Best Practices for Improving Sleep in the ICU: Part II: Pharmacologic

Sleep disruption in the intensive care unit (ICU) is frequent, and after non-pharmacological strategies are optimized, pharmacologic strategies should be considered. Dexmedetomidine, melatonin agonists (melatonin and ramelteon), and gabaminergic agents (i.e., propofol and benzodiazepines) are the most commonly-studied medications to improve sleep in critically ill adults. While some of these agents, when used for sleep, have reduced delirium, none have been consistently shown to improve sleep quality or circadian rhythm alterations. Despite this general lack of evidence, nocturnal neuroactive agents are commonly prescribed to improve sleep in the ICU and often continued beyond ICU discharge. Research is required to identify the ideal efficacy outcome(s) that should be used to evaluate pharmacologic sleep improvement interventions in critically ill adults and what the role is for medication-based sleep improvement interventions in the ICU.