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Melatonin for Insomnia in Medical Inpatients: A Narrative Review
Christine Salahub1, Peter E Wu2,3, Lisa D Burry4,5,6
1Support, Systems, and Outcomes Department, University Health Network, Toronto, ON M5G 2C4, Canada.
Journal of Clinical Medicine
|January 8, 2023
Summary
Hospital insomnia is common and can worsen patient outcomes. Melatonin may be a safer alternative to traditional sleep medications for inpatients, especially older adults, with careful consideration of its use.
Area of Science:
- Sleep Medicine
- Pharmacology
- Geriatrics
Background:
- Hospital-acquired insomnia is prevalent, leading to reduced sleep and increased nighttime awakenings.
- Sleep disturbances in hospitalized patients are linked to heightened inflammation, pain, and delirium risk.
- Current insomnia treatments require careful risk-benefit analysis due to potential adverse effects.
Purpose of the Study:
- To review non-pharmacological and pharmacological insomnia treatments for medical inpatients.
- To focus on the role and efficacy of melatonin as a treatment option.
- To evaluate the safety and effectiveness of melatonin compared to other sedative-hypnotics.
Main Methods:
- Narrative review of existing literature on insomnia treatments in hospitalized patients.
- Focused analysis on melatonin's properties, efficacy, and safety profile.
- Comparison of melatonin with benzodiazepines and non-benzodiazepine receptor agonists.
Main Results:
- Traditional sedative-hypnotics carry risks, particularly for patients over 65, including falls and cognitive decline.
- Exogenous melatonin demonstrates a lower likelihood of adverse effects and drug interactions.
- Melatonin shows comparable effectiveness to other sedative-hypnotics.
Conclusions:
- Melatonin may be a suitable option for inpatient insomnia refractory to non-pharmacological methods.
- Further research is warranted to confirm melatonin's effectiveness and safety in hospitalized populations.
- Low-dose melatonin before bedtime could be considered for inpatients experiencing persistent insomnia.
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