Hypnotic-associated falls across the diurnal cycle: Pharmacokinetic signal or delirium rhythm?

Shishida and colleagues report that hypnotic-associated fall risk in hospitalized patients varies by drug class and time of day. We propose that the observed pattern may reflect a temporal misalignment between reactive as-needed hypnotic prescribing and the circadian architecture of in-hospital delirium, rather than purely pharmacokinetic effects. This reframing has implications for consultation-liaison workflow, suggesting that nighttime hypnotic requests should trigger structured delirium assessment rather than automatic dispensing.