Pharmacologic treatment of sleep disturbances in Alzheimer disease

Alzheimer’s disease (AD) is a progressive neurodegenerative disease characterized by the deposition of amyloid-b and neurofibrillary tau tangles. It is estimated that sleep disturbances affects even 66% patients with AD. The most common complaints are insomnia, sleep fragmentation and excessive daytime sleepiness. Sleep problems have negative impact on cognitive function of patients, increase risk of progression of AD and are significant factor in decisions to admit a person with dementia to institutional care. The pharmacological treatment options for sleep disturbances in patients with AD insomnia include benzodiazepines, tricyclic antidepressants, melatonin agonists and dual orexin receptor antagonists. The results of studies suggest that melatonin is unlikely to be of effective in treatment of sleep disturbances in patients with moderate-to-severe dementia. Although a larger trial is needed to be able to draw a more definitive conclusion on the balance of risks and benefits available evidence suggest that a low dose (50 mg) of trazodone improves sleep in this population. Dual orexin receptor antagonists may probably improve some aspects of sleep in people with mild-to-moderate AD. The treatment of sleep disturbances in elderly patient remains a challenge due to limited evidence. Moreover some of the drugs such as benzodiazepines may increase the risk of falls, drug dependence or even cognitive impairment.