Popular sleep aids before surgery could prevent painkiller dependence later

Taking melatonin or Ambien (zolpidem) before surgery may be associated with less pain and a smoother recovery afterward, according to new research.

Research presented at the ANESTHESIOLOGY 2026 annual meeting in San Diego on Oct. 18 found that improving sleep before surgery with one of these two sleep aids could ease anxiety while reducing post-surgical pain and opioid use.

The researchers analyzed 16 studies of patients who underwent abdominal, gynecologic, orthopedic, urologic, dental and other surgical procedures between 2000 and 2025.

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This amounted to more than 1,100 patients, according to a press release from the American Society of Anesthesiologists.

Melatonin was typically taken the night before surgery and/or 20 to 90 minutes before anesthesia, with dosages ranging from 1 mg to 20 mg.

Ambien, consistently dosed at 10 mg, was taken at bedtime either the night before surgery or for multiple nights up to two days before the procedure.

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Although both are used as sleep aids, melatonin and Ambien work differently.

Melatonin is a naturally occurring hormone that helps regulate the sleep-wake cycle, according to the National Institutes of Health. Ambien, or zolpidem, acts on GABA-A receptors in the central nervous system to produce a sedative effect, states FDA prescribing information.

Sleep aids and surgery

Across all studies, melatonin was associated with less anxiety, pain and inflammation, in addition to a more than 30% reduction in opioid use among some abdominal surgery patients.

The analysis suggested melatonin could offer advantages over traditional sedatives for older adults, who may be more susceptible to confusion after surgery. Studies that used activity monitors also found that patients who took melatonin showed improvements in recovery and sleep patterns.

Melatonin is a naturally occurring hormone that helps regulate the sleep-wake cycle, according to the National Institutes of Health. (iStock)

Ambien reportedly helped patients with pre-existing sleep problems sleep better before surgery and was also associated with less pain afterward.

Patients who underwent colorectal surgery and took Ambien required less opioid medication during and in the first 24 hours after the procedure. They also had lower inflammation levels.

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Those who had hip replacement reportedly experienced less anxiety and depression and were more satisfied with the recovery process.

Because this was a scoping review, which summarizes existing research rather than testing a treatment directly, the researchers could not make clinical recommendations or fully assess the risk of bias. They noted that more research is needed.

Ambien reportedly helped patients with pre-existing sleep problems sleep better before surgery, and results found an association to less pain after surgery. (iStock)

Why sleep could affect pain

Dr. Sebastian Amaya, senior study author and senior anesthesiology resident at Yale School of Medicine, said he was not surprised that improving sleep was associated with positive outcomes.

He noted that sleep is “extremely important” for maintaining overall health and controlling the immune system, cognitive function and emotional well-being.

In the studies reviewed, use of melatonin and Ambien was associated with less pain and lower opioid use, the doctor reiterated.

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“Pain is ultimately an experience,” Amaya said, noting that a person’s environment and other individual factors can influence pain levels.

Sleep also plays an important role in brain function, including the processes involved in how pain is experienced, he added.

Multiple studies showed patients had decreased pain levels and decreased opioid consumption in the immediate post-operative period, according to the researcher. (iStock)

“A lot of the hormones that are involved in pain are also involved in sleep,” he said. “If you have insomnia, if you have other chronic sleep issues, all these different biological pathways can be disrupted, and that could lead to increased pain after surgery.”

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“So, by having somebody with optimized sleep preoperatively, we decrease the risk of increased pain after surgery.”

Opioids are commonly prescribed to manage pain after surgery, and research has linked greater post-surgical opioid exposure with an increased risk of persistent use. Although the possibility that better sleep could reduce opioid use after surgery is promising, Amaya cautioned that the findings are not conclusive.

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“A lot of these studies did show that the patients had decreased pain levels and decreased opioid consumption in the immediate post-operative period,” he said. “Unfortunately, they didn’t get followed up for the next couple of days. That would be another study that should be done.”

Sleep experts recommend speaking with a primary care provider about sleep solutions prior to surgery. (iStock)

Amaya said the goal is to get patients out of the hospital as soon as possible while keeping pain under control. Improving sleep before surgery may be “low-hanging fruit,” particularly as modern lifestyle factors such as blue light and noise can interfere with sleep quality.

“There are probably a lot of people who actually have poor sleep quality, and that can play a role when they come to surgery and have post-operative problems, like a lot of pain,” he said. “Maybe their sleep could have been optimized with better sleep hygiene, or maybe they could have talked to their primary care physician.”

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Dr. Wendy Troxel, a Utah-based licensed clinical psychologist and senior behavioral scientist at RAND, who was not involved in the study, said the findings “make sense” from a sleep perspective.

“We know how important sleep is for healing and recovery, and it’s very normal to feel anxious and sleep poorly before a major medical procedure,” she told Fox News Digital. “For some patients, a short-term sleep aid around the time of surgery may help.”

Pre-procedure anxiety and low sleep quality are normal, one expert said.

Troxel suggested the concern would be that sleep medications generally are not recommended as a long-term solution for insomnia.

“I’m a little surprised that melatonin showed benefits, since the overall evidence suggests it has limited effects as a sleep aid for most people,” she noted. “It may be that placebo, or expectancy effects, could also contribute, particularly in such a stressful context.”

“We know how important sleep is for healing and recovery, and it’s very normal to feel anxious and sleep poorly before a major medical procedure.”

Despite the limitations, Troxel concluded that the findings are “interesting and could positively impact patient care for surgical procedures.”

For patients who are anticipating an upcoming surgery, Troxel noted that pre-procedure anxiety and disjointed sleep are “normal,” and there may be short-term solutions.

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“Anyone considering melatonin or a prescription sleep medication should check with their surgical and anesthesia team about what is appropriate for them,” she advised.

Fox News Digital reached out to manufacturers of Ambien and melatonin requesting comment.