Insomnia - unable to sleep issues
🌙 Sleeping medication is generally for hospital use only.
New prescriptions should be stopped at discharge - patients should not be sent home on these drugs 🚫🏠.
📝 About
- Insomnia is very common in hospital wards 🏥.
- Sleep disturbance is often due to the ward environment (noise, light, interruptions).
- Improving sleep can help expedite discharge by getting patients home where sleep is often better 🏡.
🔎 Aetiology
- Anxiety, stress, or low mood 😟.
- Alcohol 🍷 or caffeine ☕ (particularly late in the day).
- Electronic devices 📱 disrupting circadian rhythm.
🩺 Clinical Features
- Daytime fatigue, reduced alertness, impaired concentration 💤.
- Increased risk of falls and accidents in hospital 🚑.
- Drug-related “hangover” effect the next morning.
🔬 Investigations
- No specific tests required.
- Key: assess contributing factors such as anxiety, stimulants, or underlying conditions (e.g., pain, delirium).
🌿 General Management
- Optimise ward environment: reduce light, noise, and interruptions 🌙.
- Avoid caffeine/tea/coffee after midday ☕❌.
- Limit alcohol intake 🍺.
- Avoid stimulant medications after midday (steroids, SSRIs, aminophylline).
- Encourage regular routine, activity, and daytime mobilisation 🚶.
- Suggest earplugs, eye masks, or relaxation strategies 😌.
- Discourage use of electronic devices at night 📵.
💊 Drug Management
- Short-term use only (≈ 1 week in hospital).
- Always discontinue before discharge ❌🏠.
- Temazepam: 10–20 mg ON 🌙.
- Zopiclone: 3.75–7.5 mg ON 🌙.
- Diazepam: 5–15 mg/24h (occasionally for anxiety, but significant next-day drowsiness).
🚫 Contraindications
- Cardiac, respiratory, or hepatic failure.
- Obstructive sleep apnoea 🛑😴.
⚠️ Side Effects
- Morning drowsiness, grogginess, and “hangover effect.”
- Confusion, unsteadiness, and falls in older adults 👴.
- Dependence and withdrawal symptoms if prolonged use.
📚 References
- Refer to BNF & hospital guidelines on sedative prescribing.
💡 Clinical Pearls
- Most hospital insomnia is environmental - non-drug measures first 🌿.
- Stop hypnotics before discharge to avoid community dependence 🚫.
- Elderly patients are highly vulnerable to side effects - use extra caution 👵.
