From the Guidelines
Sedatives for sleep disturbances in dementia patients should be used with caution, and the choice of medication depends on the patient's underlying disease and symptoms.
- For patients with dementia, clonazepam can be used in lower doses, starting at 0.25 mg, but its use is often limited due to concerns about morning sedation, gait imbalance, and cognitive disturbances 1.
- Melatonin is a mildly sedating option, with dosing starting at 3 mg and increasing by 3-mg increments to 15 mg, and is often considered for older patients (> 50 years old) and those with neurodegenerative disease 1.
- Rivastigmine, an acetylcholinesterase inhibitor, may be an appropriate choice for patients with dementia and sleep disturbances, particularly those with cognitive impairment refractory to other treatments, but its use may be associated with excessive daytime sleepiness 1. When choosing a medication, clinicians should consider the patient's underlying disease and attendant symptoms, and non-pharmacological approaches should always be the first line of treatment.
From the Research
Sedatives Used for Sleep Disturbances in Patients with Dementia
- The following sedatives have been studied for their effectiveness in treating sleep disturbances in patients with dementia:
- Melatonin: There is low-certainty evidence that melatonin doses up to 10 mg may have little or no effect on any major sleep outcome over eight to 10 weeks in people with Alzheimer's disease and sleep disturbances 2, 3.
- Trazodone: There is low-certainty evidence that trazodone 50 mg may improve total nocturnal sleep time and sleep efficiency in people with moderate-to-severe Alzheimer's disease 2, 3.
- Ramelteon: There is low-certainty evidence that ramelteon 8 mg may have no effect on total nocturnal sleep time in people with mild-to-moderate Alzheimer's disease 2, 3.
- Orexin antagonists: There is moderate-certainty evidence that an orexin antagonist may increase total nocturnal sleep time and decrease time awake after sleep onset in people with mild-to-moderate Alzheimer's disease 2.
- Other treatments that may be used to help manage sleep disturbances in patients with dementia include:
- Light therapy: Bright light therapy may be used to help regulate the sleep-wake cycle in patients with dementia 4, 5.
- Non-pharmacological interventions: Non-pharmacological interventions such as physical and social activities, carer interventions, and multimodal interventions may be used to help improve sleep in patients with dementia 6.
- Cognitive-behavioral therapy for insomnia: This type of therapy may be used to help treat chronic insomnia in patients with neurocognitive disorders 5.