Zolpidem for dementia-related insomnia and nighttime wandering

OBJECTIVE: To describe two elderly patients with dementia and severe nighttime wandering in whom zolpidem restored normal sleep patterns. CASE SUMMARIES: A 90-year-old African-American woman (case 1) and an 87-year-old African-American man (case 2) presented with nighttime wandering associated with the progression of Alzheimer-like dementia. Both patients had previously not responded to bedtime regimens of benzodiazepines, trazodone (an antidepressant used for its sedative properties), and neuroleptics. Both patients averaged 2-3 hours of sleep each night. Low-dose zolpidem (5 mg hs) was initiated with only partial response. The dosage was titrated in 5-mg increments until the optimum dosage was reached for case 1 (15 mg hs) and case 2 (10 mg hs). These dosages have proven to be effective over a period of 3 months, with both patients averaging 7-8 hours of sleep each night with no apparent adverse effects. DISCUSSION: Dementia produces inversion of the circadian sleep/ wake cycle, leading to daytime sedation and nighttime wandering. Zolpidem, a nonbenzodiazepine hypnotic with proven safety and efficacy in older patients with insomnia, was well tolerated and improved sleep patterns in two patients with dementia and severe nighttime wandering. CONCLUSIONS: Zolpidem appears to be useful for restoring normal sleep patterns in elderly patients with dementia and nighttime wandering.

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				R. J. Caselli and R. Yaari Medical Management of Frontotemporal Dementia American Journal of Alzheimer's Disease and Other Dementias, January 1, 2008; 22(6): 489 - 498. [Abstract] [PDF]