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Guidance on Night Sedation

Patients on night sedation prior to admission

  • Enquire whether the patient is a regular or occasional user of night sedation.
  • Continue prescription if appropriate.

Patients who have not received night sedation before

  • Routine prescribing of night sedation is undesirable.
  • Consider rectifiable causes of insomnia e.g. depression, pain, drugs (e.g. decongestants, theophylline, steroids or selective serotonin reuptake inhibitors (SSRIs) taken late in the day).
  • Discuss advantages and disadvantages of night sedation with patient.
  • Prescribe zopiclone 3.75-7.5mg at night, preferably as 'once only' on the prescription form or on HEPMA (hospital electronic prescribing medicines administration) - see cautions below.
  • If prescribing zopiclone regularly, review daily and stop after the shortest possible time.

Discharge procedure

Pharmacy will not supply any drug prescribed for night sedation at discharge, unless it is prescribed for a fixed interval and an acceptable reason for this is given in the comments section of the prescription. Contact your clinical pharmacist or dispensary for further advice (see Appendix 6 for contact details).

(Refer to BNF / summary of product characteristics for full prescribing information). Hypnotics should be used with extreme caution in patients:

  • With respiratory disease
  • With a history of drug / alcohol abuse
  • Who have been co-prescribed other CNS depressants
  • Who are elderly or debilitated and/or have hepatic and renal impairment.

If required, a very small dose of a short-acting agent e.g. zopiclone oral 3.75mg at night or temazepam oral 5mg at night is safest in these patients.

  • Hypnotics are contraindicated in severe respiratory depression and severe hepatic insufficiency.

Abrupt withdrawal of benzodiazepines may cause confusion, toxic psychosis, convulsions.

Notes

Due to the potential for dependence, there may be important legal implications for the prescriber if a patient who has been prescribed night sedation while in hospital is discharged on the drug long-term.

 

Guideline reviewed: August 2021

Page updated: March 2022