DOI: https://doi.org/10.36347/sjmcr.2026.v14i04.054

Pages: 813-817

Insomnia is common in patients with dementia, affecting up to 60% of individuals, and is associated with poorer quality of life, increased caregiver burden, and faster cognitive decline. Managing these symptoms is difficult, given the limited available pharmacological options and their safety concerns. This narrative review summarizes current evidence on pharmacological treatments for insomnia in older adults with dementia, based on a structured search of PubMed, the Cochrane Library, and ScienceDirect (2010–2025). We reviewed available data on orexin receptor antagonists, melatonin, hypnotics, antidepressants, antihistamines, and antipsychotics; with particular attention to their efficacy and safety profiles. We propose a pragmatic, stepwise clinical algorithm to support day-to-day decision-making. The approach favors better-tolerated options such as orexin receptor antagonists and low-dose trazodone, while reserving higher-risk medications for selected, refractory situations.