1.8 Medications to Assist with Sedation

Sleep – Patient does not settle at night, will rest for 45 minutes at a time and take hours to re-settle.  However, additional PRN’s given at night make him very drowsy during the day and staff has been phoning for additional medications each night for the past week.

What medication would you recommend to help him sleep?

  • Medication of choice would be benzodiazepines (Lorazepam and Zopiclone have had the most research conducted on them).

The following medications may be prescribed for sleep:

Diazepam (Valium Oral)

  • Benzodiazepine which provides sedation, is used to treat muscle spasms, enhancing the effects of gamma-amino-butyric acid (GABA).
     
  • Diazepam is not useful to treat cognitive and attention disorders for patients with TBI40.
     
  • Diazepam can be used as treatment for patients who have sleep walking and night terrors41.

Lorazepam and Zopiclone

  • Given to a group of stroke and TBI patients in one RCT 42

     

  • Study findings noted there were no differences reported in the length of sleep, on quality of sleep, depth of sleep, feelings of being refreshed or alertness in each group. 
     
  • There is Level 1 evidence supporting the use of both lorazepam and zopiclone for insomnia symptoms post ABI 43.
     

For more details on the effectiveness of various treatments to assist with sleep disorders and fatigue post ABI see ERABI/Fatigue and Sleep Disorders Post ABI.