Sleeping Pills for People with AD?

We know that good sleep is important in the fight against AD, and we discussed this in our post of July 13, 2018.  But people with dementia have trouble sleeping well.  I've heard some authorities describe this as a vicious circle, which makes sense.  You need good sleep to fight AD, but AD makes it much harder to get good sleep.  So why not take sleeping pills to rest better?

Hypnotics (like Ambien) and tranquilizers (like Valium) are known to aggravate AD, and so are not usually prescribed for people with AD.  Or at least my doctor won't prescribe them for me.  But is there another medication that would help us sleep better at night and feel better during the day without causing problems with AD?  Maybe there is.

A recent stage 3 (final stage) trial for the drug Suvorexant, sold under the trade name Belsomra, suggested that Suvorexant prolongs sleep, with more overall sleep time and shorter bouts of nighttime wakefulness for people with AD than with a placebo.  (Caregivers also slept better...)  Suvorexant was approved by the FDA in 2014, so we have some experience with its behavior and side effects.  This recent trial was specifically to determine if it is appropriate for people with AD.  All well and good. 

But a couple of things here.  First is that some users complain that it doesn't help them sleep, so it may be weaker than the hypnotics for some.  Also, it has been reported to cause some of the same problems reported with other drugs, such as night terrors and thoughts of suicide.   The drug was tested on AD patients for only two years, and some say it's not clear if a longer period of usage would cause problems for people specifically with AD.

The study involved 266 people with an average age of 70 who scored between 12 and 26 out of 30 on the MMSE.  When the MMSE is used as a screening tool, 24 is considered passing, but there are caveats with that.  The MMSE is not intended for diagnosing dementia, but it is sometimes used in a research setting to track changes in cognition.  To test the effect of the drug on cognition, patients received a follow-up MMSE after four weeks into the trial.  These tests did not show evidence of reduced cognition that might be attributed to the drug.  But some wondered about what would be seen for people tested when they had been on the drug longer.  That information was not available.

You can read more about this here.

I have a lot of trouble sleeping, and I really miss Ambien.  But I'm not sure about jumping into this one.