Sleep in Hospitalized Medical Patients, Part 2: Behavioral and Pharmacological Management of Sleep Disturbances

BACKGROUND: As described in Part I of this article, multiple factors lead to disrupted sleep in hospitalized medical patients. Recognizing and addressing these factors can help clinicians more effectively manage patients' sleep complaints. METHODS: A PubMed search was conducted by cross-referencing the terms sleep deprivation, insomnia, and sleep; hospitalized, acutely ill, and critically ill; and medication, drugs, hypnotics, benzodiazepines, and sedatives. The search was limited to English-language articles published between 1997 and 2008. Subsequent PubMed searches were performed to clarify the data described in the initial search. RESULTS: Few articles addressed the topic of the assessment and management of sleep problems in hospitalized medical patients. In Part 2, we propose an evaluation and treatment algorithm that includes recommendations regarding the use of nonpharmacologic and pharmacologic therapies as clinicians consider relevant clinical data. The algorithm is accompanied by 5 tables that include pertinent and practical information to assist clinicians as they manage their inpatients' sleep complaints. CONCLUSIONS: Assessment of a sleep complaint should include a review of factors that could exacerbate patients' sleep. The treatment could then focus on ameliorating these factors, and the judicious use of nonpharmacologic strategies and psychopharmacologic agents. Journal of Hospital Medicine 2009;4:50-59. (c) 2009 Society of Hospital Medicine.