Taking melatonin or Ambien (zolpidem) before surgery might lead to reduced pain and a smoother recovery, according to recent research. Findings from the ANESTHESIOLOGY 2026 annual meeting in San Diego on October 18 indicated that enhancing sleep with either of these aids could alleviate anxiety and decrease post-surgical pain and the need for opioids.
The researchers looked into 16 studies involving surgical patients from 2000 to 2025, encompassing over 1,100 individuals who underwent various procedures, including abdominal, gynecological, orthopedic, and dental surgeries. According to a press release from the American Society of Anesthesiologists, melatonin may be a preferable choice over standard sedatives for older adults, who might be more prone to post-operative confusion.
Typically, melatonin is taken the night before surgery or between 20 to 90 minutes prior to anesthesia, in doses ranging from 1 mg to 20 mg. In contrast, Ambien is generally taken at bedtime, either the night before or for a few nights leading up to the surgery, at a consistent dosage of 10 mg.
While both medications are presented as sleep enhancers, they function in different ways. Melatonin is a natural hormone that helps manage the sleep-wake cycle, as per the National Institutes of Health, whereas Ambien targets GABA-A receptors in the central nervous system to induce a sedative effect.
Across the studies reviewed, melatonin was linked to lower anxiety, pain, and inflammation, showing a more than 30% decrease in opioid use among certain patients post-abdominal surgery. The analysis suggested that melatonin could be particularly beneficial for older adults, who are more susceptible to confusion. Additionally, studies utilizing activity monitors demonstrated that melatonin users exhibited better recovery and sleep patterns.
Ambien was found to assist patients with pre-existing sleep issues in getting better rest before surgery, which correlated with less pain afterward. Patients undergoing colorectal surgery and taking Ambien reported a reduced need for opioids during and after the procedure and also experienced lower inflammation levels. Those who had hip replacement surgery experienced decreased anxiety and depression, alongside greater satisfaction during recovery.
Because this was a scoping review summarizing existing research rather than a direct treatment test, the researchers refrained from making clinical recommendations or fully evaluating the risk of bias, noting the necessity for more research.
Dr. Sebastian Amaya, the senior study author and anesthesiology resident at Yale School of Medicine, expressed no surprise at the connections between better sleep and positive surgical outcomes. He highlighted that sleep is crucial for overall health, immune function, cognitive abilities, and emotional well-being. He reiterated that both melatonin and Ambien were associated with reduced pain and lower opioid consumption shortly after surgery.
Pain, according to Amaya, is influenced by various factors, including an individual’s environment and personal experiences. Sleep significantly affects brain functioning, particularly how pain is processed. Multiple studies showed that patients had lower pain levels and reduced opioid needs right after surgery. “Many hormones involved in pain regulation are also tied to sleep,” he explained. “If someone suffers from insomnia or chronic sleep troubles, these biological mechanisms can be disrupted, potentially leading to more pain post-surgery.”
Amaya emphasized that optimizing sleep pre-surgery could lower the risk of heightened pain afterward. Given that opioids are often prescribed for post-operative pain, and excessive exposure increases the risk of prolonged use, the idea that better sleep might reduce opioid dependency is an intriguing one. Nevertheless, he warned that the findings should not be seen as definitive.
While many studies indicated decreased pain levels and opioid needs shortly after surgery, the lack of follow-up in subsequent days pointed to the need for further investigations.
Both Amaya and Dr. Wendy Troxel, a Utah-based clinical psychologist and behavioral scientist at RAND, underscored the importance of addressing sleep quality before surgery. Troxel mentioned that pre-surgery anxiety and poor sleep quality are common occurrences, suggesting that some patients may benefit from temporary sleep aids.
However, she also expressed concern that sleep medications are generally not recommended for chronic insomnia. Notably, she was a bit surprised by the benefits of melatonin, given that its effectiveness as a sleep aid is often found to be limited. But in a stressful context, factors like placebo effects could play a role.
Despite limitations, Troxel found the study’s outcomes intriguing and possibly beneficial for surgical patient care. She encouraged those about to undergo surgery to discuss sleep solutions with their medical team.
The manufacturers of Ambien and melatonin were contacted for comments.
