There are many ways of getting people to sleep. On the CL service, lullabies don't really cut it. Thus, we rely on benzodiazepines, antihistamines and a few other novel hypnotic agents. Here are few notes:
Chloral hydrate
This is an old psychiatric standby that has been in use over 100 years. It is metabolized to trichoroethanol and is very inexpensive. Chloral hydrate has a half life of approximately 8-10 hours, so there can be some morning somnolence. Chloral hydrate is effective as a hypnotic for 1-3 nights, and loses potency over two weeks. The usual dose is 0.5-1 gm at bedtime. note that patients who are seriously ill or who have overdosed should not be given chloral hydrate. Chloral hydrate is also not ideal for geriatric patients or patients with hepatic failure because it is metabolized through oxidation.
Temazepam
Temazepam is another great standby for insomnia. Usually 15-30 mg at bedtime will suffice, although patients sometimes complain of early waking. Temazepam is reasonably safe for geriatric patients as it undergoes conjugative metabolism.
Trazodone
Trazodone was originally developed as an antidepressant, but is very sedating. For sleep, a realistic dose is 50-100 mg the first night with upward titration after that. For older or frail patients, 25 mg is likely sufficient.
Lorazepam
Lorazepam is not a good hypnotic because people just don't get that sleepy from it. It is good as an anxiolytic, however.
Diphenydramine
Diphenhydramine is a good hypnotic and economical as well. It can be given in doses from 25-100 mg (immediate release) or 12.5 mg (controlled release) at bedtime.
Zolpidem
Zolpidem is quite popular and despite inital advertising that it was non-addictive, it actually is addictive and has affinity for a GABA receptor. Dosage guidelines are that it should not be prescribed for more than 10 nights. People who take zolpidem chronically can get significant rebound insomnia when they stop taking it. It is usually dosed at 10-20 mg at bedtime.
Eszopiclone
A newer hypnotic agent that presumably works a GABA subtype receptor. It has a fairly rapid onset of under an hour and by many accounts is not associated with tolerance or dependence. An odd side effect is unpleasant taste. It an be dosed at 1-3 mg at bedtime.
Zaleplon
Yet another hypnotic agent that is not a benzodiazepine yet works on GABA receptors. Zaleplon is a Schedule IV drug yet is not supposed to be addictive. It should not be given for more than 7-10 days and is often prescribed at doses of 10-20 mg at bedtime.
Ramelteon
Ramelteon is a nice sleep agent that is expensive but doesn't bind GABA receptors. Rather it selectively binds melatonin 1 and 2 receptors. It takes effect quickly and there is no time limit on its use. Given its mechanism of action, there is no reason for it to be addictive. It is usually dosed at 8 mg at bedtime.