Objective To describe two elderly patients with dementia and severe nighttime wandering in whom Zolpidem restored normal sleep patterns. Case Summaries A 90-year-old African-American woman (case 1) and an 87-year-old African-American man (case 2) presented with nighttime wandering associated with the progression of Alzheimerlike dementia. Both patients had previously not responded to bedtime regimens of benzodiazepines, trazodone (an antidepressant used for its sedative properties), and neuroleptics. Both patients averaged 2–3 hours of sleep each night. Low-dose Zolpidem (5 mg hs) was initiated with only partial response. The dosage was titrated in 5-mg increments until the optimum dosage was reached for case 1 (15 mg hs) and case 2 (10 mg hs). These dosages have proven to be effective over a period of 3 months, with both patients averaging 7–8 hours of sleep each night with no apparent adverse effects. Discussion Dementia produces inversion of the circadian sleep/ wake cycle, leading to daytime sedation and nighttime wandering. Zolpidem, a nonbenzodiazepine hypnotic with proven safety and efficacy in older patients with insomnia, was well tolerated and improved sleep patterns in two patients with dementia and severe nighttime wandering. Conclusions Zolpidem appears to be useful for restoring normal sleep patterns in elderly patients with dementia and nighttime wandering.

Careful differential diagnosis is an essential preliminary step to successful treatment. Non-pharmacologic interventions (behavioral treatments, in particular) may be effective for many patients. Consideration of both the benefits and the risks of medication management is recommended, as elderly patients are especially vulnerable to side effects.

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