The Challenge of Sleep in a Hospital Setting
Sleep is a critical component of healing, yet up to 80% of ICU patients experience sleep deprivation during their hospital stay [1.3.2]. A major study found that hospitalized patients get, on average, 83 minutes less sleep per night compared to their habits at home [1.3.3]. This disruption is caused by a variety of factors unique to the hospital environment. The most frequently cited reasons for poor sleep are noise from other patients and equipment, pain, and being awakened by hospital staff for clinical activities like checking vital signs or administering medication [1.3.3]. The constant light, anxiety about one's health, and the unfamiliar surroundings also contribute significantly to insomnia [1.3.4].
Due to these challenges, healthcare providers often turn to pharmacological solutions to ensure patients get the rest they need. The choice of medication is carefully considered based on the patient's specific condition, age, other medications they are taking, and the underlying cause of their sleeplessness [1.4.3].
Common Classes of Sleeping Pills Used in Hospitals
Hospitals use several classes of medications, known as sedative-hypnotics, to treat insomnia. The goal is to induce sleep safely without causing significant side effects or dependency. The most common categories include:
- Non-Benzodiazepine Sedative-Hypnotics (Z-Drugs): This class is often a first-line choice and includes medications like Zolpidem (Ambien), Eszopiclone (Lunesta), and Zaleplon (Sonata) [1.2.2, 1.10.2]. They work by slowing brain activity and are effective for helping patients fall asleep [1.10.1]. Eszopiclone, with its longer half-life, is particularly useful for patients who have trouble staying asleep [1.10.3]. These are generally preferred because they are thought to have a better safety profile than older medications [1.9.3].
- Benzodiazepines: This older class of drugs includes Temazepam (Restoril), Lorazepam (Ativan), and Estazolam [1.2.5, 1.9.4]. They are effective for treating insomnia, severe anxiety, and panic disorders [1.9.1]. Benzodiazepines work by enhancing the effect of the neurotransmitter GABA, which inhibits brain activity, leading to sedation and muscle relaxation [1.9.4]. However, their use is often short-term due to risks of dependency, tolerance, and withdrawal symptoms [1.9.3, 1.9.4].
- Sedating Antidepressants: Certain antidepressants are used in lower doses for their sedative effects. Trazodone is one of the most commonly used in this category within hospitals because it is less likely to cause dependency [1.2.2, 1.2.3]. It can improve sleep duration and reduce awakenings, making it a viable option, especially for patients who also have depression or a history of substance abuse [1.7.4, 1.2.4].
- Melatonin Receptor Agonists: Ramelteon (Rozerem) is a medication that mimics the natural sleep hormone melatonin [1.2.4]. It helps regulate the body's sleep-wake cycle and is used for patients who have difficulty falling asleep [1.2.2]. It is not a controlled substance and may be a good option for patients with a history of drug abuse [1.2.4]. Studies have also explored its role in preventing delirium in hospitalized patients, though results are mixed [1.11.1, 1.11.4].
- Antihistamines: First-generation antihistamines like Diphenhydramine (Benadryl) and Doxylamine are sometimes used for their sedating side effects [1.8.4, 1.6.4]. However, their routine use as a hypnotic in hospitalized patients is often discouraged due to potential side effects like confusion, dry mouth, and blurred vision, especially in the elderly [1.2.4, 1.5.2].
Comparison of Hospital Sleeping Pills
| Medication Class | Common Examples | Primary Use in Hospital | Key Considerations |
|---|---|---|---|
| Non-Benzodiazepines (Z-Drugs) | Zolpidem, Eszopiclone | Sleep onset and maintenance [1.10.3] | Generally a first-line choice; lower risk of dependence than benzodiazepines but can cause next-day drowsiness and complex sleep behaviors [1.10.2, 1.10.1]. |
| Benzodiazepines | Temazepam, Lorazepam | Short-term treatment of severe insomnia and anxiety [1.9.1] | Effective but carry risks of dependence, tolerance, and cognitive impairment; not recommended for long-term use [1.9.4]. |
| Sedating Antidepressants | Trazodone | Insomnia, especially with co-existing depression [1.2.4] | Lower dependency risk; can cause side effects like orthostatic hypotension (dizziness upon standing) [1.2.4]. |
| Melatonin Receptor Agonists | Ramelteon | Sleep-onset insomnia [1.2.2] | Not a controlled substance; good safety profile with mild side effects like dizziness and headache [1.2.4]. |
| Antihistamines | Diphenhydramine | Mild, occasional insomnia | Use is discouraged in hospitals due to anticholinergic side effects, especially in elderly patients [1.2.4, 1.8.1]. |
Risks and Side Effects
All sleeping pills carry potential risks. Common side effects include daytime drowsiness, dizziness, confusion, and impaired coordination, which can increase the risk of falls, particularly in older adults [1.5.1, 1.5.5]. Some medications, like Z-drugs, have been associated with rare but serious complex sleep behaviors such as sleepwalking or sleep-driving [1.10.1]. Long-term use of benzodiazepines can lead to physical dependence and difficult withdrawal symptoms [1.5.1]. It is crucial that these medications are administered under close medical supervision, at the lowest effective dose, and for the shortest duration possible [1.2.5].
Non-Pharmacological Alternatives
Recognizing the risks of medication, hospitals are increasingly implementing non-pharmacological strategies to improve patient sleep. These interventions focus on making the hospital environment more conducive to rest and include:
- Noise Reduction: Using earplugs, white noise machines, and creating designated "quiet times" [1.4.5, 1.4.4].
- Light Control: Providing eye masks and dimming lights at night to promote a natural circadian rhythm [1.4.5].
- Clustering Care: Grouping nursing tasks like administering medications and checking vitals to minimize nighttime interruptions [1.4.3].
- Relaxation Techniques: Offering guided imagery, music, or massage to reduce anxiety and promote relaxation [1.4.4].
Conclusion
Hospitals employ a variety of sleeping pills to manage the significant challenge of patient insomnia, with choices ranging from modern Z-drugs and benzodiazepines to sedating antidepressants. The selection of a specific medication is a careful decision, balancing the need for rest against potential side effects and patient-specific factors. As awareness of sleep's importance in recovery grows, these pharmacological treatments are increasingly supplemented by non-pharmacological strategies aimed at creating a more restful healing environment.
For more information, a useful resource is MedlinePlus from the National Library of Medicine: Medicines for sleep [1.2.2].
