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Trazodone for insomnia7/31/2023 It is essential that trials include careful assessment of side effects. More trials are required to inform medical practice. We concluded that there are significant gaps in the evidence needed to guide decisions about medicines for sleeping problems in dementia. Only four trials measured side effects systematically. No trials assessed how long participants spent asleep without interruption, a high priority outcome to our panel of carers. All participants had dementia due to Alzheimer's disease, although sleep problems are also common in other forms of dementia. The drugs that appeared to have beneficial effects on sleep did not seem to worsen participants' thinking skills, but these trials did not assess participants' quality of life, or look in any detail at outcomes for carers.Īlthough we searched for them, we were unable to find any trials of other sleeping medications that are commonly prescribed to people with dementia. Side effects were no more common in participants taking the drugs than in those taking placebo. There was also a small increase in sleep efficiency, but no evidence of an effect on the number of times participants woke up. On average, participants in the trials slept 28 minutes longer at night and spent 15 minutes less time awake after first falling asleep. We found evidence that an orexin antagonist probably has some beneficial effects on sleep. The two orexin antagonist trials had 323 participants. ![]() It did not reduce the number of times the participants woke up at night. 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). 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. People with dementia frequently experience sleep disturbances.
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