Makindo Medical Notes

Sleeping medication is for hospital use only. New prescriptions should be stopped at discharge, and patients should not be sent home on these medications.

About

• Insomnia is a very common issue in hospital settings.
• Sleeping on a hospital ward can be difficult due to the environment.
• Improving sleep can be a good reason to expedite discharge and get patients home.

Aetiology

• Anxiety and stress.
• Alcohol or caffeine intake, especially later in the day.
• Disruptions from smart devices or electronic notifications.

Clinical Features

• Daytime tiredness and reduced alertness, leading to a higher risk of accidents.
• Medications used for sleep can also cause next-day drowsiness or hangover effects.

Investigations

• No specific investigations, but assessing contributing factors to poor sleep is important (e.g., anxiety, caffeine intake).

General Management

• Hospitals are often not conducive to good sleep; addressing environmental factors is important.
• Avoid caffeinated drinks (e.g., tea, coffee) in the afternoon and evening.
• Limit alcohol intake.
• Avoid medications that can act as stimulants, such as steroids, SSRIs, or aminophylline, after midday.
• Encourage a regular routine and physical activity where possible.
• Encourage patients to leave electronic devices in another room to avoid disturbances.
• Use sleep aids like eye masks or earplugs to reduce noise and light interference.

Drug Management

• Short-term use of sleep medications is acceptable during hospital stays (approximately one week).
• Sleep medications should be discontinued before discharge to avoid dependence.
• Temazepam: 10-20 mg at night (ON).
• Zopiclone: 3.75-7.5 mg ON.
• Diazepam: 5-15 mg/24h. Useful for patients with anxiety, but has significant hangover effects the next morning.

Contraindications

• Patients with cardiac, respiratory, or hepatic failure.
• Patients with sleep apnoea.

Side Effects

• Morning drowsiness and grogginess.
• Increased risk of confusion, unsteadiness, and falls, especially in older patients.
• Potential withdrawal symptoms when stopped after prolonged use.

References

• Refer to clinical guidelines on sedative use in hospital environments.