Taking melatonin or Ambien before surgery may be associated with less pain, reduced anxiety and lower opioid use during recovery, according to research presented at the ANESTHESIOLOGY 2026 annual meeting. The findings suggest sleep could become a useful focus of surgical preparation, although researchers stressed that the evidence remains inconclusive.

The research, presented in San Diego on Oct. 18, examined whether improving sleep before surgery with either medication could support a smoother recovery. Researchers analyzed 16 studies conducted between 2000 and 2025 and involving more than 1,100 patients.

Those patients underwent abdominal, gynecologic, orthopedic, urologic, dental and other surgical procedures, according to a press release from the American Society of Anesthesiologists. The review considered how the sleep aids were associated with anxiety, pain, inflammation, sleep quality and opioid requirements.

Melatonin was generally taken the night before surgery, 20 to 90 minutes before anesthesia, or at both times. Doses ranged from 1 mg to 20 mg.

Ambien, also known as zolpidem, was consistently given at a dose of 10 mg. Patients took it at bedtime on the night before surgery or for multiple nights beginning up to two days before their procedures.

Although both products are used to promote sleep, they work differently. The National Institutes of Health describes melatonin as a naturally occurring hormone that helps regulate sleep and wakefulness, while FDA prescribing information says zolpidem acts on GABA-A receptors in the central nervous system to create a sedative effect.

Across the studies, melatonin was associated with less anxiety, pain and inflammation. Some abdominal surgery patients experienced a reduction of more than 30% in opioid use.

The analysis also suggested that melatonin may have advantages over traditional sedatives for older adults, who may be more susceptible to confusion following surgery. In studies that used activity monitors, patients taking melatonin also showed better recovery and sleep patterns.

Ambien was associated with improved sleep before surgery among patients who already had sleep problems, as well as less pain afterward. Colorectal surgery patients who received Ambien needed less opioid medication during surgery and throughout the first 24 hours after the procedure, while also showing lower inflammation levels.

Patients who underwent hip replacement and took Ambien reportedly experienced less anxiety and depression. They also expressed greater satisfaction with the recovery process.

Dr. Sebastian Amaya, senior study author and senior anesthesiology resident at Yale School of Medicine, said the positive associations were not surprising. He described sleep as “extremely important” for overall health and for controlling the immune system, cognitive function and emotional well-being.

“Pain is ultimately an experience,” Amaya said, explaining that a patient’s environment and individual circumstances can affect pain levels. He also said sleep has an important role in brain function, including the processes involved in experiencing pain.

“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.”

Multiple studies found reduced pain and opioid consumption during the immediate period after surgery, Amaya said. However, patients were not followed for the next several days, leaving unanswered questions about how long the apparent benefits might continue.

That limitation matters because opioids are commonly prescribed for surgical pain, and research has linked greater exposure after surgery with an increased risk of persistent use. Amaya nevertheless cautioned that the review does not prove improving sleep will prevent continued opioid use.

Because the research was a scoping review that summarized existing studies instead of directly testing a treatment, the researchers could not make clinical recommendations or fully evaluate the risk of bias. They said additional research is necessary.

Dr. Wendy Troxel, a Utah based licensed clinical psychologist and senior behavioral scientist at RAND who was not involved in the research, said the findings “make sense” because sleep is important for healing and recovery. She noted that anxiety and disrupted sleep are normal before a major medical procedure.

Troxel said she was somewhat surprised by the reported melatonin benefits because the overall evidence suggests limited effects as a sleep aid for most people. She said placebo or expectancy effects could also contribute in the stressful setting surrounding surgery.

Despite those limitations, Troxel called the findings “interesting and could positively impact patient care for surgical procedures.” She advised anyone considering melatonin or a prescription sleep medication to consult the surgical and anesthesia team about what is appropriate.

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