Night Sedation 🌙

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🧠 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

Melatonin MR
Natural

Dose: 2–4 mg PO

Notes: Preferred in elderly/delirium risk

Chlorphenamine (Piriton)
Antihistamine

Dose: 4 mg PO

Notes: Caution in elderly; sedating antihistamine

Zopiclone (Zimovane)
Z-drug

Dose: 3.75–7.5 mg PO

Notes: Short-acting; common first-line

Zolpidem (Stilnoct)
Z-drug

Dose: 5–10 mg PO

Notes: Short-acting; less hangover

Temazepam (Normison)
Benzodiazepine

Dose: 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
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