Rapid Clinical Updates: No Rest for the Admitted: Tackling Insomnia in the Hospital-Slides

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The panel discussion "No Rest for the Admitted: Tackling Insomnia in the Hospital," featuring Drs. Jennifer Woodard, Vineet Arora, and Ethan Molitch-Hou, addresses the pervasive issue of inpatient insomnia, especially among older adults, and provides strategies to improve sleep quality in hospitals. Hospitalized patients experience significantly reduced and fragmented sleep, averaging two hours less than at home, which negatively impacts recovery, cognitive function, immune response, and metabolic stability. Poor sleep is linked to adverse outcomes like hypertension, hyperglycemia, delirium, functional decline, and increased readmissions.<br /><br />Multiple factors disrupt sleep in hospitals, including noise, frequent nighttime vital sign checks, medical interventions, discomfort, and environmental factors. Evidence shows that routine overnight vital signs often lack clinical justification and contribute to sleep fragmentation.<br /><br />To combat these issues, two evidence-based interventions were discussed: SIESTA (Staff-focused Intervention to Enhance Sleep Tranquility in the Acute-care setting) and I-SLEEP (patient-centered approach). SIESTA empowers healthcare teams through education, workflow changes, and electronic health record (EHR) adjustments to reduce nighttime disruptions, such as limiting routine overnight vitals and lab draws. This strategy showed a 44% reduction in nighttime room entries and improved patient-reported sleep. I-SLEEP equips patients with tools like sleep kits (eye masks, earplugs), educational materials, and advocacy skills to request clustering of care to minimize sleep interruptions.<br /><br />Regarding pharmacologic management, melatonin is the most commonly prescribed inpatient sleep aid, with a favorable safety profile but variable dosing and limited high-quality evidence. Selective melatonin receptor agonists (ramelteon) and dual orexin receptor antagonists (daridorexant, lemborexant, suvorexant) show promise in improving sleep and potentially reducing delirium risk without significant adverse effects. Conversely, commonly used medications such as benzodiazepines, Z-drugs, trazodone, and hydroxyzine carry risks including falls, delirium, and orthostatic hypotension, and should be used cautiously, especially in older adults.<br /><br />Non-pharmacologic strategies like sleep hygiene, environmental modifications, daytime activity, and limiting nighttime interruptions are emphasized. Clinicians are encouraged to view sleep as a vital sign and actively engage patients in sleep protection to enhance recovery and patient satisfaction.

Keywords

inpatient insomnia

hospital sleep disruption

older adults sleep

SIESTA intervention

I-SLEEP program

melatonin inpatient use

orexin receptor antagonists

non-pharmacologic sleep strategies

sleep hygiene in hospitals

sleep as a vital sign