Sleep Aids: Medications Melatonin And Dementia
In some cases, the doctor may prescribe medications to help your loved one sleep. However, older adults with cognitive impairment are more likely to experience side effects from sleep-inducing drugs, so those medications arent usually recommended for long-term use.
Some studies show melatonin may improve sleep in people with mild to moderate dementia. It may also help reduce agitation and confusion late in the day. Check with your loved ones doctor before starting any over-the-counter supplements or sleep aids.
Diagnostics Of Sleep Disorders Based On Questionnaires In Ad Patients
In patients with AD, the diagnostics of sleep disorders based on specific questionnaires is difficult due to cognitive impairment affecting reliability of self-report measures of sleep. It may happen that patients who suffer from severe difficulties in falling asleep and frequent awakenings at night do not complain of insomnia at all . The study comparing results of sleep questionnaires, such as Pittsburgh Sleep Quality Index, the Sleep Disorders Questionnaire, and the Athens Insomnia Scale, with the results of actigraphy in 55 patients with AD and 26 controls revealed limited value of those sleep questionnaires in early and moderate AD stage . Based on the results obtained in the questionnaires, it has been found that sleep disorders occurred in 24.5% of patients with mild to moderate form of AD . However, it appears that sleep disorders occur much more frequently in the course of this disease .
Can Poor Sleep Cause Alzheimers
We know that cognitive impairment, such as that seen in Alzheimerâs, leads to poor sleep. Itâs also clear that poor sleep can itself lead to cognitive impairment.
So it seems like there could be a vicious circle where poor sleep â cognitive impairment â poor sleep. Herein lies the classic chicken and egg scenario, in that we donât know which comes first:
- poor sleep â cognitive impairment, or
- cognitive impairment â poor sleep.
As we mentioned earlier, our sleep naturally becomes lighter and more easily disrupted as we age due to decreases in our deep sleep.
Strikingly, nearly half of older people report sleep problems and for people with cognitive decline this figure rises to as high as 70%. 8
One such study followed the sleep of nearly 8,000 people aged over 50 in the UK over the course of 25 years. 9 They found that people who reported an average of six or less hours of sleep per night had a 30% higher likelihood of developing dementia, when compared to those sleeping for seven or more hours.
An even longer study looked at the sleep of around 1,500 men aged over 50 and found that those with sleep disturbance had a 51% increased risk of developing Alzheimerâs. 10
In this study of people with no reported dementia, the participants wore actigraphs on their wrists which tracked their sleep over the course of 10 days.
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Causes Of Sleeping Problems In Dementia
There are numerous underlying causes that can contribute to sleep changes in dementia. These causes include:
- Brain changes that occur in dementia
- Other illnesses the patient may have, including angina, congestive heart failure, or diabetes
- Pain which could be a result of arthritis
- Urinary tract infections or the frequent need to urinate, especially at night
- Disturbing dreams
Flush Your Brain While You Sleep
Although it is not totally understood why inadequate sleep increases your dementia risk, one possible reason relates to the deposition of the Alzheimers protein, beta amyloid. Beta amyloid is the protein that clusters and clumps together to form Alzheimers plaques. No one is completely certain what its normal function is, although there is increasing evidence it is involved in the brains defense against invading microorganisms.
During the day, we all make some of this beta amyloid protein in the brain. When we sleep, however, brain cells and their connections actually shrink. This shrinking allows more space between the brain cells, so that beta amyloid and other substances that accumulate during the day can be flushed away.
So the theory is, if you dont get enough sleep, your brain wont have enough time to drain away beta amyloid and other substances. These substances then continue to accumulate, day after day, until they cause dementia.
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Caring For The Caregivers
When we talk about the effects of Alzheimerâs on sleep, itâs important not to overlook the fact that thereâs a whole army of caregivers who are also at high risk of experiencing sleep problems.
Caring for someone with Alzheimerâs is a full-time task and it can be both mentally and physically exhausting. As a caregiver, if your sleep is being compromised or youâre struggling to sleep, then you shouldnât feel as if youâre fighting a lone battle.
Surveys show that around 70% of caregivers for people with dementia report problems sleeping. The majority sleep for fewer than seven hours per night and up to a fifth use alcohol or medication to get to sleep. 21222324
These figures are worrisome and show that thereâs a definite need for greater support for caregivers of people with Alzheimerâs.
