title: Inpatient pharmacological sleep aid utilization is common at a tertiary medical center.
abstract: BACKGROUND
  Sleep is known to be poor in the hospital. Patients frequently request pharmacological sleep aids, despite the risk of altered mental status (delirium) and falls. Little is known about the scope of pharmacological sleep aid use in hospitalized patients.
  
  
  METHODS
  We performed a single center, retrospective review of all patients admitted to the general adult (age >18 years) medical and surgical units of a tertiary care center during a recent 2-month period (January 2013-February 2013). Review of the electronic medication administration system was performed to assess for medications administered for sleep.
  
  
  RESULTS
  Of 642 unique admissions, 168 patients (26.2%) received a medication for sleep. Most (n = 115, 68.5%) had no known history of insomnia or regular prior sleep medication use. Patients most frequently were treated with trazodone (30.4%; median dose, 50 mg; range, 12.5-450 mg), lorazepam (24.4%; median, 0.5 mg; range, 0.25-2 mg), and zolpidem tartrate (17.9%; median, 10 mg; range, 2.5-10 mg). Of the medications given, 36.7% were given early (before 9 pm) or late (after midnight). Of patients not known to be previously taking a pharmacological sleep aid, 34.3% of them were discharged with a prescription for one.
  
  
  CONCLUSIONS
  Despite increasing evidence of risks such as delirium or falls, pharmacological sleep aid use in general wards remains common, even in elderly patients. Medication administration time is frequently suboptimal. Many previously sleep medication-naïve patients leave the hospital with a sleep aid prescription. Further research is needed to understand the factors that contribute to the high rate of sleep medication use in hospitalized patients.
authors.affiliation: Department of Pharmacy Services, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Gillis
authors.forename: Janelle O
authors.initials: JO
authors.lastname: Poyant
authors.forename: Jeremy R
authors.initials: JR
authors.lastname: Degrado
authors.forename: Lichuan
authors.initials: L
authors.lastname: Ye
authors.forename: Kevin E
authors.initials: KE
authors.lastname: Anger
authors.forename: Robert L
authors.initials: RL
authors.lastname: Owens
mesh_terms: D000367:Age Factors; D000368:Aged; D004305:Dose-Response Relationship, Drug; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000627:therapeutic use; D007297:Inpatients / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012890:Sleep; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy*; D062606:Tertiary Care Centers
chemical_list: D006993:Hypnotics and Sedatives