As I noted in We Know Better, the FDA issued a black box warning stating any type of antipsychotic (new or old) is not safe for people with dementia.  I also said when we know better, we do better.  The FDA warning was issued in June 2008, so clearly we know better.  Now, how do we do better?

First, it’s useful to understand why people with dementia are put on antipsychotic medications in the first place.  The top three most-cited reasons I hear are:

  1. “The doctor said this medication is for dementia.”
  2. “The doctor said this will make him stop having behaviors.”
  3. “The doctor said this will help her sleep.”

One of the big problems with treating dementia effectively is that doctors typically get one 50-minute class on depression, delirium, and dementia in medical school (yes, one class combining all three topics, lasting less than an hour).  Once in practice, doctors see their patients with dementia for about 15-20 minutes in the course of an office visit.  If you are the primary care partner, it’s likely you have more experience with the day-to-day ins and outs of dementia than the doctor does.

Let’s look at the top three reasons, check the facts, and explore alternatives.

“The doctor said this medication is for dementia.”  Currently, there are only four medications approved for treatment of dementia: Aricept (donepezil), Exelon (rivastigmine), Razadyne (galantamine), and Namenda (memantine).  Any other drug is NOT approved for the treatment of dementia.

“The doctor said this will make him stop having behaviors.”  Because dementia-related behaviors are attempts to communicate, it’s much more effective to identify what is causing the behavior and then fix the underlying cause.  See Behavior=Communication: Learn to Speak Alzheimer’s, Fast!  for more details and tips.

“The doctor said this will help her sleep.”  Instead of using an antipsychotic to achieve sleep, try these ideas:

  • Is the person getting so much sleep during the day that sleeping during the night is difficult?  If so, start gradually reducing nap times by 5-10 minutes until they’re about 30-60 minutes long.  If a person doesn’t feel a sense of purpose or have something to look forward to during the day, daytime sleep can become the default mode and disrupt nighttime sleep.
  • Establish a bedtime routine and stick to it.  Allow extra time to get through the routine (about 1.5-2 times as long as it would take you to do it) and provide cueing and assistance as needed.
  • Check the environment.  Ensure the temperature is comfortable (remembering people with dementia often are colder than we are), try soft music as a background noise, and introduce a nightlight for an added sense of security.
  • Full days lead to good sleep.  Exercise, household chores, leisure pursuits…these all create a full day.  Be mindful, though, of the difference between a “full” day and an overstimulating one.  Overstimulation, just like understimulation, will lead to nighttime sleep difficulty.

What’s been your experience?  What have you found helps with sleep?  Let us know in the comments section below!