Many of the medications used to treat sleep disorders in AD are associated with adverse events. Sedating antipsychotics (e.g. quetiapine or olanzapine) have been linked to increased mortality and other serious side effects.12

Benzodiazepines and non-benzodiazepine hypnotics, sedating antidepressants and antihistamines (often present in over the counter sleep aids) may improve some aspects of sleep but may produce daytime sleepiness, rebound insomnia, confusion, amnesia and increased fall risk for falls.13 Current research suggests that pharmacological treatments should be avoided as first-line treatment for sleep disorder in older adults, especially in the context of cognitive impairment.14

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Treatment Without Medication

Non-pharmacological treatments offer a different approach to the treatment of sleep disorder in AD. Non-pharamcological approaches include light therapy, physical activity, behavioral and environmental interventions. But there is limited research on the efficacy of these interventions in patients with AD.

Light therapy has become an increasingly popular intervention for insomnia since exposure to light affects the complex metabolic processes associated with the sleep-wake cycle. Current practice guidelines suggest that older adults whose sleep is phase-advanced (i.e., those who fall asleep in the early evening and awaken too early in the morning) should be exposed to bright light in the evenings. Older adults whose sleep is phase-delayed (i.e., those whose sleep onset and final awakening occurs later in the day) should have bright light exposure early in the morning.15,16

Regular physical activity has been associated with more restful sleep in older adults.17,18 Several studies report that nursing home residents with dementia who participate in nonstrenuous daytime activities can have improved sleep quality. Although regular physical activity may also enhance the sleep of individuals with dementia, no published controlled trials have examined the isolated effects of exercise on sleep in dementia.

Behavioral, nutritional and environment interventions have been used to reduce insomnia. Behavioral strategies include maintaining regular bedtimes and rising times, limiting daytime napping, and restricting time in bed. Nutritional approaches include establishing consistent meal times; avoiding alcohol, nicotine, and caffeine; and emptying the bladder several hours before bedtime. Environmental approaches to reducing insomnia include maintaining a comfortable room temperature in sleep environment and reducing excessive ambient light and noise.19