Undergoing surgery is a massive physiological trauma. Beyond the immediate incision, patients must navigate a gauntlet of bodily stress, anesthesia side effects, and hospital disruptions that frequently trigger postoperative sleep disturbance (PSD)—a condition affecting up to 72% of patients. For those already struggling with sleep before entering the operating room (identified by a score greater than five on the Pittsburgh Sleep Quality Index), surgery can be the tipping point that leads to delirium, heightened pain, and cognitive decline. In this episode, we unpack a clinical trial involving 130 high-risk patients that demonstrated how a continuous, subanesthetic infusion of esketamine during surgery can act as a powerful shield. On the first day after surgery, the esketamine group experienced a dramatic drop in sleep disturbances (falling from ...