Various sleep parameters assessed actigraphically Sleep disturbances determined using the sleep disorders item from the NPI caregiver-reported
Sleep problems defined using the CUSPAD and NPI Rest-activity disruptions, including insomnia, frequent nighttime awakenings, wandering at night, unusually early morning awakenings, “sundowning,” and excessive daytime sleepiness Sleep disturbances rated using a subsection of the MOUSEPAD (caregiver-reported) Unsatisfied sleep defined by patient (confirmed by caregiver) Sleep disturbances causing emotional distress to caregivers (score of≥1 on NPI caregiver-reported) and sleep profile determined via actigraphyĭisturbed circadian rest-activity cycles (caregiver-reported frequent nighttime awakenings and daytime napping) Sleep disturbances: nighttime insomnia/sleep complaints reported after AD diagnosis, ≥2 sleep disorders on NPI. Sleep disorder/sleep disturbances reported via sleep logs (caregiver-reported) Moderate and severe sleep disturbances defined by≥1 or≥2 observations of wakefulness during night, respectivelyĤ1 (retrospective analysis including only AD: 14) Insomnia recorded at discharge (not defined) Studied effects of treatment on sleep and circadian activity rhythms, measured via wrist actigraphyĢ,796,871 insomnia patients of whom 138,270 had newly diagnosed AD Sleep disturbances, determined using a Spanish version of the NPI (unusual behavior at nighttime) Included studies and definitions used for cognitive impairment and sleep problems StudyĬlinic/hospital (19 patients were institutionalized) This literature review aims to summarize the clinical, economic, and QoL impact of insomnia and sleep disturbances on patients and their caregivers, as well as the abilities of currently available therapies to treat sleep problems and reduce their impacts in this population. Currently, one medication (suvorexant) has been specifically approved for the treatment of insomnia in AD patients by the US Food and Drug Administration (FDA). Due to the limitations of non-pharmacological and pharmacological treatments for the management of insomnia in AD patients there is a significant unmet need. Moreover, current non-pharmacological treatments such as cognitive behavioral therapy for insomnia (CBT-I) may not be effective as AD patients may be unwilling or unable to participate in therapy. The American Geriatrics Society strongly recommends against the use of benzodiazepines and related non-benzodiazepines in elderly patients. Benzodiazepine receptor agonists are associated with an increased risk of falls, fractures, and clinically significant impairments in balance and cognition upon awakening. ĭespite the high prevalence and substantial disease burden of insomnia in AD patients, including negative impacts of insomnia symptoms on mental and physical health, quality of life (QoL), and functional ability, treatment options for this patient population are limited. Moreover, insomnia is also a risk factor for AD, and a bidirectional relationship is thought to exist between poor sleep and AD pathology. AD patients also experience more severe symptoms of insomnia and sleep disturbances, such as increased sleep latency and reduced sleep maintenance, as well as progressive deterioration and instability of circadian rhythms, compared to older adults without AD. Insomnia symptoms and sleep disturbances (collectively referred to in this manuscript as sleep problems) increase with age and are common in AD patients, with a prevalence of > 50%. Insomnia is characterized by difficulty initiating or maintaining sleep among individuals with adequate opportunity to sleep and is associated with daytime consequences, such as an inability to perform daily activities. The behavioral symptoms of dementia, including disturbed sleep, nighttime awakenings and wanderings place a substantial burden on family and caregivers, and lead to the early institutionalization of AD patients. ĪD is associated with significant healthcare costs and resource utilization, particularly when patients require admission to care facilities. With an aging global population, the AD population is expected to triple over the next 40 years, to over 13 million cases. Alzheimer’s disease (AD) is a progressive neurodegenerative disease, characterized by continuing cognitive decline and memory loss it accounts for 60% to 80% of dementia cases in adults > 65 years of age.
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