Sleep before surgery is emerging as a recovery factor
Improving sleep in the days or hours before surgery may help patients recover with less anxiety, less pain and lower opioid use, according to a review presented at the ANESTHESIOLOGY 2026 annual meeting. The analysis examined research on pre-surgery use of melatonin and zolpidem, sold under the brand name Ambien.
The findings point to a potentially modifiable part of surgical preparation. Clinical attention often concentrates on the procedure itself, anesthesia and postoperative care. But sleep disruption and anxiety are common before surgery, and both can be associated with greater pain sensitivity, increased opioid use and slower recovery.
Researchers reviewed 16 studies published from 2000 through 2025, involving more than 1,100 patients undergoing a range of procedures. These included abdominal, gynecologic, orthopedic, urologic and dental surgeries. The review focused specifically on use before surgery, rather than medication given as part of postoperative treatment.
What the review found
Across the studies, melatonin was associated with lower anxiety, pain and inflammation, as well as a reduction in opioid use in some patients. In some abdominal-surgery studies, the reported reduction in opioid use exceeded 30%. Studies using wrist-worn activity monitors also suggested that melatonin helped patients return to more typical sleep and daytime activity patterns during recovery.
Zolpidem was also included in the review. The source describes both medicines as approaches that may help support sleep before a procedure and, in turn, improve postoperative comfort and reduce the need for heavy pain medication.
The timing varied across the underlying research. Patients generally took melatonin on the night before surgery, 20 to 90 minutes before anesthesia, or both. Zolpidem was taken at bedtime either the night before surgery or on multiple nights beginning as much as two days beforehand. Melatonin doses in the studies ranged from 1 to 20 milligrams, while zolpidem was consistently given at 10 milligrams.
Why sleep could influence pain
The review's premise is straightforward: poor sleep and preoperative anxiety can make pain harder to manage. Better sleep may therefore affect recovery before a patient even enters the operating room. The researchers describe the period before surgery as an important window that may receive less attention than what happens in the operating room.
This does not mean that a sleep aid is a universal substitute for individualized surgical care. The studies covered different operations, schedules and patient groups, and the results summarized in the review are associations across the available evidence. Still, the analysis suggests that sleep deserves consideration as part of preparation for surgery rather than as an afterthought once a patient returns home.
Sebastian Amaya, the review's senior author and an anesthesiology resident at Yale School of Medicine, said the work was distinct because it concentrated on medication used only before surgery. That focus was intended to isolate whether better sleep in advance of a procedure could make the subsequent recovery more comfortable.
What patients should take from the evidence
The study is a research review presented at a medical meeting, not a personal treatment recommendation. Patients should not begin melatonin, zolpidem or any other medicine before surgery without discussing it with their surgical and anesthesia teams. Medication choices can depend on the procedure, other prescriptions, medical history, sleep conditions and instructions about what is safe to take before anesthesia.
That caution is especially relevant because the reviewed studies used different schedules and melatonin doses. A result observed in one type of surgery or patient group does not automatically establish the best regimen for every person. The authors' finding is better understood as evidence that sleep may be a worthwhile clinical target, not as a one-size-fits-all protocol.
For clinicians, the review raises a practical question: could preoperative assessment more systematically address sleep and anxiety? If subsequent research confirms which patients benefit, when treatment should be used and how risks should be managed, sleep interventions could become a more deliberate part of recovery planning.
Reducing reliance on opioids is a meaningful goal
Postoperative pain control remains a balance between keeping patients comfortable and limiting the risks associated with opioid medications. The finding that some abdominal-surgery studies reported more than a 30% reduction in opioid use with melatonin is therefore notable. It suggests that improving sleep could complement, rather than replace, the broader set of approaches used to manage pain after surgery.
The evidence also connects recovery to daily functioning. Wrist-monitor findings suggesting a return toward regular sleep and activity patterns may be significant because recovery is not measured only by pain scores. It also concerns whether patients can resume ordinary rhythms of rest and movement.
A case for studying the preoperative window
The review offers a simple but consequential reframing: recovery may begin before surgery. By examining sleep in the nights and hours ahead of a procedure, researchers are looking for ways to influence anxiety, pain and medication use before they become postoperative problems.
More research will be needed to define the safest and most effective approaches. For now, the analysis adds support to the idea that sleep quality is not peripheral to surgical care. It may be one of the factors that shapes how patients feel, function and use pain medication after an operation.
This article is based on reporting by Medical Xpress. Read the original article.
Originally published on medicalxpress.com
