A woman in pajamas looks skeptically at a bottle of pills she is holding up. The background shows a pattern of pills, stars, and a moon.

Are Sleeping Pills Safe for People with Alzheimer’s?

People with Alzheimer’s disease (AD) commonly complain about disrupted sleep. Not only do they struggle with sleep, but so do their caregivers.

Sleep aids have become a popular remedy to ensure that everyone can get their sleep. Unfortunately, some insomnia drugs may be very problematic for people with AD.

The problem of sleep for people with Alzheimer's

Alzheimer's is linked to poor sleep for two reasons:

  • Toxic proteins in the brain (tau tangles or beta-amyloid buildup) disrupt the sleep-wake process.
  • People with AD need uninterrupted sleep. When they don't get it, they often miss out on two beneficial sleep stages: Stage 3 “deep” sleep and rapid-eye-movement (REM) sleep. Both are known for healing and improving brain health.

Also, people with Alzheimer's may:

  • experience undetected - and therefore, untreated - sleep disorders (such as sleep apnea, restless legs, or sleepwalking)
  • have separate health conditions which affect sleep (such as insulin resistance or acid reflux)
  • take medications that interfere with sleep quality or duration (such as certain antidepressants or corticosteroids)

For many, better sleep comes in the shape of a sleeping pill, either prescribed or purchased from the drugstore.

Common over-the-counter sleep aids

There are a few common over-the-counter sleep aids. They include:

  • Diphenhydramine (common brands include Benadryl, Nytol, and Sominex)
  • Doxylamine (common brands include Unisom and NyQuil)
  • Melatonin (dozens of brands)

Common prescription sleep aids

There are a few common prescription sleep aids. They include:1

  • “Z-class” sedatives (including eszopiclone/brand Lunesta, zolpidem/brand Ambien, and zaleplon/brand Sonata)
  • Benzodiazepines (common brands include Valium, Ativan, and Restoril)
  • Trazodone antidepressants (common brands include Desyrel and Oleptro)

Sleep aids: Pros and Cons

Using any of these sleep aids has both benefits and risks.

A report published in Clinical Neurology News detailed the impact of sleep aid use on people with AD. It also warned that some may face a higher risk of developing AD due to sleep aid use.2

Benefits of using sleep aids

The link between sleep health and dementia is too critical to ignore. Doctors may treat some patients with occasional sleep aids. This can help them reclaim enough quality sleep to support brain health.

For those likely to develop AD, active management of sleep disorders can help reduce one's overall risk. In these cases, using the occasional sleep aid, either prescription or over-the-counter, can help.

Risks of using sleep aids

Other evidence shows that regular or nightly use of certain sleep aids may lead to the development or worsening of AD.3 Specifically, Z-class drugs can lead to sleepwalking, a dangerous side effect for considered at high risk for falling.4

Over-the-counter sleep aids such as diphenhydramine don’t get a free pass, either. Research continues to show links between their use and increases in dementia risk or its aggravation.5

Finally, we should consider this negative aspect: Several of these drugs aren’t meant for nightly, perpetual use. If they’re used this frequently, they may become less effective over time. Also, some people may become addicted to them or even abuse them.

The good news about sleep aids: Looking ahead

Researchers have focused on supporting better sleep for people with dementia in recent years. Some promising options are now available for people with AD or Parkinson's disease:6-9

  • Belsomra (suvorexant) was approved in 2014 to treat insomnia. Recent research shows it can prevent delirium in some with moderate to severe AD.
  • Dayvigo (lemborexant) became the second approved option for treating insomnia in December 2019. It's been heralded as a potentially safer and more effective sleep aid for people with AD.
  • Research for a third drug to treat both insomnia and mood disorders, seltorexant, is also underway.

What to do about AD sleep disruption

There aren’t a lot of good alternatives for treating problematic sleep in AD. The following best practices, most of which are recommended by the Alzheimer’s Association’s, all pertain to good sleep hygiene:10

  • Maintain a consistent mealtime, bedtime, and wake time.
  • Get 20 minutes of morning exposure to natural sunlight for a solid circadian reset.
  • Get daily exercise, for the same reason.
  • Keep cooler, but still comfortable, sleeping quarters.
  • Make sure your sleep space is very dark and very quiet.
  • Avoid screens (including television) within 1 hour of bedtime to help the body continue to generate natural melatonin, our built-in “sleep aid.”
  • Avoid taking certain medications at bedtime that might disrupt sleep. This can include certain AD-related drugs such as tacrine, donepezil, rivastigmine, or galantamine.
  • Manage pain so that it doesn’t disrupt sleep. Avoid sleep-stealing substances such as caffeine, nicotine, and alcohol.
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