Expert: Mary Gordon - 10/27/2008

Question
Good morning Mary,
I was reading one of your answers on medication and saw that you had said that you should give aricept in the morning as this can cause sleeplessness.
My mum has been on this medication for 10 months now and I was told to give it to her at nightime.
She was having trouble sleeping of a night and has been taking Risperdal + Mirtazapine of a night as well.
Do you think that taking the Aricept in the morning may help her with her sleeping?

Answer
They probably told you to give it to her at night because in some people it causes drowsiness, and taking it at night is the usual advice. However, in about 9% of people, it causes insomnia and other sleep problems.

If you go to this drug description for Aricept
http://www.rxlist.com/aricept-drug.htm  
and you go way over to the consumer advice on page 8 it says "Take this medication by mouth once daily with or without food, usually just before bedtime, or as directed by your doctor. If you experience sleep problems (insomnia), talk to your doctor about switching to a morning dose."
You will also see the same advice here about trying a morning dose:
http://www.alzheimer.ca/english/treatment/treatments-aricept.htm

Many dementia specialists recommend taking Aricept and other cholinesterase inhibitors in the morning to avoid the potential sleep disruption.  As you probably know, it helps to  to take it with some food to delay absorption and decrease GI side effects, and oatmeal, eggs, cottage cheese, yogurt, etc  fit the bill perfectly.

Its completely worth a try to see if it helps - doesn't cost you anything, and worth a shot. You haven't got much to lose. Talk to the doctor and see - you will just have to watch her to make sure she isn't changing out one side effect for another.

Having said all that, many people in mid dementia have sleep problems - in fact its about 70%. The disease really disrupts their biological rhythms. Here is a good Australian page with a range of tips and ideas.
http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Dementia_and_slee...

Hope this helps. The big ones are usually making sure the person keeps a routine (going to bed and getting up at the same time every day), getting some exercise if possible (even a walk around the block with an escort helps a bit), and not letting them sleep during the day. The last one is a difficult one, I know! On my mother in law's Alzheimer's ward, they actually banned TVs from the floors, because too many residents would spend their day drowsing in front of the tube, instead of interacting and moving around, and then they'd be up half the night !

Talk to the doctor. As you can see for yourself, wiser heads than mine have suggesting trying Aricept in the morning if the person is having sleep problems.

Mary G.