Sleep Drugs and Anesthesia 

Postoperative sleep disturbances like insomnia, hypersomnia, narcolepsy, altered sleep patterns and frequent awakening may be triggered by the use of general anesthesia. Luo et al. write that postoperative sleep disorders potentially increase the risk of postoperative complications like severe exhaustion, anxiety and depression, and delirium. The type of surgery performed can disrupt physiological sleep pathways; for example, patients undergoing coronary artery bypass graft surgery (CABG) had a high rate of postoperative sleep disorders which was partly attributed to disruptions in melatonin secretion, during the perioperative period. ¹ As a result, some patients may benefit from sleep drugs after anesthesia to facilitate recovery. 

The timing of the surgery and the circadian rhythm of patients strongly impact the way anesthesia is metabolized in the body. Hou et al. find that while both morning and afternoon surgical procedures significantly affect patients’ postoperative sleep patterns following general anesthesia, afternoon surgeries have a more severe impact. Research has established that the circadian rhythm, the human wake-sleep cycle, significantly influences the potency of intravenous anesthetics. Hou’s et al. research found that while greater amounts of anesthetics are required during the morning and active periods, due to accelerated liver and kidney metabolism during these times, drugs would not accumulate. On the other hand, the afternoon surgery patients experienced higher rates of drug accumulation in their bodies.  

Hou et al. highlighted that Sufentanil, due to its prolonged effect, is more disruptive to patients’ sleep patterns when it accumulates. Another side effect of anesthesia which leads to postoperative sleep disturbances is the interruption of the secretion and cycle of melatonin. Cortisol interrupts the secretion of melatonin, and Hou’s et al. study found that cortisol levels on the first postoperative day were higher in the afternoon surgery group than in the morning surgery group. Thus, melatonin levels were lower in the afternoon surgery group on the first postoperative day. General anesthesia induces stress pathways in patients, leading to elevated cortisol and depressed melatonin levels, which might negatively affect recovery and even lead to long term sleep disorders in patients if not treated promptly – sleep drugs can be helpful in this regard. 

Luo et al. and Huo et al. agree that adjusting melatonin levels with supplemental melatonin could potentially mitigate these sleep disturbances. Lou et al. writes that zolpidem (Ambien) is one of the sleep drugs that can be administered before and after surgery and anesthesia to enhance sleep quality and reduce fatigue. Both options reduce the chance of long-term sleep disturbances in recovering patients. ^1,2 

Other strategies to reduce postoperative sleep disturbances include avoiding major surgeries whenever possible to reduce physiological reactions to general anesthesia that trigger postoperative sleep disorders. Su et al. write that opting for laparoscopic cholecystectomy instead of open cholecystectomy is recommended since the former does not affect REM sleep the night of the operation. Avoiding opioid analgesics can also be beneficial since they tend to worsen postoperative sleep, reducing REM sleep and increasing the Apnea-Hypopnea Index (AHI). However, hospital environment, such as ward noise and lighting, disturbances from healthcare staff, and disturbances from other patients, play a significant role in sleep disruption. Noise levels can reach up to 85 dB due to alarms and staff conversations in the ICU. Therefore, several strategies should be considered to minimize these disturbances making the ward a quiet place for the recovering patient after surgery and anesthesia, including but not limited to sleep drugs.³ 

References 

1. Luo M, Song B, Zhu J. Sleep Disturbances After General Anesthesia: Current Perspectives. Front Neurol. 2020 Jul 8;11:629. doi: 10.3389/fneur.2020.00629. PMID: 32733363; PMCID: PMC7360680.  

2. Hou, H., Wu, S., Qiu, Y., Song, F., & Deng, L. (2022). The effects of morning/afternoon surgeries on the early postoperative sleep quality of patients undergoing general anesthesia. BMC Anesthesiology, 22, 1-8. doi:https://doi.org/10.1186/s12871-022-01828-w 

3. Su X, Wang DX. Improve postoperative sleep: what can we do? Curr Opin Anaesthesiol. 2018 Feb;31(1):83-88. doi: 10.1097/ACO.0000000000000538. PMID: 29120927; PMCID: PMC5768217.