Original ArticlesMelatonin, Ramelteon, Suvorexant, and Dexmedetomidine to Promote Sleep and Prevent Delirium in Critically Ill Patients A Narrative Review With Practical ApplicationsFontaine, Gabriel V. PharmD, MBA, BCPS; Der Nigoghossian, Caroline PharmD, BCCCP; Hamilton, Leslie A. PharmD, FCCP, FCCM, BCPS, BCCCPAuthor Information Department of Pharmacy, Intermountain Medical Center, Intermountain Healthcare, Salt Lake City, Utah (Dr Fontaine); Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York (Dr Der Nigoghossian); and Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, Knoxville, Tennessee(Dr Hamilton). Correspondence: Gabriel V. Fontaine, PharmD, MBA, BCPS, Department of Pharmacy, Intermountain Medical Center, 5121 S. Cottonwood St, Murray, UT 84107 (email@example.com). The authors thank Adrian Wong, PharmD, MPH, BCPS, BCCCP, for his review of the manuscript. All authors declare no relevant conflicts of interest. Critical Care Nursing Quarterly: April/June 2020 - Volume 43 - Issue 2 - p 232-250 doi: 10.1097/CNQ.0000000000000304 Buy Metrics Abstract Sleep plays an important role in the recovery of critically ill patients. However, patients in the intensive care unit (ICU) often suffer sleep disturbances and abnormal circadian rhythms, which may increase delirium and lengthen ICU stay. Nonpharmacologic strategies for preventing and treating sleep disturbances and delirium, such as overnight eye masks and ear plugs, are usually employed first, given the lack of adverse effects. However, a multimodal approach to care including pharmacotherapy may be necessary. Despite the limited available data supporting their use, medications such as melatonin, ramelteon, suvorexant, and dexmedetomidine may promote sleep and improve a variety of patient-centric outcomes such as delirium. This narrative review focuses on these nonbenzodiazepine agents used for sleep in the ICU. Practical application of each of these agents is described for when providers choose to utilize one of these pharmacotherapies to promote sleep or prevent delirium. © 2020 Wolters Kluwer Health, Inc. All rights reserved.