Sleep disturbance

Drugs for treating sleep disturbance

Sleep disturbance, and in particular persistent wakefulness and night-time restlessness of the person with dementia, can be very disturbing for carers.  Many of the drugs commonly prescribed for people with dementia can cause excessive sedation during the day, leading to an inability to sleep at night.

Increasing stimulation during the day can reduce the need for sleep-inducing medication (hypnotics) at night.  Hypnotics are generally more helpful in getting people off to sleep at bedtime than they are at keeping people asleep throughout the whole of the night.  They are usually taken 30-60 minutes before going to bed.

Chlormethiazole is generally well tolerated by elderly people, although some cannot take it because it produces an unpleasant itching sensation in the nose.  Benzodiazepines (see section on drugs for treating anxiety) such as temazepam are frequently prescribed.  Thioridazine is also sometimes used for night-time sedation (see section on drugs for treating agitation). Examples are flurazepam (Dalmane) and temazepam (Temazepam).

Side-effects

If excessive sedation is given at bedtime, the person may be unable to wake to go to the toilet and incontinence may occur, sometimes for the first time. If the person does wake through the night despite sedation, increased confusion and unsteadiness may occur.

Hypnotics are best used only when the carer and person with dementia feel that a good night's sleep is necessary for either or both of them.  The doctor should regularly review the use of such drugs.