치매환자의 수면장애의 실질적 치료
Practical Management of Sleep Problem in Dementia
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Patients with dementias, such as Alzheimer’s disease (AD), often have sleep disturbances. Clinically, this may present as agitation during the nighttime, we often have been called sundowning. Sleep disturbance in AD may be multifactorial, for example, sleep-disordered breathing, restless leg syndrome, and disrupted chronobiology, which often caused by excessive daytime napping. So we carefully consider these secondary cause of insomnia, especially in elderly demented patients. Unfortunately, there have been no randomized clinical trials of sedative-hypnotic medications specifically targeted at AD patients with sleep problems. Evidence suggests that sedative-hypnotics, such as benzodiazepine site-specific agonists, may have a role in some cases, whereas atypical antipsychotics or specific antidepressants may be necessary in other cases. There are also reports of successful interventions with nonpharmacologic options (eg, exercise, illumination). The utility of melatonin as a hypnotic in this population appears equivocal.
Abstract
Patients with dementias, such as Alzheimer’s disease (AD), often have sleep disturbances. Clinically, this may present as agitation during the nighttime, we often have been called sundowning. Sleep disturbance in AD may be multifactorial, for example, sleep-disordered breathing, restless leg syndrome, and disrupted chronobiology, which often caused by excessive daytime napping. So we carefully consider these secondary cause of insomnia, especially in elderly demented patients. Unfortunately, there have been no randomized clinical trials of sedative-hypnotic medications specifically targeted at AD patients with sleep problems. Evidence suggests that sedative-hypnotics, such as benzodiazepine site-specific agonists, may have a role in some cases, whereas atypical antipsychotics or specific antidepressants may be necessary in other cases. There are also reports of successful interventions with nonpharmacologic options (eg, exercise, illumination). The utility of melatonin as a hypnotic in this population appears equivocal.
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