Inpatient pharmacological sleep aid utilization is common at a tertiary medical center

Abstract

BACKGROUND Sleep is known to be poor in the hospital. Patients frequently request pharmacological sleep aids, despite the risk of altered mental status (delirium) and falls. Little is known about the scope of pharmacological sleep aid use in hospitalized patients. METHODS We performed a single center, retrospective review of all patients admitted to the general adult (age >18 years) medical and surgical units of a tertiary care center during a recent 2‐month period (January 2013–February 2013). Review of the electronic medication administration system was performed to assess for medications administered for sleep. RESULTS Of 642 unique admissions, 168 patients (26.2%) received a medication for sleep. Most (n = 115, 68.5%) had no known history of insomnia or regular prior sleep medication use. Patients most frequently were treated with trazodone (30.4%; median dose, 50 mg; range, 12.5–450 mg), lorazepam (24.4%; median, 0.5 mg; range, 0.25–2 mg), and zolpidem tartrate (17.9%; median, 10 mg; range, 2.5–10 mg). Of the medications given, 36.7% were given early (before 9 pm) or late (after midnight). Of patients not known to be previously taking a pharmacological sleep aid, 34.3% of them were discharged with a prescription for one. CONCLUSIONS Despite increasing evidence of risks such as delirium or falls, pharmacological sleep aid use in general wards remains common, even in elderly patients. Medication administration time is frequently suboptimal. Many previously sleep medication‐naïve patients leave the hospital with a sleep aid prescription. Further research is needed to understand the factors that contribute to the high rate of sleep medication use in hospitalized patients. Journal of Hospital Medicine 2014;9:652–657. © 2014 Society of Hospital Medicine

Good Night's Sleep Gone Wrong

“…As a result, patients are frequently prescribed pharmacologic sleep aids during hospitalizations. In fact, approximately 34% of patients who do not have documented sleep disorders before hospitalization, and have not been previously prescribed pharmacologic sleep aids, are discharged from the hospital on sleep aid medications 4 …”

“…In fact, approximately 34% of patients who do not have documented sleep disorders before hospitalization, and have not been previously prescribed pharmacologic sleep aids, are discharged from the hospital on sleep aid medications. 4 Despite emerging evidence that use of sleep aids is associated with adverse effects and detrimental outcomes, such medications are still commonly prescribed during hospital stays and upon discharge. 4 A wide variety of medications are used as sleep aids, including first-generation antihistamines (eg, diphenhydramine), benzodiazepines (eg, lorazepam), antidepressants (eg, amitriptyline), typical antipsychotics (eg, haloperidol), atypical antipsychotics (eg, quetiapine), melatonin, and melatonin agonists (eg, ramelteon).…”

The Sleeping Pill Prescription Rate for Inpatients at a General Hospital

“…Previous studies have also reported higher hypnotics prescription rates among hospitalized patients compared to the general population. 35,36 Gillis et al 35 reported that 26.2% of inpatients were prescribed hypnotics during a 2-month period of hospitalization, and one third of patients who were not previously taking sleeping pills were prescribed hypnotics at discharge. Somers et al 36 showed that 33.1% of patients were prescribed hypnotics during hospitalization.…”

Evidence-based out-of-hours hospital medicine

“…Nearly 70% of these patients had no prior insomnia or sleep aid use, despite 34% being prescribed sleep aids on discharge 10. The British National Formulary states that routine prescribing of anxiolytic and hypnotic agents as sleep aids is undesirable.…”