Encouragingly, thereâs plenty of research looking into the best ways to improve the sleep and overall quality of life of people in caregiving roles.
Research has shown that non-medical interventions are successful in improving sleep in caregivers and may additionally help to reduce stress levels. 21
Sleepstationâs drug-free and clinically validated sleep improvement programme can help you to identify your sleep problems and will give you the tools you need to get your sleep back on track.
How To Diagnose The Sleep Problems Of A Person With Dementia
Like many problems that affect older adults, sleep problems in dementia are almost always multifactorial, which means that there are usually several underlying issues creating the problem.
Multifactorial problems can be improved, especially if a family and the doctors are diligent about trying to identify as many contributing factors as possible. But youll need to start by helping the doctors understand what kinds of sleep-related symptoms and problems a loved one is experiencing.
Here is a list of questions that a group of geriatrics experts recommends, for evaluating sleep problems.
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Why Is Sleep Important For Health And Wellbeing
A person with dementia needs regular sleep to stay well. Most adults need between seven and nine hours of sleep a night. Sleeping well helps a person to be in a better mood, think more clearly, and maintain a healthy immune system. It can also help to prevent falls and accidents, and puts the body under less stress.
The two systems in the body that work together to control sleep are a persons body clock and sleep pressure.
Check For Other Medical Conditions
Both sleep apnea and restless leg syndrome are associated with increasing age and have symptoms which will easily wake someone with dementia. To identify if your parent or partner has sleep apnea, you may have to watch them while they sleep. Someone with this condition will pause when they breathe, almost momentarily stopping breathing. This momentary lack of air can wake someone up, and is really quite frightening for the person sleeping next to them as they wait for the next breath.
If your parent/partner suffers from restless leg syndrome they move or twitch their legs uncontrollably, especially during the evenings and night-time. They may also experience tingling, burning and fizzing sensations in their legs too. Symptoms can be relieved by rubbing and stretching legs – but it can be so bad that it wakes the person up. If you discover that your parent/partner has either of these medical conditions, its wise to see a GP and ask for help.
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Causes Of Sleeping Problems
It is important to try to recognise what may be causing the problem is it the environment, the dementia or the medications used? This will help to decide on which strategies may be helpful.
Some families and carers find that keeping a log or diary may help them see the pattern of behaviour that may be developing, enabling the cause of the problem to be pinpointed.
What Are The Stages Of Alzheimer’s Disease
The progression of Alzheimers disease is measured in seven stages:
- Severe memory loss, mood swings, and behavior changes
- Extreme confusion about time, place, and life events
- Trouble speaking or communicating
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Does Alcohol Cause Parkinson’s Disease
Study Finds No Link Between Alcohol Consumption, Risk of Parkinson Disease. Although men with moderate lifetime alcohol consumption were at higher risk of developing Parkinson disease compared with light drinkers, no significant link was found between alcohol consumption and risk of PD, according to study findings
Why Do Parkinsons Patients Sleep So Much
Parkinsons patients experience difficulties with their sleep due to the disease itself and the medications that treat it. This can lead to increased sleepiness during the day.
Parkinsons disease can cause problems with sleep, and the medications used to treat it can cause even more. Difficulties sleeping during the night can cause daytime sleepiness, and the medications can also cause drowsiness. This disruption to the circadian rhythms can lead to more frequent, lower quality sleep.
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Tremors Yes Parkinsons Disease No
Essential tremor is often mistaken for Parkinsons disease, but the two conditions differ in several ways. Essential tremor is an action tremor, meaning that the involuntary shaking increases when you move and try to use your hands. In Parkinsons disease, tremors occur mainly at rest, and activity reduces the symptoms. Some people with essential tremor develop head nodding or shaking few people with Parkinsons do. Balance problems and rigidity of the arms and legs are common features of Parkinsons disease but not of essential tremor. One of the hallmarks of essential tremor, useful in diagnosing the disorder, is that alcohol can temporarily ease symptoms in Parkinsons, alcohol has little effect on the tremor.
Parkinsons disease is marked by a progressive loss of brain cells that produce dopamine, a chemical messenger that enables normal body movements. Essential tremor also appears to involve a disruption in the activity of motor pathways, but its uncertain whether there is any loss of brain cells. Postmortem examinations of brain tissue taken from people with essential tremor reveal various abnormalities in the cerebellum and brainstem, including the loss of Purkinje cells, which produce an important neurotransmitter, called GABA. But the samples dont all show the same changes, so the import of these findings is uncertain.
