Co-use of donepezil and hypnotics among Alzheimer's disease patients living in the community

J Clin Psychiatry. 2003 Apr;64(4):466-72. doi: 10.4088/jcp.v64n0418.


Background: In clinical trials, sleep problems have been identified as side effects of donepezil, an acetylcholinesterase (AChE)-inhibiting medication for the treatment of Alzheimer's disease (AD). Poor sleep quality can exacerbate behavior problems among patients and add to the burden experienced by their caregivers. We examined the relationship between co-use of donepezil and hypnotics in a large sample of persons with AD living in the community.

Method: This secondary data analysis used cross-sectional subjects from a multiwave, consumer-based survey of AD caregivers conducted in 1997 and 1998. Rates of hypnotic use among users and non-users of donepezil were compared using chi-square analysis for independent samples, and multivariate logistic regression was used to identify significant independent correlates of hypnotic use.

Results: A total of 2638 caregivers completed at least 1 study wave. Use of hypnotics was higher in the donepezil subgroup (9.78%) compared with subjects not taking this medication (3.93%). Multivariate analysis demonstrated that donepezil use was independently linked to increased hypnotic use after controlling for the potential confounding effects of disruptive behavior and depressive symptoms (adjusted odds ratio = 3.34, p <.001).

Conclusion: In this large community sample, donepezil use was statistically linked to increased hypnotic use. Because sleep quality may be a critical issue for persons with AD and their caregivers, more rigorous evaluation of sleep problems linked to AChE-inhibitor treatment is indicated.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Alzheimer Disease / drug therapy*
  • Alzheimer Disease / psychology
  • Caregivers / psychology
  • Caregivers / statistics & numerical data
  • Chi-Square Distribution
  • Cholinesterase Inhibitors / adverse effects*
  • Cholinesterase Inhibitors / therapeutic use
  • Cross-Sectional Studies
  • Data Collection / statistics & numerical data
  • Donepezil
  • Female
  • Humans
  • Hypnotics and Sedatives / administration & dosage
  • Hypnotics and Sedatives / therapeutic use*
  • Indans / adverse effects*
  • Indans / therapeutic use
  • Male
  • Piperidines / adverse effects*
  • Piperidines / therapeutic use
  • Polypharmacy
  • Sleep Wake Disorders / chemically induced*
  • Sleep Wake Disorders / drug therapy*


  • Cholinesterase Inhibitors
  • Hypnotics and Sedatives
  • Indans
  • Piperidines
  • Donepezil