Dexmedetomidine and Melatonin for Postoperative Sleep Disturbances and Delirium in Neurosurgical ICU: An Observational Study of 40 Patients

Background: Postoperative sleep disturbances and delirium are frequent in neurosurgical ICU patients, leading to agitation, sympathetic surges, raised intracranial pressure, and prolonged ICU stay. Pharmacological strategies remain underexplored. Methods: This prospective observational study was conducted at SKIMS Soura Srinagar between August 2024 and July 2025. Forty postoperative neurosurgical ICU patients with intracranial tumors who developed sleep disturbances and delirium were included. Patients were managed with either low-dose dexmedetomidine infusion (0.2–0.4 μg/kg/hr, no loading dose) or oral melatonin (3–6 mg at bedtime). Primary outcomes were sleep quality and delirium resolution; secondary outcomes were adverse effects and ICU stay. Results: Twenty patients received dexmedetomidine and twenty received melatonin. Dexmedetomidine improved nocturnal sleep continuity in 85% and resolved delirium in 90% of patients within 24 hours, but was associated with mild bradycardia in 2 patients. Melatonin improved sleep–wake rhythm in 80% and resolved delirium in 75% of patients within 48 hours, with no haemodynamic side effects. Mean ICU stay was 4.2 ± 1.1 days in the dexmedetomidine group and 4.6 ± 1.3 days in the melatonin group. Conclusion: Both dexmedetomidine and melatonin are effective in managing postoperative sleep disturbances and delirium in neurosurgical ICU patients. Dexmedetomidine provides rapid control of agitation and sleep induction, whereas melatonin restores circadian rhythm with excellent safety.