Pharmacological and non-pharmacological treatment options for sleep disturbances in Alzheimer’s disease

ABSTRACT

Introduction

Alzheimer’s disease (AD) is one of the most common neurodegenerative disorders among the older population. Sleep disruption and circadian rhythm disorders often develop in AD patients, and many experience sleeping difficulties requiring pharmacological and non-pharmacological interventions.

Areas covered

This review appraised the evidence from clinical studies on various pharmacological and non-pharmacological therapies for sleep disturbances in AD patients and proposed an algorithm to manage sleep disturbances in this population of patients.

Expert opinion

Non-pharmacological interventions are generally preferred as the first-line approach to improve sleep-related symptoms in AD due to their favorable safety profile. However, when non-pharmacological interventions alone are insufficient, a range of pharmacological agents can be considered. Trazodone and melatonin are commonly used as adjunctive therapies, while Z-drugs including zopiclone and zolpidem are specifically employed to treat insomnia in patients with late-onset AD. Furthermore, a newer class of agents known as dual orexin receptor antagonists has emerged and gained approval for improving sleep onset and maintenance in AD patients.

KEYWORDS:

• Alzheimer’s disease
• dementia
• sleep disorders
• tau proteins
• melatonin levels
• cholinesterase inhibitors

Article highlights

• Alzheimer’s disease (AD) is the most common type of dementia among the older population.

• Sleep disruption in AD patients can have a significant role in the progression of AD symptoms.

• Melatonin was the most widely used treatment of choice, despite its limited efficacy.

• Non-pharmacological interventions such as CPAP treatment in AD patients can lead to significant improvement in sleeping disturbances.

Acknowledgments

The authors would like to thank Ezekwesiri Nwanosike for his support in completing this review.

Abbreviations

CPAP	=	Continuous positive airway pressure
ESS	=	Epworth Sleepiness Scale
AD	=	Alzheimer’s disease
OSA	=	Obstructive sleep apnea
tCPAP	=	therapeutic CPAP
pCPAP	=	placebo CPAP
PD	=	Parkinson’s disease patients
MSQ	=	Mini-Sleep Questionnaire
PIAQ	=	Pfeffer Instrumental Activity Questionnaire
BLT	=	Bright light treatment
PSQI	=	Pittsburgh Sleep Quality Index
LP	=	Light and Placebo
LM	=	Light and Melatonin
SEM	=	standard error of the mean
DDS	=	Dawn – dusk simulation
NITE-AD	=	Nighttime Insomnia Treatment and Education in Alzheimer’s Disease;
TST	=	Total sleep time
NST	=	nocturnal sleep time
MDA	=	mean daily activity
LPRS	=	London Psychogeriatric Rating Scale
CES	=	Cranial electrical stimulation
NPI	=	Neuropsychiatric Inventory
PRM	=	Prolonged release melatonin
SWD	=	Short scale for sleep – wake disturbances in dementia

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This research was not funded.