Inclusion Criteria:  Medical or surgical ICU patient Ability to take oral or nasogastric tube within 48 hours of admission to ICU Expected ICU length of stay and life expectancy at least 48 hours Patient or POA capable of signing informed consent within 48 hours of ICU admission  Exclusion Criteria:  Past medical history includes cirrhosis Active alcohol withdrawal Patients taking fluvoxamine prior to admission Self-reported hypersensitivity to ramelteon Incarcerated patients Pregnant patients Patients with acute neurological conditions including brain abscess, head bleed, meningitis Patients who are transferred from an outside hospital where they have resided for greater than 4 days Non-English speaking patients Hearing-impaired patients requiring sign language for communication Visually-impaired patients