Nursing Habits: Sleeping Pills

[Tait, MSN, RN]

Just wondering in general what everyone's policy on sleeping meds are.

I tell my patients up front that I don't give a sleeping med after 0100. I figure this is general practice for most of us, however I like to make threads that aren't the same old thing.

Generally we give Restoril with an occasional 5-10mg Ambien patient.

Tait

[NurseCard, ADN]

We don't have any kind of special policy in place, but I too generally do not give any sleeping pills after about 1 am.

[Straydandelion]

There was no policy where I worked and I would generally give one after 1 depending on the tests etc. planned the next day yet when making rounds would inform them I can't give the sleeping pill too late when I offer it. If too late when they finally decide on one, sometimes I could find a prn ordered to give instead even if tylenol, one time I discussed the benefits of warm milk and sleep offering that to a patient, she went right to sleep after drinking it. Sometimes I think just the thought of something that will help calms and lets them sleep.

[StNeotser, ASN, RN]

1 am was about my cut off time too. Sometimes patients would be asleep from about 8pm till 1am and then ask me for a pill because they woke up. I didn't think it was a good idea after that.

[queenjean]

Our official protocol is 2am. If the pt has one ordered, I try to remember to tell them they can have it up until about 2.

We usually use ambien. I hate it. It makes so many people goofy. I'd rather we use lunesta. Or why not a straight up ativan or xanax? If someone takes a sleeper at home, great, let's give them what they usually take. But if they can't sleep in the hospital, it's usually because they are anxious or worked up from the change in environment, being ill, tests in the morning, etc. Why not just give them something to take the edge off instead of something that makes them think they need to chase the chickens out of the room?

[Xbox Live Addict]

Our official protocol is 2am. If the pt has one ordered, I try to remember to tell them they can have it up until about 2.

We usually use ambien. I hate it. It makes so many people goofy. I'd rather we use lunesta. Or why not a straight up ativan or xanax? If someone takes a sleeper at home, great, let's give them what they usually take. But if they can't sleep in the hospital, it's usually because they are anxious or worked up from the change in environment, being ill, tests in the morning, etc. Why not just give them something to take the edge off instead of something that makes them think they need to chase the chickens out of the room?

I've found Ambien is rather safe, myself. I've noticed fewer side effects in patients and less grogginess in them when it wears off. And any benzo can have paradoxical effects on patients (causing severe anxiety and confusion). Most HCP's these days try to stay away from Restoril unless the insurance or Medicare is adamant about not paying for Ambien or Lunesta.

[queenjean]

My experience is completely opposite, particularly in the population over 60. Give a perfectly a/o 70 year old fellow ambien, and you know you are going to end up with a confused little guy who pulls out his foley and tries to herd the chickens he heard clucking outside his door (nurses chatting at the station). If you don't, you're lucky.

If a pt hasn't taken ambien previously and they are older, I don't even offer it to them unless I have absolutely no alternative. I've had too many of them get goofy on me after taking the ambien. Even just 5mg.

[beckabeckahi]

I've learned my lesson with Ambien too. Turns alert and oriented into disoriented and a fall risk. If patient takes at home, usually not an issue, but if not, there about a 20% chance they'll go off the deep end.

[Tait, MSN, RN]

I am in complete agreement about Ambien. I feel it is too strong for most people. I remember having to ask a very competent patient if he remembered standing at his door in the buff at one point during the night. He was mortified and completely amnesic of the event.

While Restoril doesn't work for everyone, I tend to find it doesn't drive quite as many of my patients bonkers. We use no other options at our hospital.

Tait

[nursemike, ASN, RN]

I work on a neuro/neurosurg unit where a lot of patients have explicit orders not to give narcs for pain after 0400, until rounds have been completed, since docs need to assess LOC. If the patient is having any sort of pain issues, I try to time their last dose for 0359.

I don't think there's a formal protocol, but my mentor usually cuts off sleep aids after 0200, and that's pretty much what I do. But it's tough, because a lot of times you don't know you have insomnia until 0300. A lot of patients have nothing ordered, anyway, and if I check with the docs, they'll often clear giving something. We use Benadryl a lot, Ambien occassionally. Then again, sometimes I have to awaken a pt for 0400 Ativan. So it all depends...

[Gr8Dane]

My Sleeping Pill Policy:

If theres a sleeping pill ordered, its added into the 2100 med pass lol Unless their in some sort of distress, but even then I may give it to relax them pending on situation of course. (Not going to give a non/semi responsive patient one).

Makes for a nice night and if they ask for one later on I simply say you got it at 9, close your eyes.

[ByTheLake]

I will give sleep meds until 0200, but I work psych, and our pts often have serious sleep issues, and if they are psychotic, manic, etc. will often still be up for breakfast 5 hrs later. When I work the psych ICU I will give downers any time they want, especially the really paranoid ones who haven't slept for days and are afraid you're trying to poison them every time you try to give them a geodon or seroquel--so if they are willing to swallow a pill, boy howdy they can have it! LOL!

Where I draw the line is that I won't give benzos between like 4-5 am until after breakfast (as in the next shift). "Awake is not anxiety. It's just being awake."