the variance was significantly different among the 3 groups, and reanalysis of data with only 17 subjects in each group revealed no difference among groups (P=.06). CONCLUSIONS: Back massage is useful for promoting sleep in critically ill older men.