Presurgical sleep medications linked to less pain and anxiety after surgery

Improving sleep before surgery through the use of melatonin or Ambien (zolpidem) may ease presurgical anxiety, reduce pain after surgery, decrease opioid requirements and help patients recover better, according to an analysis of 25 years of research presented at the ANESTHESIOLOGY^® 2026 annual meeting.

Poor sleep and anxiety are common before surgery and can contribute to heightened pain sensitivity, increased opioid use and slower recovery. In the studies, patients typically took melatonin the night before surgery and/or 20 to 90 minutes before anesthesia. Ambien was taken at bedtime, either the night before surgery or on multiple nights beginning up to two days before surgery. The findings suggest that addressing sleep may be a modifiable part of preparing for surgery that helps support recovery.

While we usually focus on what happens in the operating room, our review suggests we may be overlooking a critical window for improving outcomes in the nights before surgery. Our paper is unique because it focused exclusively on pre-surgery-only use of melatonin or Ambien, showing that something as simple as improving sleep before a procedure can help patients have a more comfortable recovery while reducing the need for heavy painkillers and their potential risks."

Sebastian Amaya, M.D., senior author of the study and anesthesiology resident, Yale School of Medicine, New Haven, Connecticut

The researchers analyzed 16 studies of patients undergoing abdominal, gynecologic, orthopedic, urologic, dental and other surgical procedures published between 2000 and 2025, which included a total of more than 1,100 patients. Melatonin doses ranged from 1 to 20 mg, while Ambien was consistently dosed at 10 mg.

Across the studies, melatonin, a naturally occurring hormone that helps regulate sleep, was associated with less anxiety, pain and inflammation, as well as more than a 30% reduction in opioid use in some abdominal surgery patients. Studies using wrist-worn activity monitors also suggested melatonin helped patients return to more normal patterns of sleep and daytime activity during recovery. The review also suggested that melatonin may offer advantages over traditional sedatives for older adults who may be more vulnerable to confusion after surgery.

Ambien, a commonly prescribed sleep medication, helped patients with preexisting sleep problems sleep better before surgery and was linked to less pain after. The idea is that by helping patients get more normal, restorative sleep before the physical stress of surgery, it may indirectly improve how they experience pain and recover afterward. Patients undergoing colorectal surgery needed less opioid pain medication during and in the first 24 hours after the procedure and also had lower levels of certain inflammatory markers. Patients undergoing hip replacement reported less anxiety and depression and greater satisfaction with their recovery, researchers said.

"Melatonin may be particularly valuable for patients who experience significant anxiety before surgery, those at higher risk for respiratory complications and older adults who may be vulnerable to cognitive side effects from traditional sedatives," said Dr. Amaya. "Ambien may be better suited for patients with preexisting insomnia or significant sleep disruption."