Things We Do for No Reason™: Pharmacological sleep aids for hospitalized patients with acute insomnia

Longino, August; Zero, Odette; Lorenz, Matthew L.

doi:10.1002/jhm.13182

Journal of Hospital Medicine

2023

DOI: 10.1002/jhm.13182

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Things We Do for No Reason™: Pharmacological sleep aids for hospitalized patients with acute insomnia

August Longino

Odette Zero

Matthew L. Lorenz

Abstract: The overnight hospitalist receives a page requesting sleep medication for a 78-year-old patient recovering from a surgical repair of a hip fracture. The patient's medications include as-needed acetaminophen and maintenance intravenous fluids.

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A patient‐centered approach to acute inpatient insomnia

Kadura,

Stewart,

Pigeon

2023

Journal of Hospital Medicine

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We commend Longino et al. for their patient-centered approach to acute inpatient insomnia. 1 In addition to their thorough recommendations, we suggest evaluating for sleep apnea, restless legs syndrome (RLS), and circadian rhythm disturbances. While contributing to acute sleep onset and sleep maintenance insomnia, these disorders are also prevalent and exacerbated in the inpatient setting. Specifically, sleep apnea worsens by starting certain medications (opioids, benzodiazepines, or muscle relaxants) and discontinuing home positive airway pressure (PAP) therapy. Treating sleep apnea with PAP can help inpatients fall asleep and stay asleep.RLS intensifies with inactivity during hospitalization, iron deficiency, and using certain medications (anticholinergics, antidopaminergics, antidepressants). Medications relieving RLS, like gabapentin, can be withheld on admission, needing consideration for resumption or alternate therapy during hospitalization.We also suggest highlighting melatonin's potential to augment circadian rhythm signaling, particularly for "night owls" and older patients with diminished melatonin production. Finally, although untested among inpatients, sleep hygiene may be augmented with components of single-session cognitive behavioral therapy for acute insomnia for those with extended stays. 2 Evaluating known sleep disorders and reviewing medications may enhance the proposed comprehensive and effective patientcentered approach to managing acute inpatient insomnia.

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A patient‐centered approach to acute inpatient insomnia

Kadura,

Stewart,

Pigeon

2023

Journal of Hospital Medicine

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show abstract

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Things We Do for No Reason™: Pharmacological sleep aids for hospitalized patients with acute insomnia

Abstract: The overnight hospitalist receives a page requesting sleep medication for a 78-year-old patient recovering from a surgical repair of a hip fracture. The patient's medications include as-needed acetaminophen and maintenance intravenous fluids.

Cited by 1 publication

References 12 publications

A patient‐centered approach to acute inpatient insomnia

A patient‐centered approach to acute inpatient insomnia

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