Sleep Medicines and Dementia: Melatonin, Trazodone and What to Avoid

What the research says about melatonin, trazodone and other sleep medicines for people with dementia, which common sleep aids experts say older adults should avoid, and safer first steps to try.

By Jim Pavlish, Editor · Last updated: November 3, 2026 · Editorial policy

Short answer: there's surprisingly little good research on sleep medicines for people with dementia. A 2020 Cochrane review found no evidence that melatonin (up to 10 mg) improves sleep in Alzheimer's. Low-dose trazodone and a newer type of sleep drug called an orexin blocker (such as suvorexant) showed modest benefits in small trials. Experts advise older adults to avoid common sleeping pills like zolpidem and benzodiazepines, and "PM" sleep aids with diphenhydramine. The Alzheimer's Association says to try non-drug steps first and to decide on any medicine with the doctor.

When the person you care for is up at 2 a.m., pacing, calling out or trying to leave, nobody in the house sleeps. It's no wonder caregivers reach for the melatonin bottle or ask the doctor for a sleeping pill.

Here's what the research actually shows, and what to talk over with the doctor.

This page is general information, not medical advice. Don't start, stop or change any medicine or supplement for someone with dementia without checking with their doctor or pharmacist.

Start with the cause

Poor sleep in dementia often has a cause that can be fixed. The Alzheimer's Association lists urinary tract infections, incontinence, restless legs and sleep apnea among the problems that can cause or worsen sleep trouble. Pain, too much napping, caffeine, a too-dark or noisy room, and other medicines can also play a part.

For sleep problems caused mainly by Alzheimer's itself, the Association says most experts encourage non-drug approaches first. See Sleep Problems in Dementia and Sundowning for practical tips.

What the research says about each option

In 2020, Cochrane reviewers looked for every good-quality randomized trial of medicines for sleep problems in dementia. They found only nine trials with 649 people, all with Alzheimer's disease. Here's what they found.

Melatonin

Melatonin is a hormone that helps regulate the body clock, sold over the counter as a supplement.

• Five trials tested melatonin doses up to 10 mg.
• The reviewers found no evidence that melatonin improved sleep in people with Alzheimer's: not total sleep time, not night waking.
• No serious harms were reported.

There's also a quality problem. A 2023 study in JAMA tested 25 melatonin gummy brands sold in the U.S. Most were mislabeled. The actual amount of melatonin ranged from 74% to 347% of what the label said, and some products also contained CBD. In the U.S., melatonin is sold as a supplement and isn't checked like a prescription drug.

Trazodone

Trazodone is an older antidepressant that causes drowsiness, often prescribed at low doses for sleep.

• One small trial of 30 people with moderate to severe Alzheimer's tested 50 mg at night for two weeks.
• People slept about 43 minutes longer a night on average, and spent a larger share of their time in bed asleep.
• It didn't reduce the number of times people woke up. No serious harms were reported, but the trial was tiny and short.

Orexin blockers (suvorexant, lemborexant)

These newer prescription sleep drugs block orexin, a brain chemical that keeps us awake.

• Two trials included 323 people with mild to moderate Alzheimer's.
• In the larger trial, people slept about 28 minutes longer a night and spent about 16 fewer minutes awake after first falling asleep.
• Side effects weren't clearly more common than with a placebo.

Common sleeping pills: little research, real risks

The Cochrane reviewers found no trials at all of many widely prescribed sleep drugs in dementia, including benzodiazepines and "Z-drugs" such as zolpidem (Ambien).

The American Geriatrics Society's Beers Criteria, a widely used list of medicines that can be risky for older adults, advises avoiding:

• Benzodiazepines (such as lorazepam, alprazolam or temazepam) and Z-drugs (zolpidem, eszopiclone, zaleplon). In older adults they raise the risk of confusion, delirium, falls, fractures and car crashes.
• First-generation antihistamines, such as diphenhydramine and doxylamine. These are the sleep ingredients in many over-the-counter "PM" products and nighttime sleep aids. Their anticholinergic effects can worsen confusion and memory.

