Sleeping pill at THIS time????

TazziRN, RN · Aug 26, 2006

I would try to avoid giving a sleeping pill to a pt during the day if it's a once-daily dose, because to the "normal world", HS is at night.

What bugs me about sleeping pills is having a pt awakened for VS after the pill is given. My mom was in the hospital 3 weeks after she had her stroke, and she would go to sleep after getting a pill, only to be awakened by the night shift for VS and then would be unable to get back to sleep. I finally asked the doc to write orders to leave her alone after the pill was given.

HappyNurse2005, RN · Aug 26, 2006

Well, I think that if given a sleeping pill too late in the night, say, after 2a or so, that they might be too sleepy to participate in any tests they have scheduled. Like treadmill stress tests, dialysis, or how about physical therapy? What if they are too sleepy from their ambien at 5am to participate in PT at 1000, and that messes with their recovery. People are hardly "sitting in the hospital all day watching TV or talking on the phone" at least not in my post op PCU.

Had a pt once, post op cabg, request a restoril at 0900. The new nurse almost gave it to her, after i suggested that might not be a good idea.

Had a pt once who needed a pa and lat cxr, but had had some phenergan at 0600 and it knocked her out bad enough she couldn't stand up for the cxr (not a sleeping pill, but same effect)

you could clarify w/ the MD

Sylv · Aug 26, 2006

Well, I think that if given a sleeping pill too late in the night, say, after 2a or so, that they might be too sleepy to participate in any tests they have scheduled. quote
I agree with the above. Don't work nights now, but we wouldn't give sleeping pills after 2 a.m., they'll be asleep all day.
I wouldn't give a sleeping pill during the day unless it was ordered to be given that way.

ZASHAGALKA, RN · Aug 26, 2006

Day/Night orientation is EXTREMELY inportant to the elderly. Purposely confusing normal circadian boundaries is a primary cause of in-hospital delirium, what we used to call, "ICU Psychosis".

As nurses, we must respect tactile, observational, and yes, CHEMICAL orientation cues.

My rule is no sleeping pills after 2am. Are there exceptions? Of course. I recently gave a gentleman an Ambien at 5am. But then, I had also just pulled an arterial sheath from his groin and he was required to remain on strict bedrest for 6 more hours. And aid to sleeping through that was a valid exception.

Otherwise, respect circadian rhythms. They are powerful. There is a REASON why most heart attacks happen between 3 and 6 am: that is when the body of normal people (unlike shiftworkers like myself) are metabolically 'ramping up' for the day ahead.

~faith,

Timothy.

mediatix8 · Aug 26, 2006

The causes of ICU psychosis aren't really known, but confusion of day and night is one theory or one possible contributing factor. Also is sleep deprivation, sensory deprivation, pain.

I know I'm trying to be the devil's advocate here, but people respond to medications differently. When I posted about sleeping pills, I really had ambien in mind. Some people say their ambien doesn't "work." Or it only works for a couple of hours. For others, it works too well and they're sleeping too much! Some pain medications and antianxiety medications often will make a patient sleepy...depending on the medication and the patient physiological response to the medication. Do we not give these during the day? If a patient asks for benadryl for their itchy rash at 9 am do you not give it because it will make them tired? I know we should tell them that is likely to happen but then it's up to them if they want benadryl or not. I know these meds are given for other reasons besides to sleep but they often do have that outcome. I once had an I & D of an abcess and was in the hospital for about 2 days. I accepted a couple of pain pills (don't remember what they were as I was 18 at the time). They made me so sleepy...I slept almost the entire time- day and night- and I am still alive to talk about it.

If the patient has a stress test scheduled for the morning and they are asking for ambien at 3am I would not give it to them, either. But what if they actually don't have anything ordered besides some lab work and respiratory treatments or something. Then again, you don't know what might be ordered later in the day. But I believe in discussing all of this with the patient and if they are still adamant about it then do we really have the right to say that HS is a specific time or range of times? When is it? 9pm-1am? 8pm-2am? What about 8:30pm to 2:30 am? One nurse will say one time and another will say another time.

Giving ambien at an off time may be beneficial to the patient, depending on their physiological response to it, what tests or treatments are happening, and how sleep deprived they are. If a patient still hasn't fallen asleep by 3:30am then they may not be much good for PT whether you give them an ambien or not. I believe that as nurses we need to educate the patient about the effects of ambien and discourage it being given at an off time but I think they have a right to get ambien at an off time- with a few exeptions.

