Approach to insomnia in patients with dementia

Insomnia occurs in one-fourth to one-third of patients with dementia, and can lead to patient and caretaker distress and early institutionalization. An array of effects from the disease, medication, behaviors, and mood issues may play a role in influencing sleep. This perplexing issue can be handled effectively with appropriate evaluation and understanding of basic sleep-wake physiology. For most patients, appropriate timing of cues, modifying behavior, and optimizing medications can improve the patient's and caregiver's quality of life. In this article, we review signs that may help the clinician recognize insomnia early and approach the issue in a logical manner.