Dementia Behavior: Sleep Problems
While quality sleep tends to decrease as you age, people who have dementia experience more sleep disturbances than other seniors. In fact, sleep problems affect as many as a third of seniors with dementia.
Common sleep issues may include:
- Difficulty getting and staying asleep
- Agitation and restlessness when trying to sleep
- Thinking its daytime when its night, going as far as getting up, getting dressed and wanting to start the day, Hashmi says
Sleep disturbances are hard on patients and caregivers alike, Hashmi says. Its physically and mentally exhausting to be up night after night.
More About Dementia And Being Mean
Understanding how dementia changes our thinking skills is the beginning of understanding why someone experiencing dementia might be mean, and how to avoid getting aggressive and combative dementia behaviors.
But this is not a simple problem, so theres more to think about. In my next article, Dementia Anger Stage, Ill explain how wethe companions of people experiencing dementiaare actually in control of their moods rather than them. This is one of the key reasons for why relationships that include dementia are different from anything weve ever experienced before.
Aggressive Behaviour From People With Dementia
Being on the receiving end of aggression is often frightening and distressing. When this has come from a person we are trying to help, we may also feel hurt and rejected. But if the person has dementia, we need to be aware that such behaviour is unlikely to be a deliberate act of aggression in fact, it is much more likely to suggest fear or desperation.
When we realise that aggression is usually a reaction, theres good news we can do something about it.
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How The Body Shuts Down
As your body declines it raises the risk for other health problems.
- Infections may develop as your immune system begins to fail.
- Pneumonia can set in, especially if you inhale food or drinks by accident.
- Injuries from falls are more likely to happen.
Most people with Alzheimer’s disease die from pneumonia, another infection, or a heart attack.
It’s best to have conversations early on about how you’d like to be cared for. These conversations can be hard, but having a plan can make it easier for you and your family.
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Stage : Mild Cognitive Impairment
Clear cognitive problems begin to manifest in stage 3. A few signs of stage 3 dementia include:
- Getting lost easily
- Noticeably poor performance at work
- Forgetting the names of family members and close friends
- Difficulty retaining information read in a book or passage
- Losing or misplacing important objects
- Difficulty concentrating
Patients often start to experience mild to moderate anxiety as these symptoms increasingly interfere with day to day life. Patients who may be in this stage of dementia are encouraged to have a clinical interview with a clinician for proper diagnosis.
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Understanding Why Someone With Dementia Is Being Mean
Does dementia cause meanness or is something else going on? The short answer is that most of us dont really understand which cognitive skills dementia takes away. More importantly, we do not realize which skills are not lost. And so we inadvertently embarrass people and unintentionally belittle or frustrate them without realizing what weve done. We then find ourselves on the receiving end of a verbal or physical blow with no idea what went wrong, and their response seems unwarranted or crazy.
But think about how you feel when someone you loveor someone you expect kindness fromstarts doing things that make you feel bad. None of us behave well when we feel that were being taken advantage of, made fun of, or picked on. When that happens, we feel indignant and angry and usually tell the other person why. Anger, aggression, frustration, and just plain meanness result when we feel that were not being treated fairly or respectfullyespecially if it happens over and over again with people whom we are close to or expect better from.
This doesnt change when we begin to experience dementia. What changes is the skills we have available to work with. Dementia takes away skills weve been using our entire lives. And even if our companions love us dearly, their attempts to help us often make us feel worse.
Body Languagestop And Face Them
Next, we have to think about posture. When someone lacks memory skills, it changes how they interpret gesture and posture. Suppose Im making sandwiches for lunch and my husband walks into the kitchen and asks what Im doing. If he isnt experiencing dementia, I dont need to stop and turn around to face him. I can simply direct a brief answer over my shoulder, because if hes not experiencing dementia our previous conversations and exchanges will be there in his mind to temper my lack of attention during this moment.
However, if hes experiencing dementia, he will by default interpret my posture as dismissive, because for him its our first interaction and for him my posture will speak louder than my words. So, if my husband is experiencing dementia I need to pause and turn to look at himand make eye contactto avoid inadvertently hurting his feelings.
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Who Has Alzheimers Disease
- In 2020, as many as 5.8 million Americans were living with Alzheimers disease.1
- Younger people may get Alzheimers disease, but it is less common.
- The number of people living with the disease doubles every 5 years beyond age 65.
- This number is projected to nearly triple to 14 million people by 2060.1
- Symptoms of the disease can first appear after age 60, and the risk increases with age.
What Happens To A Persons Brain And Body As Dementia Gets Worse
Unfortunately, many types of dementia are conditions that worsen over time. When your brain doesnt get the nutrients and oxygen it needs, or junk blocks needed communication between the nerve cells of the brain, your brain tissue begins to die.
