Sebastian Amaya, M.D., on presurgical sleep aids and pain

Taking melatonin or zolpidem (Ambien) in the nights before surgery was associated with better presurgical sleep, lower postoperative pain and reduced opioid use, according to a review of 25 years of research presented at the ANESTHESIOLOGY 2026 annual meeting in San Diego. Sebastian Amaya, M.D., an anesthesiology resident at Yale School of Medicine in New Haven, Connecticut, is the senior author.

In this interview with Managed Healthcare Executive, Amaya explains why the team focused on melatonin, which patients can buy over the counter and sometimes take without telling their physicians, and zolpidem, which is commonly prescribed by primary care physicians. He also makes the case for insurance coverage of preoperative sleep optimization. For patients with a diagnosed sleep disorder, he said coverage would benefit both patients and health systems through less pain, faster recovery and shorter hospital stays that use fewer resources. For patients without a diagnosis, he said stronger evidence is still needed to show that improving sleep before surgery reduces pain.

Amaya also calls for anesthesiologists to coordinate with surgeons and primary care physicians in the days before surgery when a patient is known to have sleep disturbances, whether through sleep hygiene or a sleep aid. He described the potential reduction in postoperative opioids such as oxycodone and hydromorphone as “a pretty big gain for a small intervention.”

For this study, Amaya and his team examined 16 studies published between 2000 and 2025 that included more than 1,100 patients undergoing abdominal, gynecologic, orthopedic, urologic, dental and other procedures. Melatonin doses ranged from 1 mg to 20 mg and were typically taken the night before surgery, 20 to 90 minutes before anesthesia or both. Zolpidem was consistently dosed at 10 mg at bedtime, either the night before surgery or over several nights starting up to two days beforehand.

Melatonin was associated with lower anxiety, pain and inflammation, and some patients undergoing abdominal surgery used more than 30% fewer opioids. Studies that used wrist-worn activity monitors suggested a faster return to normal sleep and daytime activity. Zolpidem improved sleep among patients with preexisting sleep problems and was linked to lower pain. In colorectal surgery, patients who took it needed less opioid medication during the procedure and in the first 24 hours afterward and had lower levels of certain inflammatory markers. Patients undergoing hip replacement reported less anxiety and depression and greater satisfaction with their recovery.