Question: In adults with a reversed sleep-wake cycle, particularly those with dementia, how effective is Melatonin compared to treatment as usual, in improving sleep initiation, prolonging sleep and correcting the reversed sleep-wake pattern?

Answer:

Limited evidence, from one systematic review with methodological flaws, one additional small, poor quality RCT and one good quality RCT, suggests that melatonin, particularly when used in combination with bright light treatment, may be effective in improving symptoms of sleep disturbance in elderly patients with dementia. However, further high quality research is needed, in particular to explore the interaction between melatonin and bright light and its importance for treatment effectiveness.