BACKGROUND:Multiple factors lead to sleep disturbances in hospitalized medical patients. Inadequate sleep can lead to both psychological and physiological consequences.METHODS:A PubMed search was conducted using the terms: (“sleep deprivation,” “sleep,” or “insomnia”) and (“hospitalized,” “inpatient,” “critical illness,” or “acute illness”) to review the published data on the topic of sleep in hospitalized medical patients. The search was limited to English‐language articles published between 1997 and 2008. Subsequent PubMed searches were performed to clarify the data described in the initial search, including the terms “hospital noise,” “hospital environment,” “obstructive sleep apnea,” and “heart failure.”RESULTS:Few articles specifically addressed the topic of sleep in hospitalized medical patients. Data were limited to observational studies that included outcomes such as sleep complaints and staff logs of wakefulness and sleep. In Part 1, we review normal sleep architecture, and discuss how major medical disorders, the hospital environment, and medications can disrupt sleep during hospitalization. In Part 2, we will propose an evaluation and treatment algorithm to optimize sleep in hospitalized medical patients.CONCLUSIONS:Hospitalization may severely disrupt sleep, which can worsen pain, cardiorespiratory status, and the psychiatric health of acutely ill patients. Like vital signs, the patient sleep quality reveals much about patients' overall well‐being, and should be a routine part of medical evaluation. Journal of Hospital Medicine 2008;3(6):473–482. © 2008 Society of Hospital Medicine.

BACKGROUND:As described in Part 1 of this article, multiple factors lead to disrupted sleep in hospitalized medical patients. Recognizing and addressing these factors can help clinicians more effectively manage patients' sleep complaints.METHODS:A PubMed search was conducted by cross‐referencing the terms “sleep deprivation,” “insomnia,” and “sleep”; “hospitalized,” “acutely ill,” and “critically ill”; and “medication,” “drugs,” “hypnotics,” “benzodiazepines,” and “sedatives.” The search was limited to English‐language articles published between 1997 and 2008. Subsequent PubMed searches were performed to clarify the data described in the initial search.RESULTS:Few articles addressed the topic of the assessment and management of sleep problems in hospitalized medical patients. In Part 2, we propose an evaluation and treatment algorithm that includes recommendations regarding the use of nonpharmacologic and pharmacologic therapies as clinicians consider relevant clinical data. The algorithm is accompanied by 5 tables that include pertinent and practical information to assist clinicians as they manage their inpatients' sleep complaints.CONCLUSIONS:Assessment of a sleep complaint should include a review of factors that could exacerbate patients' sleep. The treatment could then focus on ameliorating these factors, and the judicious use of nonpharmacologic strategies and psychopharmacologic agents. Journal of Hospital Medicine 2009;4:50–59. © 2009 Society of Hospital Medicine.