Table 3.

Medications commonly used to promote sleep in hospitalized patients [58, 64, 124–126]

Medication	Mechanism of action	Route of administration	Side effects	Sleep effects	Risk of delirium in older adults
Listed under Beers criteria
Opiates [127–129]	CNS opioid receptor agonist	Oral or intravenous	Dependency, hypotension, respiratory depression, withdrawal	↓N3, ↓REM, ↓TST, ↑W	↑
Atypical antipsychotics [130, 131]	5HT2 D2-receptor antagonist	Oral	Dizziness, extrapyramidal symptoms, neuroleptic malignant syndrome, orthostatic hypotension	↑N3, +/−↑REM, ↑SE, ↓SL, ↑TST, ↓W	No change
Typical antipsychotics [130, 131]	Dopamine receptor antagonist	Oral or intravenous	Anticholinergic effects, extrapyramidal symptoms, neuroleptic malignant syndrome, QT prolongation, tardive dyskinesia	↑N2, ↑N3, ↑SE, ↓SL, ↑TST, ↓W	No change
Trazodone [132, 133]	Serotonin reuptake inhibitor, 5-HT1A,1C,2; H1 receptor antagonist	Oral	Anticholinergic syndrome, arrhythmias, orthostatic hypotension	↑N3, ↑↓REM, +/−↑SE, ↓SL	+/−↑
Antihistamines [133]	H1-receptor antagonist	Oral or intravenous	Anticholinergic syndrome, dizziness, impaired coordination	+/−↑N3, ↓REM, +/−↑SE, ↓SL	↑
Benzodiazepines [3, 134–136]	GABA receptor agonist	Oral or intravenous	Dependency, deliriogenic, dizziness, hypotension, withdrawal	↓N3, ↓REM, ↓SL, ↑TST, ↓W	↑
Non-benzodiazepine hypnotics [137]	GABA receptor agonist	Oral	Daytime somnolence, dizziness, confusion	↓N2, ↓N3, ↑↓REM, ↓SL ↑TST, ↓W	↑
Not listed under Beers criteria
Dexmedetomidine [136, 138]	a2-Agonist	Intravenous	Bradycardia, hypotension	↑N2 with sleep spindles, +/−↑N3/SWS, ↓REM, ↑SE, ↓SL	↓
Propofol [139, 140]	GABA receptor agonist	Intravenous	Bradycardia, hypotension, propofol infusion syndrome, respiratory depression	↓REM, ↓SL, ↑TST, ↓W	↑
Melatonin and melatonin receptor agonists [141–145]	Melatonin 1 and 2 receptor agonist	Oral	Dizziness, hallucinations, nausea, vivid dreams	↑SE, ↓SL, ↑ TST	↓

SWS slow wave sleep, REM rapid eye movement, SE sleep efficiency, SL sleep latency, TST total sleep time, W wake

↓ = decreased; ↑ = increased; ↑↓ = equivocal; +/−↑ = may increase; +/−↓ = may decrease