Alzheimers disease and other types of dementia usually begin with memory loss or lapses in judgment things that can be lived with for a while. As you lose more and more brain function, functions vital to life begin to be affected. Vital functions include breathing, digestion, heart rate and sleep.
In the late stages of dementia, people cant perform the tasks needed to keep their bodies alive. Brain damage and muscle weakness no longer allow even simple, needed movements. You cant communicate, walk, talk, control your bladder or bowels, feed yourself, or chew or swallow food without help.
When you cant care for yourself, move about, eat or drink enough to keep yourself hydrated and nourished, plus have mental decline, you leave yourself vulnerable to other illnesses. Pneumonia is one of these commonly seen illnesses in people with dementia. With a now frail body, a person may not be able to fight infections or even benefit from medication. The persons pain and discomfort may outweigh treatment options that can only offer a short-term benefit.
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If You’re Looking After Someone With Dementia
Your needs as a carer are as important as the person you’re caring for.
To help care for yourself:
- join a local carers’ support group or a specialist dementia organisation â for more details, call the Carers Direct helpline on 0300 123 1053 lines are open 8am to 9pm Monday to Friday, and 11am to 4pm at weekends
- call Dementia UK’s Admiral Nurse Dementia Helpline free on 0800 888 6678 to talk to a registered specialist dementia nurse lines are open 9am to 9pm Monday to Friday, 9am to 5pm at weekends
Aggressive Behavior In Memory Care / Assisted Living
The staff in an assisted living home for people with dementia should be uniquely capable at handling aggression in people with dementia. In fact, how a memory care community handles residents who have issues with aggression is a good gauge of whether its the right place for your loved one. If staff seem annoyed by aggression, or disdainful, then they arent good for mom or dad.
To know if a memory care home can handle your loved one with dementias aggression issues, look for these signs: Staff gets to know residents, becoming like friends. If they form a connection or bond to residents, employees at memory care homes will have a better understanding of what triggers aggression and how to cool it down. Communication with loved ones outside the community is encouraged. A memory care home that handles aggression well will want loved ones to be accessible. They should take your phone number so you can be reached quickly to help if the person with dementia decides they need to speak with you. Incidents of aggressive behavior should be documented in reports. This can identify causes of outbursts, and show patterns unique to individuals.
Ask about training. Is there regular training and continuing education for employees, and do they learn techniques to deal with aggressive behavior in residents?
Did You Know?
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The Brain And Body Connection
Though the cause of Alzheimerâs is not known, doctors think the symptoms of the disease are caused by a buildup of harmful proteins in your brain called amyloid and tau. These proteins form large clumps, called tangles and plaques. They get in the way of normal brain function and kill healthy cells.
The damage usually starts in the area of your brain that forms memories. People with early-stage Alzheimer’s disease often have trouble remembering things. As the disease gets worse, the plaques and clusters also appear in the parts of the brain in charge of bodily behaviors.
Everyday activities like walking, eating, going to the bathroom, and talking become harder.
The effects of the disease will differ for each person as it gets worse. The pace can be slow. Some people live up to 20 years after a diagnosis. The average life expectancy, though, is 4 to 8 years.
Whats The Difference Between Dementia And Alzheimers Disease
Dementia is a description of the state of a persons mental function and not a specific disease. Dementia is an umbrella category describing mental decline thats severe enough to interfere with daily living.
There are many underlying causes of dementia, including Alzheimers disease and Parkinsons disease. Alzheimers disease is the most common underlying cause of dementia.
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How To Cope With Common Changes In Behaviour
Although changes in behaviour can be difficult to deal with, it can help to work out if there are any triggers.
For example:
- Do some behaviours happen at a certain time of day?
- Is the person finding the home too noisy or cluttered?
- Do these changes happen when a person is being asked to do something they may not want to do?
Keeping a diary for 1 to 2 weeks can help identify these triggers.
If the change in behaviour comes on suddenly, the cause may be a health problem. The person may be in pain or discomfort from constipation or an infection.
Ask a GP for an assessment to rule out or treat any underlying cause.
Keeping an active social life, regular exercise, and continuing activities the person enjoys, or finding new ones, can help to reduce behaviours that are out of character.
Read more about activities for dementia.
Other things that can help include:
- providing reassurance
- activities that give pleasure and confidence, like listening to music or dancing
- therapies, such as animal-assisted therapy, music therapy, and massage
Remember also that it’s not easy being the person supporting or caring for a person with behaviour changes. If you’re finding things difficult, ask for support from a GP.
How Do People Know They Have It
The first sign of Alzheimer disease is an ongoing pattern of forgetting things. This starts to affect a person’s daily life. He or she may forget where the grocery store is or the names of family and friends. This stage may last for some time or get worse quickly, causing more severe memory loss and forgetfulness.
