Night Sedation 🌙
Clinical guide for prescribing night sedation and sleep aids. Drug reference table, dosing, contraindications, and sleep management for hospital inpatients.
🧠 Definition
- Short-term use of medication to aid sleep in hospital.
- Always consider underlying causes first.
📞 What to Ask / Check
- Why aren’t they sleeping? (pain, noise, anxiety, delirium?)
- Any prior use of sedatives?
- Fall risk, confusion, substance use?
📋 Common Causes
- Noise / light / unfamiliar setting
- Pain or discomfort
- Delirium / anxiety
- Steroids, withdrawal
🧾 History
- Sleep pattern + duration
- Previous sedative use
- Psych history / substance use
- CNS depressant meds
🩺 Exam
- Check orientation (rule out delirium)
- Vitals
- Pain, distress, retention
🔍 Investigations
- Usually none
- If unwell/confused: bloods, imaging as needed
💊 Management
- Non-drug first: comfort, noise, toilet, analgesia
- Avoid sedation in confusion/fall risk
- Short-term only, at lowest dose
💊 Sedation Options
- See table below for typical agents with dosing and safety considerations. If a patient is already on a particular sedative at home, consider continuing it if appropriate.
Night Sedation Medications
Sleep aids and sedatives
| Drug | Category | Dose | Notes |
|---|---|---|---|
| Melatonin MR | Natural | 2–4 mg PO | Preferred in elderly/delirium risk |
| Chlorphenamine (Piriton) | Antihistamine | 4 mg PO | Caution in elderly; sedating antihistamine |
| Zopiclone (Zimovane) | Z-drug | 3.75–7.5 mg PO | Short-acting; common first-line |
| Zolpidem (Stilnoct) | Z-drug | 5–10 mg PO | Short-acting; less hangover |
| Temazepam (Normison) | Benzodiazepine | 10 mg PO | Avoid in elderly; addictive potential |
Melatonin MR
NaturalDose: 2–4 mg PO
Notes: Preferred in elderly/delirium risk
Chlorphenamine (Piriton)
AntihistamineDose: 4 mg PO
Notes: Caution in elderly; sedating antihistamine
Zopiclone (Zimovane)
Z-drugDose: 3.75–7.5 mg PO
Notes: Short-acting; common first-line
Zolpidem (Stilnoct)
Z-drugDose: 5–10 mg PO
Notes: Short-acting; less hangover
Temazepam (Normison)
BenzodiazepineDose: 10 mg PO
Notes: Avoid in elderly; addictive potential
⚠️ Important Considerations
- • Avoid benzodiazepines in elderly patients due to fall risk
- • Z-drugs preferred over benzodiazepines when possible
- • Consider non-pharmacological sleep hygiene first
- • Monitor for dependency and tolerance with regular use
- • Review and discontinue if no longer needed