The Beers Criteria also says these sedating drugs are especially worth avoiding in people with dementia or memory problems. See Medications That Can Affect Memory and Delirium vs. Dementia.

What about antipsychotics or cannabis?

Antipsychotic medicines are sometimes used for severe agitation, but they carry serious risks for people with dementia and aren't sleeping pills. See Antipsychotics and Dementia: Risks. For CBD and cannabis, see Cannabis, CBD and Dementia: What the Evidence Shows.

Non-drug steps to try first

The Alzheimer's Association suggests:

• Keep a regular routine for waking, meals and bedtime.
• Get outside in daylight when possible.
• Limit daytime naps if night sleep is a problem.
• Plan busy activities, such as appointments and baths, for the morning or early afternoon.
• Serve a bigger lunch and a lighter evening meal.
• Cut back on caffeine, alcohol and nicotine.
• Keep evenings calm: less TV and noise, soothing music, a familiar routine.
• Keep the home well lit in the evening to reduce confusing shadows.
• Ask the doctor about the best time of day to take each medicine.

If the person wakes up upset, approach calmly, check whether they need something, such as the bathroom, gently remind them of the time, and avoid arguing.

Questions to ask the doctor

• Could pain, an infection, sleep apnea or one of their current medicines be causing this?
• Are any of their medicines on the Beers list, including over-the-counter ones?
• If a sleep medicine makes sense, what are the risks of falls and confusion?
• How long should we try it, and how will we know if it's working?
• Is the melatonin or "PM" product we're using safe with their other medicines?

Bring every pill bottle, including vitamins and supplements, to the appointment. See Managing Medications for Someone with Dementia.

Common questions

Does melatonin help dementia patients sleep?

The best evidence says probably not. A 2020 Cochrane review of five trials found no clear improvement in sleep with melatonin up to 10 mg in people with Alzheimer's. No serious harms were reported, but talk to the doctor before using it.

Is trazodone safe for dementia sleep?

One small two-week trial found low-dose trazodone (50 mg) helped people with Alzheimer's sleep about 43 minutes longer, with no serious harms reported. That's too little evidence to call it proven. Whether it's right for one person is a decision for their doctor.

What sleep aid is safest for someone with dementia?

There's no proven "safe" sleep aid. Non-drug steps come first. Experts advise older adults to avoid benzodiazepines, zolpidem and similar drugs, and diphenhydramine "PM" products. If medicine is needed, the doctor can weigh the options.

Can Tylenol PM or Benadryl make dementia worse?

They can worsen confusion. Many "PM" products contain diphenhydramine, which the Beers Criteria says older adults should avoid because of anticholinergic effects such as confusion. Ask the pharmacist about safer choices.

The bottom line

Sleep medicines are no quick fix for dementia-related sleep problems. Melatonin hasn't been shown to help, a couple of prescription options show modest benefit in small studies, and many common sleep aids can make confusion and falls more likely. Look for fixable causes, try a steady daily routine, and work out any medicine plan with the doctor.

Sources

1. Cochrane (2020): McCleery J, Sharpley AL, Pharmacotherapies for sleep disturbances in dementia
2. Journal of the American Geriatrics Society (2023): American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults (PubMed 37139824)
3. Alzheimer's Association: Sleep Issues and Sundowning
4. JAMA (2023): Cohen PA et al., Quantity of Melatonin and CBD in Melatonin Gummies Sold in the US (PubMed 37097362)

Not medical advice. This article is general information, not a diagnosis or treatment plan for any individual. Talk with a doctor about your situation.

Related articles

• Sleep Problems in Dementia
• Sundowning
• Medications That Can Affect Memory
• Managing Medications for Someone with Dementia
• Antipsychotics and Dementia: Risks
• Treating Behavioral Symptoms