Sleeping Aids for Seniors and Seniors With Dementia: Melatonin and Zolpidem

Poor sleep habits can have a negative impact on your thought process, heart health, and overall wellness. About 67% of US seniors reported difficulty in getting proper sleep . They are more likely to experience problems because of changes in medication, health issues, and lifestyle. Dementia disorders can also decrease sleep ability. Current sleep treatments include lifestyle changes, medication, and supplements. A common sleep supplement is melatonin . It is a hormone made in our brains that triggers our wake and sleep cycles. Pharmacological treatment and melatonin are common approaches to managing sleep issues, but there are safety concerns.

Two recent studies reviewed these approaches for elderly recipients. Researchers at the Sleep Medicine and Research Center at St John’s and St Luke’s Hospital reviewed the effects of a drug called zolpidem . In the study, published in the American Journal of Geriatric Psychiatry , zolpidem did show promising results in helping seniors achieve a more effective sleep. Researchers at the Netherlands Institute for Neuroscience reviewed the benefits of melatonin and the effect of environmental light in elderly with dementia. In this study, published in the Journal of the American Medical Association , melatonin did help with sleep but increased withdrawn dementia-related behavior. The results improved when given in combination with a bright light environment.

About the Studies

The zolpidem study was a randomized control study. It involved 205 patients aged 65-87 years. They were split into two groups. One group received zolpidem (6.25 mg extended release) every night. The second group received a placebo.

Baseline measurements were taken for both groups. At the end of 21 days, compared to the placebo group, the group that took the zolpidem reported:

  • 24.01 more minutes in total sleep time
  • An average of one fewer awakenings per night
  • 14.82 minutes more sleep before experience an awakening

In general, the zolpidem group reported a better overall sleep. Negative reports (eg, headache, dizziness , somnolence, nasopharyngitis) were about the same for both groups.

The melatonin study involved 189 elderly patients, 87% had dementia. All participants resided in assisted care facilities. The patients were randomly assigned to one of the following groups:

  • Melatonin and exposure to bright light
  • Melatonin and dim light exposure
  • Placebo and bright light
  • Placebo and dim light

Melatonin did help to improve onset of sleep and sleep duration by 27 minutes. However, it did cause unwanted side effects of increased withdrawn and depressive behavior in patients. The good news is the bright light therapy was linked to improvement of cognitive deterioration and depressive symptoms, and increased functional abilities and activities of daily living.

The combination of these two therapies seemed to produce the best results. There were decreases in nighttime restlessness, agitation, and aggression. The bright light environment seemed to counteract negative effects of the melatonin.

How Does This Affect You?

Adequate sleep is important to everyone’s overall health. Sleep solutions need to complement any current medical support you may have. Although both zolpidem and melatonin with bright light therapies showed positive outcomes it is important to understand the possible side effects as well.

Pharmacological drugs and supplements can both have significant adverse effects. Research continues to understand the benefits and risks of both. This study has revealed a caution against using melatonin for dementia patients because of the negative side effects. Talk to your doctor if you or someone you are caring for is having difficulty sleeping. Together you can develop a plan that may include lifestyle changes or medical interventions.

  • American Family Physician

    http://www.aafp.org/

  • National Sleep Foundation

    http://www.sleepfoundation.org/

  • Riemersma-van der Lek RF, Swaab DF, Twisk J, et al. Effect of bright light and melatonin on cognitive and noncognitive function in elderly residents of group care facilities: a randomized controlled trial. JAMA . 2008 Jun 11;299(22):2642-55.

  • Walsh JK, Soubrane C, Roth T. Efficacy and safety of zolpidem extended release in elderly primary insomnia patients. AM J Geriatr Psychiatry . 2008 Jan;16(1):44-57.

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