Zolpidem, zopiclone help insomniac seniors with Alzheimer’s disease sleep

Short-term treatment with zolpidem or zopiclone in older patients with Alzheimer’s disease and insomnia appears beneficial, even though safety and tolerance issues have yet to be personalized in healthcare settings and further investigated in subsequent trials, according to a study.

The study included 62 patients (average age 80.5 years) with probable late-onset Alzheimer’s dementia and insomnia. They were randomized to receive zolpidem 10 mg/day, zopiclone 7.5 mg/day, or placebo for 14 days. All patients underwent actigraphy.

The primary endpoint was the main nocturnal sleep duration (MNSD), whereas secondary outcomes were the proportion of the night-time slept, awake time after sleep onset (WASO), nocturnal awakenings, total daytime sleep time, and daytime naps. Researchers tested cognitive and functional domains before and after treatment.

Three participants in the zopiclone group discontinued treatment due to intense daytime sedation and worsened agitation with wandering. Zopiclone was associated with an 81-minute increase in MNSD (95 percent confidence interval (CI), −0.8 to 163.2), a 26-minute reduction in WASO (95 percent CI, −56.2 to 4.8), and a two-episode decrease in awakening per night (95 percent CI, −4.0, 0.4) on average compared to placebo.

Zolpidem yielded no substantial difference in MNSD despite a significant 22-min drop in WASO (95 percent CI, −52.5 to 8.3) and a one-episode reduction in awakening each night (95 percent CI, −3.4 to 1.2) as compared with placebo. A 1-point reduction in mean performance was seen in the symbols search test among zolpidem-treated participants, as well as an almost 8-point reduction in average scores in the digit-symbol coding test among zopiclone users (95 percent CI, −21.7 to 6.2).