Tweety, BSN, RN · Aug 26, 2006

When I worked nights I tried not to give sleeping pills after 2AM. But I didn't make it a hard and fast rule and took each case as it came. Not being able to sleep is stressful situtation. I don't think in all my years I gave a sleeping pill past 3:30AM.

It's frustrating that when they ask for a sleeping pill at 9pm and then 3 hours later you're taking their vitals.

I disagree with families and doctors that insist their loved one's sleep not get distrubed during the night shift. If they are that stable, they should be discharged. But it does seem counterproductive "here's your sleeping pill but I'll be waking you up later".

nursenatalie, ADN, RN · Aug 26, 2006

As a general rule with only a few exceptions, I would not give a sleeping pill past 2 am. I work on a surgical floor and the day time is reserved for walking and therapy so pts need to be as awake as possible for that. Ambien and other sleep meds are given with the intent to make the pt sleep and this is the only reason they are given. Although they may also make the pt go crazy, disrobe, pull out their IV and run down the hallway naked, that is another story. Other meds are given for nausea, itching or pain and have the side effect of sleepiness. There are few exceptions but generally no reason to give a med to make a pt sleep while the sun is shining.

melpn · Aug 26, 2006

At our rehab facility we don't give sleepers past 0100 per house policy. We've found that anything later than that interferes w/ getting 'em up for PT/OT/ST/physiatry visits. These disciplines operate on a pretty tight schedule, so if pts. aren't ready or are logy (we try to pre-medicate w/ pain meds for therapy sessions,too), then it screws things up all the way down the line. That said, in the hospital, if the pt isn't scheduled for anything that requires his best mental faculties, then who cares? I could see the docs (consults,etc.) being a bit peeved if the pt. is asleep or groggy from a late sleeper when they are trying to get a hx,though.

CarVsTree · Aug 26, 2006

I accepted a couple of pain pills (don't remember what they were as I was 18 at the time). They made me so sleepy...I slept almost the entire time- day and night- and I am still alive to talk about it.
If the patient has a stress test scheduled for the morning and they are asking for ambien at 3am I would not give it to them, either. But what if they actually don't have anything ordered besides some lab work and respiratory treatments or something. Then again, you don't know what might be ordered later in the day.

What you must keep in mind is that a sleeping pill is often given on top of the pain meds, benadryl, nausea meds (such as .phenergan). That is a lot of meds. And giving a sleeping pill after 2am will alter a pt for the morning assessment with the docs as well as PT/OT, etc. as stated by other posters. Docs will get a false impression of how the pt. is doing because they will be asleep.

If a pt. cannot sleep after 3 a.m. perhaps it is more important to find out why and help with that rather than give them a sleeping pill that may not kick in until it is time to get up. Then it will last another 5 hours or so which will have your pt sleeping through breakfast and lunch. Nutrition is also important.

A sleeping pill is not a patient's right. While a pt. is in the hospital, we must do what is best for them. HS means 2200 where I work. We have the leeway withing hospital policy to give a sleeping pill up until 0200. If it is after 3 a.m. the only thing I will give is ativan for anxiety and they have to be hanging off the ceiling for me to do that. On some occasions, I will give Benadryl as it is shorter acting than ambien. Even a person who works nights is on and must remain on a dayshift schedule in the hospital. This is because case manages, OT, PT, rounds are all done during the day. Nights we try to keep things quiet (not always possible) and help our patients to get rest.

Pepper The Cat, BSN, RN · Aug 26, 2006

Another problem with giving a sleeping pill after 2 or 3am is that is messes up that sleep for the next night too. If they sleep half the day away, then they can't sleep the night too. It becomes a vicious circle. Now I don't know anything about Ambien but I would assume that it would provide apporx 8 hours of sleep. Which means it could be 1:00 pm before the person is awake.

Agnus · Aug 27, 2006

In an ideal world taking the pill anytime sleeping anytime would be appropriate. Unfortunately it can cause problems in the hospital because bright and sharp things start happening in the hospital usually starting around 7 a. m. Test proceedures, doctor vists, therapies, and on and on do not accomodate the late or day sleeper. Even meals are only served at certain times and to get a meal between certain hours is impossible. If you miss breakfast it is gone. If you miss lunch just try and get it later. You are lucky to get a very minimal snack between meals and after the evening meal absolutely nothing in terms of a late supper can be gotten for a patient.

I would love to see patients be able to stick to what ever sleep schedule they are used to. But when everything works at the convenience of the hospital schedule it will not happen.

I see most patients glad to go home so they can finally get some rest.

It is a shame that our so called health care system works like that.

Look at the poor quality food of poor nutritional value served to patients and staff.