| Autor: |
Salahub C; Support, Systems, and Outcomes Department, University Health Network, Toronto, ON M5G 2C4, Canada., Wu PE; Division of Clinical Pharmacology & Toxicology, University of Toronto, Toronto, ON M5S 1A8, Canada.; Department of Medicine, University of Toronto, Toronto, ON M5S 3H2, Canada., Burry LD; Department of Pharmacy and Medicine, Sinai Health System, Toronto, ON M5G 1X5, Canada.; Interdepartmental Division of Critical Care, Leslie Dan Faculty of Pharmacy, Toronto, ON M5G 3M2, Canada.; Department of Family and Community Medicine, University of Toronto, Toronto, ON M5S 2E8, Canada., Soong C; Division of General Internal Medicine and Geriatrics, University Health Network and Sinai Health System, Toronto, ON M5G 2C4, Canada.; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada., Sheehan KA; Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada.; Centre for Mental Health, University Health Network, Toronto, ON M5T 2S8, Canada., MacMillan TE; Department of Medicine, University of Toronto, Toronto, ON M5S 3H2, Canada.; Division of General Internal Medicine and Geriatrics, University Health Network and Sinai Health System, Toronto, ON M5G 2C4, Canada., Lapointe-Shaw L; Division of General Internal Medicine and Geriatrics, University Health Network and Sinai Health System, Toronto, ON M5G 2C4, Canada.; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada.; ICES, Toronto, ON M4N 3M5, Canada.; Women's College Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON M5S 1B2, Canada. |
| Abstrakt: |
In this narrative review, we describe what is known about non-pharmacological and pharmacological treatments for insomnia in medical inpatients, with a focus on melatonin. Hospital-acquired insomnia is common, resulting in shortened total sleep time and more nighttime awakenings. Sleep disturbance has been shown to increase systemic inflammation, pain, and the likelihood of developing delirium in hospital. Treatment for insomnia includes both non-pharmacological and pharmacological interventions, the latter of which requires careful consideration of risks and benefits given the known adverse effects. Though benzodiazepines and non-benzodiazepine benzodiazepine receptor agonists are commonly prescribed (i.e., sedative-hypnotics), they are relatively contraindicated for patients over the age of 65 due to the risk of increased falls, cognitive decline, and potential for withdrawal symptoms after long-term use. Exogenous melatonin has a comparatively low likelihood of adverse effects and drug-drug interactions and is at least as effective as other sedative-hypnotics. Though more research is needed on both its effectiveness and relative safety for inpatients, small doses of melatonin before bedtime may be an appropriate choice for inpatients when insomnia persists despite non-pharmacological interventions. |
