Total Sleep Time

Total minutes of sleep obtained each night, measured continuously using a wrist-worn actigraphy device (Actigraph GT3X-BT). Between-group differences in total sleep time will be evaluated using independent t-tests or Mann-Whitney U tests, depending on distribution. Longitudinal changes will be analyzed using linear mixed-effects models with random intercepts to account for repeated measures. Covariates may include age, injury characteristics, and baseline pain levels.

Daily during inpatient hospitalization (approximately 3-7 days)

Sleep Efficiency

Percentage of time spent asleep while in bed, calculated from actigraphy data collected continuously during hospitalization. Group comparisons will be conducted using independent t-tests or nonparametric equivalents. Mixed-effects modeling will assess within-subject changes over time and the effect of group assignment.

Daily during inpatient hospitalization (approximately 3-7 days)

Number of Awakenings

Total number of nighttime awakenings detected by actigraphy, reflecting sleep fragmentation. Awakening counts will be compared between groups using Poisson or negative binomial regression models, depending on dispersion. Mixed-effects count models will evaluate changes over time.

Daily during inpatient hospitalization (approximately 3-7 days)

Subjective Sleep Quality: PROMIS scale

The PROMIS Sleep Disturbance Short Form assesses self-reported perceptions of sleep quality, sleep depth, and restoration over the past 7 days. Items are rated on 5-point Likert scales and summed to produce a raw score, which is converted to a standardized PROMIS T-score. Higher T-scores indicate greater sleep disturbance (worse sleep), and lower T-scores indicate less sleep disturbance (better sleep).

Daily during inpatient hospitalization (approximately 3-7 days)

Subjective Sleep Quality: Leeds Sleep Evaluation Questionnaire (LSEQ)

The LSEQ is a 10-item patient-reported questionnaire that assesses subjective changes in sleep and early-morning functioning using 100-mm visual analogue scales. Items evaluate four domains: Getting to Sleep (GTS), Quality of Sleep (QOS), Awakening From Sleep (AFS), and Behavior Following Waking (BFW). Each item is scored from 0-100 mm, with higher scores indicating greater improvement relative to usual sleep and lower scores indicating worsening.

Daily during inpatient hospitalization (approximately 3-7 days)

Daily Opioid Utilization

Total opioid consumption recorded from the medical record and converted to morphine milligram equivalents (MMEs) to allow standardized comparison across medication types and dosing regimens.

Daily during inpatient hospitalization (approximately 3-7 days)

Pain Interference

Patient-reported pain interference with daily activities measured using a validated pain interference scale. Higher scores indicate greater interference

Daily during inpatient hospitalization (approximately 3-7 days)

Recruitment Feasibility

Assesses the proportion of eligible orthopedic trauma patients who enroll in the study during the inpatient recruitment window. Recruitment feasibility reflects the practicality of identifying, approaching, and enrolling participants in an acute trauma setting. Recruitment rate will be calculated as the number of enrolled participants divided by the number of eligible patients approached. Results will be summarized using proportions and 95% confidence intervals.

Throughout the study (upto 7 days of hospital stay)

Adherence to Pharmacologic Components

Assesses adherence to the medication components of the multimodal sleep pathway, defined as the proportion of nights during which participants receive the prescribed low-dose zolpidem and melatonin as ordered. Adherence will be summarized as the percentage of scheduled doses administered. Means, standard deviations, and proportions will be reported.

Throughout the study (upto 7 days of hospital stay)

Adherence to Non-Pharmacologic Components

Assesses adherence to daily sleep hygiene education, including completion of brief educational sessions delivered by research staff. Adherence reflects the feasibility of implementing behavioral components in a busy inpatient trauma environment. Adherence will be summarized descriptively as the proportion of days on which sleep hygiene education was completed. Percentages and confidence intervals will be reported.

Throughout the study (upto 7 days of hospital stay)

Actigraphy Wear-Time Compliance

Assesses the proportion of hospitalization hours during which the ActiGraph GT3X-BT device records valid data. This measure assesses the feasibility and tolerability of continuous wrist-worn actigraphy in patients with orthopedic trauma. Wear-time compliance will be calculated as the percentage of total hospitalization hours with valid actigraphy data. Descriptive statistics (means, SDs, ranges) will be reported.

Throughout the study (upto 7 days of hospital stay)

Retention Through Discharge

Assesses the proportion of enrolled participants who complete all study procedures through hospital discharge without withdrawal or protocol discontinuation. Retention will be summarized as the percentage of participants completing the study through discharge. Proportions and 95% confidence intervals will be reported.

Throughout the study (upto 7 days of hospital stay)

Adverse Events Related to Study Interventions

Incidence of medication-related side effects (e.g., dizziness, drowsiness, complex sleep behaviors), melatonin intolerance, or actigraphy-related discomfort. Adverse events will be summarized using frequencies and proportions. Between-group comparisons may use Fisher's exact test.

Throughout the study (upto 7 days of hospital stay)