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How To Diagnose Dementia
To start helping doctors address your loved one’s dementia-related sleep issues, you need to understand what kinds of symptoms and problems he or she is experiencing.
I always recommend families try to keep a journal related to these questions for at least a week. Some families may also be able to use a sleep tracker or activity tracker to gather useful information.
Sometimes, additional testing is necessary, such as a sleep breathing study to evaluate sleep apnea.
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Tips For Behavior And Sleep Problems
Having a daily routine may help. Calmly reassuring and giving cues to orient the person who has dementia is also helpful in the evening and closer to bedtime. Try to keep the person going to bed at the same time every night.
Calm activities at the end of the day and before bedtime may help the person with dementia sleep better at night. If they are active during the day, these calm activities can make them tired and better able to sleep.
Avoid loud noises and activity in the home at night, so the person does not wake up once they are asleep.
Do not restrain a person with dementia when they are in bed. If you are using a hospital bed that has guard rails in the home, putting the rails up may help keep the person from wandering at night.
Always talk with the person’s health care provider before giving them store-bought sleep medicines. Many sleep aids can make confusion worse.
If the person with dementia has hallucinations :
- Try to decrease the stimulation around them. Help them avoid things with bright colors or bold patterns.
- Make sure there is enough light so that there are no shadows in the room. But do not make rooms so bright that there is a glare.
- Help them avoid movies or television shows that are violent or action-packed.
Take the person to places where they can move around and exercise during the day, such as shopping malls.
Knowing The Stages Of Dementia Helps You Plan
Even if the stages arent exact and symptoms can still be unpredictable, being able to plan ahead is essential.
The truth is that Alzheimers and dementia care is expensive and time-consuming. Being financially prepared for increasing care needs is a necessity.
On an emotional level, having an idea of what symptoms to expect helps you find ways to cope with challenging behaviors.
It also gives you a chance to mentally prepare yourself for the inevitable changes in your older adult.
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Sundowning Is Real And It’s Common But There Are Steps You Can Take To Help
In many dementia patients, the transition from day into night can become quite difficult. Known as sundowning, the syndrome is marked by a regular change of behavior characterized by confusion, agitation and anxiety. However, due to lack of research, doctors still are not clear on the cause.
Sundowning is difficult and poorly understood behavior, says Dr. Erinn E. Beagin, MD, Chief of Division of Geriatrics at Saint Peters University Hospital in New Brunswick, New Jersey. “We dont really understand why it happens.”
In addition to being aware of the syndrome, the best thing a caregiver can do is to anticipate the change in behavior and have a plan to address it.
Why sundowning happens Though causes are difficult to pinpoint, one main theory is that dementia may affect the circadian rhythm of the brain, meaning those living with the disease may have trouble telling the difference between night and day. This problem can be exacerbated during changes in the clocks, when daylight is either suddenly extended or lost.
Another potential cause could be that the needs of a person with dementia are not being met. They may be bored, hungry, dehydrated or overtired, but unable to understand and express it. All of those things that we have trouble adjusting to sometimes are exacerbated when someone has dementia, says Beagin. “And then, unfortunately, that older person cant express their needs or thoughts to us, so it comes out as a behavior.”
Sleep And Brain Glymphatic System In Ad
Recent reports indicate an important relation between disrupted sleep, brain glymphatic system and AD . For instance, glymphatic system consists of para-vascular channels located around blood vessels of the brain. CSF flows along para-arterial space, reaches the capillary bed and penetrates into the brain parenchyma, where it gets mixed with interstitial fluid and after collecting metabolic waste it is moved to para-venous space and then to cervical lymphatic vessels . Thus, it can be stated that glymphatic system acts like the lymphatic system in the other body organs.
As A clearance is impaired in both early and late forms of AD , it can be assumed that there is a link between impaired glymphatic system function and AD. Experiments in animal and humans revealed diurnal oscillation of the A level in the brain interstitial fluid . Indeed, as endogenous neuronal activity influences the regional concentration of the A in the interstitial fluid , decreased neuronal activity in some stages of sleep may cause the oscillations of the A concentrations. Slow wave sleep with periodic neuronal hyperpolarization and diminished neuronal firing in some brain regions can be associated with decreased A production . Thus, altered sleep quality might contribute to the onset and progression of the AD both through impaired glymphatic clearance and disturbances in the A production in case of disordered slow wave sleep.
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