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When "good nights" are rare: Do sleeping pills help people with dementia?

The Bottom Line

  • Sleep disorders – including nighttime wakefulness, wandering, challenging behaviours and daytime sleepiness – affect many people with dementia and their caregivers.
  • Avoid unnecessary medications: recent research shows three commonly prescribed sleeping pills do not help to improve sleep for people with dementia.
  • Non-drug therapies may help improve sleep issues with minimal risk of harm.

Sleep: a basic human need, yet so often a source of frustration.


From occasional bouts of restlessness to chronic insomnia, sleep problems can affect anyone at any age but they’re particularly common – and difficult to resolve – in people with dementia (1, 2).


Why is that? As with many aspects of dementia, we don’t yet know. Sleep problems may be related to changes in the brain that affect the “circadian rhythm” or body clock (3). As a result, people with dementia often have trouble falling or staying asleep at night, wake early or frequently, and often wander at night, risking falls and other injuries. Wakeful nights are usually followed by excessive sleepiness during the day (3). It’s a distressing problem that can affect the quality of life of people with dementia as well as their caregivers.


While prescription sleeping pills and over-the-counter sleep aids can help people with sleep problems, it’s not clear whether they work the same way in people with dementia. There are also concerns about harmful side effects (4).


The authors of a recent systematic review hoped to learn more about which medications work best to help people with Alzheimer’s disease and sleep disturbances (3). Participants were given commonly prescribed sleep medications. Their sleep quantity and quality was measured using activity sensors and compared with people in control groups, who received a placebo.


What the research tells us

Unfortunately, there does not seem to be an easy sleep solution. Three common medications were included in the studies, including the hormone melatonin (four trials), the antidepressant trazodone (one trial) and the sedative ramelteon (one trial). None of these medications significantly helped to improve sleep in people with dementia (3).


Although it is not as helpful to find out what doesn’t work – especially for people desperate for a good night’s sleep – these findings can help people with dementia and their caregivers avoid taking an unnecessary medication.


Besides the three drugs included in this review, we don’t yet know enough about the benefits and risks of other common sleep medications to recommend them… yet many people are prescribed these drugs anyway.


Until we know more, safer non-drug approaches to encourage sleep are worth a try. Some ideas include: establishing consistent daily routines (e.g. wake times, meal times, bedtimes); regular exercise; restricting naptime during the day; and ensuring a comfortable, temperature controlled and soothing environment for sleeping (5). Light therapy - exposing people to minimum amounts of bright light during the day - might also help reset circadian rhythms and improve nighttime sleeping (6).


It may take some trial and error to find the right strategy. Ideally, a safe and effective plan can be put in place that allows everyone to rest easy.


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References

  1. Dauvilliers Y. Insomnia in patients with neurodegenerative conditions. Sleep Med. 2007; 8 (Suppl 4):S27-S34. doi: 10.1016/S1389-9457(08)70006-6.
  2. Bliwise DL, Mercaldo ND, Avidan AY et al. Sleep disturbance in dementia with Lewy bodies and Alzheimer’s disease: A multicenter analysis. Dement Geriatr Cogn Disord. 2011; 31(3):239-246. doi: 10.1159/000326238.
  3. McCleery J, Cohen DA, Sharpley AL. Pharmacotherapies for sleep disturbances in dementia. Cochrane Database Syst Rev. 2016; Art No. CD009178. doi: 10.1002/14651858.CD009178.pub3.
  4. Coupland CA, Dhiman P, Barton G et al. A study of the safety and harms of antidepressant drugs for older people: A cohort study using a large primary care database. Health Technol Assess. 2011; 15(28):1–202. doi: 10.3310/hta15280. 
  5. Mayo Clinic. Sleep tips: 7 steps to better sleep. [Internet] 2014. [cited February 2017]. Available from http://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/sleep/art-20048379?pg=1
  6. Deschenes C, McCurry S. Current treatments for sleep disturbances in individuals with dementia. Curr Psychiatry Rep. 2009; 11(1):20-26.

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