Mild cognitive impairment and dementia can bring insomnia and other sleep issues. Here are the sleep aids that aren’t considered safe — and eight steps experts do recommend.
What do you do when your loved one starts getting up at night and wandering around the house?
For people whose loved ones are living with dementia, this is a common occurrence — at least one in four develop sleep problems, and when they get up at night, they may get disoriented, lost, or fall and injure themselves.
“It’s one of the main reasons people get put in nursing homes,” Dr. Hrayr Attarian, a neurologist and professor at Northwestern Medicine, told Being Patient. “The main problem of insomnia in people, especially with Alzheimer’s disease, is that they are cat napping during the day because there’s no stimulation, and then they can’t sleep at night.”
While it might be tempting to try over-the-counter sleep aids or other medicines, experts warn that many of these treatments don’t work and may cause harm. Instead, experts recommend an approach that involves mental stimulation and behavioral interventions to help keep the body’s internal clock in rhythm and improve sleep without the risk of side effects.
How effective are sleep drugs for people living with dementia?
Dr. Christina Reppas-Rindlisbacher, a geriatrician at Sinai Health and University Hospital Network, told Being Patient that older adults with cognitive impairment or dementia who take these medications have an “increased susceptibility to sleep drug side effects such as ԁrοԝѕiոеss, confusion, and falls.” And here’s another problem: Most sleep drugs haven’t been well-studied in people living with dementia.
Some doctors look for clues in larger studies conducted in older people without dementia. In sleep studies that looked at benzodiazepines like alprazolam (Xanax) or diazepam (Valium), Reppas-Rindlisbacher explained that the drugs helped people get to sleep 20 minutes faster but worsened their quality of sleep, meaning people “do not necessarily feel well rested and refreshed upon waking.”
Another 2020 study reviewed all the drug trials that have tested sleep drugs in people living with dementia.
Supplementing with the sleep hormone melatonin with medications like ramelteon (Rozerem) that boost the effects of the body’s natural melatonin had little to no effect on improving sleep quality.
“There have been several clinical trials [on melatonin],” Attarian said. “Unfortunately, it does nothing.”
One small study of 30 people found an antidepressant drug called trazadone (Desyrel) that helped people living with moderate to severe dementia sleep longer but didn’t prevent them from waking up in the middle of the night.
A new class of sleep drugs called orexin antagonists may help, though they’ve only been studied in small groups of people living with dementia. A newer drug called lemborexant (Dayvigo) improved how long people slept and decreased how often they woke up in the middle of the night. “They are very expensive, though, and most insurance companies don’t like covering them,” Attrition said
Risks and side effects of sleep drugs for dementia
In addition to being largely ineffective, like any other medication, many commonly used sleep drugs have side effects that you and your doctors should weigh against any potential benefits.
“Most sleep drugs are considered potentially inappropriate drugs to use in older persons, especially those who already have cognitive impairment,” said Reppas-Rindlisbacher.
The American Geriatrics Society considers the following drugs, which may be used to treat sleep problems, inappropriate to prescribe to older adults:
- First-generation antihistamines like doxylamine, or Nyquil
- Antidepressant drugs like nortriptyline, or Aventyl
- Antipsychotic drugs like chlorpromazine, or Thorzine
- Benzos like alprazolam (Xanax) or diazepam (Valium)
- Z-drugs like zolpidem (Ambien) or temazepam (Restoril)
These drugs “are not recommended as they are either ineffective, have too many side effects or have not been studied at all in patients with dementia,” said Reppas-Rindlisbacher.
Benzodiazepines have some of the worst side effects in older adults, she said. They are more sensitive to their effects. They increase the risk of cognitive impairment, falls, fractures, and motor vehicle accidents and can also lead to physical dependence, making it hard to stop taking them.
Xanax and Dementia: Doctors Weigh In on Safety of Benzodiazepines
Another study found that strong doses of Z-drugs (such as zopiclone, zaleplon, and zolpidem) are as harmful as benzos among people living with dementia — possibly more harmful. These particular drugs are linked to increased risk of adverse effects, including falls, fractures and strokes.
Insomnia drugs could be the next breakthrough for Alzheimer’s care, but until more research has been completed, non pharmaceutical alternatives are the safest course of action for those looking for a good night’s rest.
Alternative ways to manage sleep
Caregivers should work with their doctors to figure out the best treatment plan. “A single intervention is rarely going to be the magic bullet,” said Reppas-Rindlisbacher.
The first step involves a medication review. Doctors may ease the person with dementia off of a drug that interferes with sleep or change the timing of when the drug so the effects on sleep are less pronounced.
After that, they’ll work with you to determine what other changes might help promote healthy sleep. Medication specifically to treat insomnia may be prescribed carefully as a last resort; there are other lifestyle changes to try first that can significantly improve sleep. “You need extra light and other daytime stimulation to keep them alert during the day and regulate their sleep-wake cycle,” Attarian said.
Other strategies dementia care experts recommend include:
- Maintaining a consistent sleep schedule
- Help the body’s internal clock stay on track by spending time outdoors, especially in the morning, and staying physically active by walking during the day
- Limiting naps during the day to one hour and avoiding naps in the afternoon or evening
- Avoid caffeine, especially later in the day
- Avoid alcohol
- Avoid screens or TV exposure near bedtime
- Avoid large meals close to bedtime and cut out bedtime snacks
- Make sure the sleep environment is quiet and dark at night
For people in the milder stages of dementia, cognitive behavioral therapy (CBT) for insomnia could also help people get to sleep and stay asleep.
A Good Night’s Rest: Managing Sundowning and Sleep Issues in Alzheimer’s
