Saturday, June 26, 2010 E Landsverk MD asks

Q: Concern for treatments of insomnia in Dementia

As a Geriatrician, board certified in Internal Medicine, Geriatrics and Palliative Care Medicine, having taught at UCSF, now with a house calls practice in San Francisco, I was concerned to see the recommendation of using sleeping pills like Ambien in Alzheimer's or other dementia. Trazadone is OK, except can cause a drop in blood pressure. The other sleeping pills can cause more agitation, disinhibition and confusion and falls. And they often don't work after a week or so. I was wondering what studies you site. More often the antidepressants, such as Citalopram, can decrease agitation and improve sleep without the above side effects.

Elizabeth Landsverk MD

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Answers (2)

Carol Bradley Bursack, Health Guide

6/27/10 9:58am

Thanks for your note, Dr. Landsverk. Most people are advised to take their loved one to the doctor they are currently seeing, or seek out a second opinion if they aren't happy with treatment. As you wisely point out, side effects can be an issue with all people, especially people with dementia. Often people will say a drug worked for their loved one, but we make it plain that we are just passing along information and that each person needs specific medical advice.

As you say, antidepressants can be very effective for many with Alzheimer's, however a side effect (obviously you know this, but I'm mentioning this for general readers) of some antidepressants can be sleep problems. Trazedone is often given to counteract this, but that can be overly sedating for some. Everyone is advised to talk with the treating doctor, but to feel free to suggest a drug that has helped someone else's loved one, in case the doctor thinks it is an option.

We really appreciate your input and are looking forward to more expert comments in the future.

Carol

E Landsverk MD

6/27/10 4:01pm

Thank your for your response and information. As a Geriatrician who makes house calls in the San Francisco Bay Area, I see frail, complicated, elders often with dementia and agitation. The information to which I referred was from your section on use of Medications in Alzheimer's, reviewed by an associate professor of Medicine.

I am concerned that the benzodiazepines, Restoril, Temazepam, or Ambien category of medications cause alot of problems (see above). There are studies that show that Citalopram (Celexa) can help with agitation. I have found it to be calming and if given at night (generally ordered for the am) will help with sleep. Also need to get rid of the caffeine (decaf coffee or tea is OK) and alcohol and increase exercise for anyone with insomnia. Other antidepressants can lead to more sleep problems more often Prozac, Zoloft or Effexor, and better to change to one that does not than add another med, Trazadone.

I have written of my review of the literature and experience about use of medications for those with dementia at:

www.elderconsult.com

As with your site, I am sharing my information which should never be used independentily of the doctor who knows the patient best. I also think treating pain is very important for sleep and to decrease agitation. Tylenol 500 mg three times a day can help those who cannot express their pain directly- again, ask your doctor, liver problems or not eating drinking can be reasons to limit this more. And NEVER use Tylenol PM- has Benedry- anticholinergic and causes more agitation.

Elizabeth Landsverk MD

Carol Bradley Bursack, Health Guide

6/27/10 4:27pm

Thank you so much, Dr. Landsverk, for your input. You second note clarifies your reference, as well. I wasn't sure if it was the personal sharing on the site or the more targeted information.

The idea that you make house calls - Wow! You are one in a million. What we caregivers would do for more doctors like you. Also, you comments on pain are si right on. I'd love to know you!

Carol

E Landsverk MD

6/28/10 11:54am

It sounds like you have been doing great work getting the word out for families. You can reach me thru my web site www.elderconsult.com at contact us.

6/28/10 10:02am

Dr. Landsverk,

Your article in elderconsult.com is useful. I thank you for caring so much for the elderly. Not many doctors are really truly concerned with the medication issues.

Thank you so much for sharing the info. with us in this site.

Regards,
Nina

E Landsverk MD

6/28/10 11:56am

This disease is so heartbreaking for families. There is so much variation of information and the studies are very hard to do to get useable answers. This is the contribution I can make

E Landsverk MD

Carol Bradley Bursack, Health Guide

6/28/10 12:09pm

Your contribution is priceless. We are grateful.

Carol

Christine Kennard, Health Pro

6/28/10 2:11pm

Dear Dr Landsverk

Thankyou for your contribution. The information on drug treatments comes from information by Marc E Agronin, Director of Mental Health Services, University of Miami School of Medicine, Miami, Florida. I have now referenced the sharepost and it is made clear than an accurate diagnosis is required before treatment is begun.

Doctors with experience of sleep disorders and problems do have drugs that they have found to be more effective than others and drugs prescribed are variable because of this.

Best Wishes

Christine

E Landsverk MD

6/28/10 2:20pm

Thank you for your response. It has been recommended to use sleeping pills in dementia by various sources. However, the Geriatric Psychiatrists I hhave worked with in NY and SF point out the problems with using the benzodiazpine class chronically in this group of patients. I just wanted to bring up that has also been my experience. The American Geriatric Society may be another useful web site.

E Landsverk MD

Christine Kennard, Health Pro

6/28/10 2:36pm

Thank you for making an important point on the potential problems of long term use of the benzodiazpine class of drugs.

Best Wishes

Christine