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Angry Behavior In People With Dementia
When someone with dementia gets angry, they may:
- Raise their voice
- Display combative behavior such as hitting, kicking, or pushing
- Yell and scream
- Use foul language
Sometimes, there are warning signs. The person may raise their voice, scowl, or swing their arm at empty space.
Other times, you may not see it coming. This “no-warning” anger can be hard to cope with because it is unpredictable.
Anger and aggression are most likely to develop in the middle stages of dementia. At the same time, there may be other challenging behaviors like wandering, hoarding, and obsessive-compulsive behaviors.
In The Aftermath Of These Momentsself
These aggressive moments with someone with Alzheimers can be stressful for a caregiver. In the aftermath of these moments, remember to find the time for yourself as a caregiver, to retreat, to reflect, and to decompress from the height of the event. Such time will give you the chance to find the calm and self-assurance to continue doing the important work you do for your care recipient.
* The names and details were changed to protect privacy.
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Why Aggressive Behavior Happens
Aggressive behavior is almost always triggered by something. Figure out what that something is and youll both be much happier. If your loved one seems angry and is acting aggressively, check for pain first. Someone with dementia may not know how to express discomfort or pain. To identify the cause of aggression, look for these signs: Stroking or pulling on a particular part of the body. Facial contortions like clenched teeth or inverted eyebrows. Body language, like rocking or pulling away. Appetite change An existing condition like arthritis Dental problems like a toothache Nails that are too long Constipation
Is it a reaction to other people? Is something wrong in the environment? Does the aggressive behavior happen at the same time every day, or in the same place? Maybe a particular person coming to visit will cause your loved one to get upset.
Finding a pattern will help explain, and ultimately manage, your loved ones aggression. One good idea to help is keeping a caregiver diary that lists what was happening when your loved one became angry. Details like time of day, what activities were going on previously or were anticipated, and how exactly the lashing out occurred can be useful in identifying the problem. If you need to see a doctor to address behavior issues, having notes will be helpful for forming a medical opinion. Was the person tired? Uncomfortable? Embarrassed about something?
Physical Causes
Emotional Causes
Mood Transferenceour Mood Becomes Their Mood
Think about this: If someone experiencing dementia cannot change their own moods, what happens when a caregiver arrives looking worried or concerned, or someone walks into the room in a bad mood? What happens is mood transference, because we need memory and rational thinking skills to protect ourselves from other peoples moodsand without those skills we can only absorb their moods and feel bad too.
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No Easy Solutions But Improvement Is Usually Possible
As many of you know, behavior problems are difficult in dementia in large part because there is usually no easy way to fix them.
Many probably too many older adults with Alzheimers and other dementias are being medicated for their behavior problems.
If your family is struggling with behavior problems, I know that reading this article will not quickly solve them.
But I hope this information will enable you to make more informed decisions. This way youll help ensure that any medications are used thoughtfully, in the lowest doses necessary, and in combination with non-drug dementia behavior management approaches.
To learn about non-drug management approaches, I recommend this article: 7 Steps to Managing Difficult Dementia Behaviors
And if you are looking for a memory care facility, try to find out how many of their residents are being medicated for behavior. For people with Alzheimers and other dementias, its best to be cared for by people who dont turn first to chemical restraints such as antipsychotics and benzodiazepines.
This article was first published in 2016, and was last updated by Dr. K in May 2022.
Repeating The Same Question Or Activity
Repeating the same question or activity may be a result of memory loss where the person cannot remember what they’ve said or done.
It can be frustrating for the carer, but it’s important to remember that the person is not being deliberately difficult.
Try to:
- be tactful and patient
- help the person find the answer themselves, for example, if they keep asking the time, buy an easy-to-read clock and keep it in a visible place
- look for any underlying theme, such as the person believing they’re lost, and offer reassurance
- offer general reassurance, for example, that they do not need to worry about that appointment as all the arrangements are in hand
- encourage someone to talk about something they like talking about, for example, a period of time or an event they enjoyed
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How Is Alzheimers Disease Treated
Medical management can improve quality of life for individuals living with Alzheimers disease and for their caregivers. There is currently no known cure for Alzheimers disease. Treatment addresses several areas:
- Helping people maintain brain health.
- Managing behavioral symptoms.
- Slowing or delaying symptoms of the disease.
How To Manage The Anger
The key to managing anger issues is to be proactive and look for early signs of aggression, anger, or agitation. Do not assume that these episodes are just a one-time event because if you do not do anything, they can progress and continue to get worse. Here are some tips on what you can do when Alzheimers patients get angry.
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