A Review of Using Belsomra® in Treating Insomnia in Alzheimer's 

 

 

Insomnia—struggling to fall asleep or stay asleep—is a widespread and challenging condition in adults over 65. This is largely due to normal, age-related changes in sleep patterns. 

 

Why Sleep Problems Matter in Alzheimer’s

Sleep problems are very common in Alzheimer’s. As many as 70% of people have trouble sleeping.


Poor sleep can make memory and behavior worse, and it can be very hard on caregivers.

 

There may be a two-way connection:

  • Alzheimer’s can make sleep worse.

  • Poor sleep may make Alzheimer’s worse over time.

 

Because of this, treating sleep may help people feel better and possibly protect the brain.

 

Cognitive Behavioral Therapy for Insomnia (CBT-I) is strongly endorsed as the gold-standard, first-line treatment for , whenever feasible. While medications are often seen as easier, sleep drugs pose increasing risks with age—like drowsiness, confusion, or falls. Even if medication is needed, routines matter most. Here are some caregiver tips:

 

 

Healthy Sleep Routines That Help 

 

Keep bed and wake times consistent every day.

 

Make the bedroom quiet, dark, and cool.

 

Avoid caffeine after lunch.

 

Encourage daylight exposure and gentle activity during the day.

 

Use the bed only for sleep (and intimacy)—not TV or phones.

 

Limit naps to 20–30 minutes early in the day.

 

 

 

 

If sleep therapy isn’t enough, doctors may suggest medicines like low-dose doxepin, melatonin, ramelteon, or newer options like Belsomra. These can help, but older adults with memory problems may be more sensitive to side effects, so close monitoring at home is important.

 

No sleep medicine is officially approved just for Alzheimer’s, but providers sometimes prescribe them when sleep problems are severe or disruptive.

 

Belsomra is a newer medication that helps calm the brain so sleep comes more easily. In 2020, the FDA added results from a short study in people with mild to moderate Alzheimer’s to its official information

 

What the Medicine Does

Suvorexant is a sleep medicine that helped people with Alzheimer’s disease sleep about 28 minutes longer each night in a research study.
Overall, it was well tolerated and most people did not have serious side effects.

 

 

How These Medicines Work

These medicines affect a chemical in the brain called orexin, which keeps us awake.

 

In Alzheimer’s, orexin levels can be too high, which may make people:

  • Wake up often
  • Wander at night
  • Sleep less

 

The medicines in this group (called DORAs) help by turning down orexin, making it easier to fall and stay asleep.

 

They work differently from older sleeping pills and usually don’t cause the same memory or thinking problems.

 

 

What the Suvorexant Study Found

A study was done in 285 adults aged 50–90 with Alzheimer’s and insomnia.

 

People took suvorexant for 4 weeks.

 

By the end of the study, people taking suvorexant slept about 73 minutes more, compared to 45 minutes more in the placebo group.
That means suvorexant gave about 28 minutes of extra sleep beyond placebo.

 

Most people finished the study, which suggests the medicine was generally easy to tolerate.

 

 

​​​​​​HOW SOON DOES BELSOMRA START WORKING?

 

Suvorexant (Belsomra) can start helping people with Alzheimer’s sleep on the first night. It’s taken once before bed, and you need at least 7 hours to sleep.

 

Studies show it works quickly and keeps working over time. In one study, most people started at 10 mg, and many increased to 20 mg after two weeks if they needed more help.

 

However, it's important to note that the onset of action can be delayed if you take it with or soon after a high-fat meal. In such cases, it could take over an hour longer for it to start working. To maximize the medication's effectiveness, it's best to take it on an empty stomach or with a low-fat snack. 

Side Effects

Most side effects were mild.


The most common was sleepiness during the day, which happened in about 4% of people.

 

Because older adults with memory problems are already at higher risk for falls, doctors may want to monitor carefully when starting these medicines.

 

These medicines can also sometimes cause:

  • Tiredness
  • Strange dreams

 

They are not recommended for people with narcolepsy.

 

 

Other Similar Medicines

There are three medicines in this group available in the U.S.:

  • Suvorexant (Belsomra)
  • Lemborexant (Dayvigo)
  • Daridorexant (Quviviq)

 

All three help people fall asleep and stay asleep, but none are officially approved for Alzheimer’s-related sleep problems.

 

Early research suggests:

  • Lemborexant may help with day–night rhythm problems in Alzheimer’s.
  • Daridorexant may help with sleep but hasn’t been well studied in Alzheimer’s yet.

 

 

Could These Medicines Help Slow Alzheimer’s?

Early research suggests they might do more than help people sleep.

 

Studies in animals and small studies in people show they may:

  • Lower levels of amyloid and tau (proteins linked to Alzheimer’s)
  • Protect brain cells
  • Improve memory and thinking

 

This is promising, but still early.
We don’t yet know if these benefits last long term or make a real difference in disease progression.

 

 

What We Still Need to Learn

Research so far has mostly been short-term (about 4 weeks).


We need longer studies to understand:

  • Long-term safety
  • Whether benefits continue
  • Whether they slow down Alzheimer’s disease

 

There is also little research in people with advanced dementia or in diverse populations.

 

 

What Experts Say

Some experts think DORAs may be safer than older sleeping pills for older adults, especially for short-term use. 

But there are no official guidelines yet for using them in people with Alzheimer’s disease.

 

Because of their possible brain-protecting effects, some researchers think these medicines might work best early, before sleep problems and memory loss become very severe.

 

 

 
IN SUMMARY

 

Sleep and Alzheimer’s

 

Sleep problems are very common in Alzheimer’s and can make memory, mood, and daily functioning harder.

 

 

How Belsomra May Help

 

  • Belsomra may help people with Alzheimer’s sleep a bit longer.

  • The benefit is usually small but noticeable, and many people tolerate it well.

  • Because it can cause sleepiness, confusion, or falls in some people, careful monitoring is important, especially at home.

 

 

Start with Non-Medication Options

 

Before starting medicine, it’s usually best to try behavioral sleep strategies, like improving routines, reducing naps, and creating a calm bedtime environment.

 

If Medicine is Needed

 

Talk with a doctor (ideally a geriatric specialist) about which option is safest. 

Common choices include low-dose doxepin, melatonin/ramelteon, or newer medicines like Belsomra.

 

 
Using Belsomra Safely

 

If you and the provider decide to try Belsomra:

 

  • Start with the lowest dose that works

  • Take it right before bed with enough time for a full night of sleep

  • Watch for side effects like increased sleepiness, confusion, or unusual behaviors at night

  • Keep practicing good sleep habits at home

 

What We Still Don’t Know

 

Newer sleep medicines may be safer than older ones and could have added brain benefits, but we need more research to know for sure.

References:

1. Scheltens, P., De Strooper, B., Kivipelto, M., et al. (2021). Alzheimer’s disease. The Lancet, 397(10284), 1577–1590. https://doi.org/10.1016/S0140-6736(20)32205-4

2. U.S. Food and Drug Administration. (n.d.). Orange Book: Approved drug products with therapeutic equivalence evaluations. U.S. Food and Drug Administration.

3. Herring, W. J., Ceesay, P., Snyder, E., et al. (2020). Polysomnographic assessment of suvorexant in patients with probable Alzheimer’s disease dementia and insomnia: A randomized trial. Alzheimer’s & Dementia, 16(3), 541–551. https://doi.org/10.1002/alz.12035

4. Steinman, M. A. (2025). Alternative treatments to selected medications in the 2023 American Geriatrics Society Beers Criteria®. Journal of the American Geriatrics Society, 73(9), 2657–2677. https://doi.org/10.1111/jgs.19500