Effect of the timing of acetylcholinesterase inhibitor ingestion on sleep

Many patients with Alzheimer's disease experience sleep disturbances, and donepezil is usually prescribed for night-time administration. However, increased acetylcholine is associated with cortical arousal. We evaluated whether subjective sleep quality differed according to the timing of medication administration. Ninety-two patients with mild to moderate Alzheimer's disease who had taken donepezil at night (n=54) or galantamine in the morning (n=38) were recruited for this study. Scores on the sleep visual analogue scale (VAS) for sleep quality and daytime drowsiness were obtained. The mean sleep-quality and daytime-drowsiness VAS scores of the donepezil and galantamine groups differed significantly at baseline (44.0±26.4 vs. 55.2±27.3, respectively; P<0.001 and 48.8±28.8 vs. 38.8±25.3, respectively; P<0.001). The patients taking donepezil were then randomly assigned to take donepezil in the morning (n=24) or at night (n=30). Eight weeks later, VAS scores also differed among the three groups (P<0.001 for both sleep quality and daytime drowsiness). The VAS scores of patients taking galantamine and donepezil in the morning were different from those taking donepezil at night at week 8. Significant changes in VAS scores emerged only in the group taking donepezil in the morning (4.6±26.5, P=0.046 for sleep quality; -7.1±26.1, P<0.001 for daytime drowsiness). These results suggest that taking acetylcholinesterase inhibitors in the morning can improve the sleep states of patients with Alzheimer's disease.