#MEDICATION FOR INSOMNIA TRIAL#

It may have slightly reduced the time spent awake at night after first falling asleep, but we could not be sure of this effect.

It showed that a low dose of the sedative antidepressant trazodone, 50 mg, given at night for two weeks, may increase the total time spent asleep each night (an average of 43 minutes more in the trial) and may improve sleep efficiency (the percentage of time in bed spent sleeping).

#MEDICATION FOR INSOMNIA TRIAL#

The trazodone trial had only 30 participants. There were no serious harms for either medicine. The limited information available did not provide any evidence that ramelteon was better than placebo. We found no evidence that melatonin improved sleep in people with dementia due to Alzheimer's disease.

The five melatonin trials included 253 participants. Participants in the trazodone trial and most of those in the melatonin trials had moderate-to-severe dementia, while those in the ramelteon and orexin antagonist trials had mild-to-moderate dementia. Overall, the evidence was moderate or low quality, meaning that further research is likely to affect the results. The ramelteon trial, one melatonin trial, and both orexin antagonist trials were commercially funded. Participants in all the trials had dementia due to Alzheimer's disease. We found nine trials (649 participants) investigating four types of medicine: melatonin (five trials), trazodone (one trial), ramelteon (one trial), and orexin antagonists (two trials). We consulted a panel of carers to help us identify the most important outcomes to look for in the trials. We searched up to February 2020 for well-designed trials that compared any medicine used for treating sleep problems in people with dementia with a fake medicine (placebo). In this updated Cochrane review, we tried to identify the benefits and common harms of any medicine used to treat sleep problems in people with dementia. Since the source of the sleep problems may be changes in the brain caused by dementia, it is not clear whether normal sleeping tablets are effective for people with dementia, and there are worries that the medicines could cause significant side effects (harms). Non-drug approaches to treatment should be tried first, However, these may not help and medicines are often used. They can also be difficult for care-home staff to manage. These behaviours cause a lot of stress to carers, and may be associated with earlier admission to institutional care for people with dementia. These can include reduced sleep at night, frequent wakening, wandering at night, and sleeping excessively during the day. (Suvorexant, zaleplon and ramelteon are not currently available in Canada, but zaleplon is available through compounding pharmacies.) Trazodone, melatonin, tryptophan, tiagabine and valerian are not recommended for treating insomnia ( Sateia et al., 2017).Īll of the newest hypnotics (eszopiclone, ramelteon, zaleplon, zolpidem) have been shown to be safe and effective in older adults.People with dementia frequently experience sleep disturbances. Some sedating agents have the potential for physical or psychological dependence and there are limited studies on the effects of long-term hypnotic use.Īccording to the most recent American Academy of Sleep Medicine clinical practice guidelines, the following medications can be used to treat insomnia: suvorexant, eszopiclone, zaleplon, zolpidem, temazepam, ramelteon and doxepin. Sleep-promoting agents (hypnotics or sedatives) are generally recommended for short-term treatment of insomnia if CBT is not available or accepted by the patient. Use with caution in children and in patients with lung diseaseĬaution with renal impairment and alcohol use Temazepam (Restoril): Benzodiazepine (GABA agonist)

Cognitive Behavioural Therapy: An information guide for families.

Psychiatry in Primary Care: A Concise Canadian Pocket Guide 2019.

The efficacy of hypnotics is comparable to that of CBT-I for the acute treatment of insomnia however, the effects dissipate after the hypnotic is discontinued, whereas improvements made through CBT-I are maintained after the patient completes treatment.

Consider pharmacotherapy for chronic insomnia when CBT-I is not available, when treatment was not effective or when the patient prefers pharmacotherapy.Įvidence suggests that insomnia with objective short sleep duration has primarily biological roots (e.g., genetics and physiological hyperarousal) and may respond better to biological treatments, whereas insomnia with objective normal sleep duration has primarily psychological roots and may respond better to psychological interventions alone (CBT techniques). Pharmacotherapyįor pharmacotherapies used in Canada to treat sleep disorders, see table below. Goolam Hussain and Colin Shapiro (CAMH, 2019). Text adapted from: 'The adult patient with a sleep disorder,' in Psychiatry in primary care by Dora Zalai, M.R.

Medication for insomnia