Dementia And Sleeping Problems: Causes And Treatment
Written byMohan GarikiparithiPublished onNovember 7, 2016
Sleeping problems in dementia are quite common, and without proper sleep symptoms related to dementia can worsen greatly. Some patients sleep during the day and are wide awake at night as a result. Others may have difficulty falling asleep or staying asleep. Some patients may wander throughout the night or get confused, which can lead to greater behavioral changes making patient care difficult.
Unfortunately, these changes in sleep patterns arent fully understood by researchers. Some speculate that sleep changes could be stemming from brain changes that occur in dementia. Sleep problems may worsen as dementia worsens, too.
What Causes Excessive Sleep In The Elderly
- Depression: Depression can cause excessive sleepiness in someone of any age. According to the Centers for Disease Control and Prevention , depression affects about 1% to 5% of the general elderly population, as well as 13.5% of elderly people who require home healthcare and 11.5% of older hospital patients. It can be triggered by a medical condition, loss of loved ones or friends, lifestyle changes or chemical changes in the brain. Its important to recognize depression in seniors because while the condition is relatively common, it is not normal and should be treated.
- Dementia: Seniors with dementia may experience a wide array of sleep problems, especially as the disease progresses. Sleep deprivation can make symptoms and agitation worse, so its important to seek treatment for sleep problems and excessive sleepiness.
- Sleep Disorders and Conditions: Sleep disorders and conditions may result in changes in the way that you sleep and can impact your overall health and quality of life. Some of the more common conditions are described below.
Other Sleep Issues In People With Dementia
Sundowning is a phenomenon in which individuals with dementia experience increased agitation later in the day and in the evening. The symptoms of sundowning include confusion, anxiety, wandering, and yelling. Sundowning can contribute to insomnia and other sleep problems when these behaviors continue into the night. Possible causes of sundowning include the circadian rhythm changes that occur in dementia, as well as fatigue, depression, and pain.
People with dementia may also talk, yell, or cry out at night if they cannot sleep. Some dementia patients have a tendency to wander away from their homes, which can be especially dangerous at night. In dementia patients with REM sleep behavior disorder, shouting, grabbing, jumping, and other behaviors are related to dream enactment during sleep.
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Sleep Apnea And Excessive Sleepiness
Sleep apnea is becoming a more common cause of sleepiness in children and adults.
Sleep apnea occurs when the upper airway collapses for at least 10 seconds during sleep — and does so up to hundreds of times each night. Obstructive sleep apnea is the result of a blockage in the airway. Central sleep apnea occurs when the brain fails to send signals to the muscles that control breathing.
Snoring and gasping for air as the airway reopens occur often with sleep apnea. But you may not be aware you have sleep apnea unless your bed partner tells you about the ruckus youâre making.
Because your breathing is interrupted, so is your sleep, leading to sleepiness during school, work, or other activities. You might mistake yourself as a âgood sleeperâ because you can sleep anytime, anywhere. But falling asleep in traffic or at work is obviously less than ideal. People with sleep apnea have many more auto accidents than people who donât have the condition.
Sleep apnea can cause other problems, too: wide swings in heart rate as well as a decrease in oxygen levels. It is associated with and the possible cause of other medical conditions such as:
Why Does Dementia Affect Sleep
Problems with sleep are very common for people with dementia. They can include:
- sleeping during the day and being awake and restless during the night
- becoming disorientated in the dark if they wake up to use the toilet
- waking up more often and staying awake longer during the night
- getting up in the early hours and thinking its day time or time to go to work
- not being able to tell the difference between night and day.
Nobody completely understands why dementia affects sleeping patterns. For some people, it may be that their internal biological clock, which judges what time it is, becomes damaged so the person starts to feel sleepy at the wrong time of day.
There are also other parts of the brain which control whether or not we stay awake, and these may also not work properly if they become damaged.
Sometimes a person with dementia might completely reverse their normal sleep pattern, staying up all night and then sleeping all day.
It’s common for people with dementia, especially in the later stages, to spend a lot of their time sleeping
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Treatments For Excessive Daytime Sleepiness
Treatment will depend greatly on the underlying cause of sleepiness and whether it is a primary or secondary concern. Sometimes, catching up on sleep will alleviate the excessive sleepiness however, more often than not, it is more appropriate to treat the underlying cause than it is to treat the symptom. Most common treatments include the use of stimulant medications like amphetamines to help the individual stay awake throughout the day. In addition, behavioral therapy, sleep hygiene, and education are usually added to a treatment regimen. To help find out the cause of your EDS we recommend speaking with your doctor. A device like WatchPAT ONE allows you to take an online assessment and if at risk for sleep apnea, will send a home sleep test and send results to a sleep specialist. Click here to find out more.
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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Daytime Sleepiness Is More Common In Dementia With Lewy Bodies Than Alzheimers
Drowsiness and daytime sleepiness are often described by individuals with dementia with Lewy bodies and their caregivers. This is reported even in the very early stage of DLB. Experts have wondered whether sleepiness is a unique feature of DLB, or if it is a part of fluctuating cognition. New research using formal sleep studies reveals that daytime sleepiness not due to poor sleep the night before, can occur in the absence of cognitive fluctuations, and is more likely to occur in DLB than Alzheimers disease .
Researchers at Mayo Clinic, led by Tanis Ferman, PhD, studied 61 patients with DLB and 26 with AD. Patients also had a reliable informant complete a subjective questionnaire on sleepiness. All participants had an overnight polysomnography performed to detect sleep efficiency and underlying sleep disorders such as sleep apnea. A subgroup of 32 DLB and 18 AD patients were then assessed to determine how long it took them to fall asleep during four daytime naps. Autopsies were performed on 20 of the individuals with DLB, confirming the clinical diagnosis was correct. None of those with AD underwent autopsy.
This research suggests that daytime sleepiness is a distinct symptom of DLB that is independent of disease stage or the presence of the primary symptoms of DLB, and can be distinguished from AD. More research is required to determine whether daytime sleepiness will help improve diagnosis.
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As dementia progresses, sleep problems along with other difficult dementia symptoms tend to get worse. This may be a good time to evaluate whether you need additional support to help ensure your loved ones health and safety and your own. Learning what to expect at each stage of dementia can help you plan for adequate care.
Heres what you should know when caring for someone with dementia and sleep problems:
- Dont use physical restraints. Many people believe its best to restrain their loved ones in bed at night to prevent wandering. This may do more harm than good. Instead, if you have a bed with guard rails, raise the rails. This may help to deter them from climbing out of bed and wandering.
- Dont do it alone. Consider taking shifts with another family member or looking into respite care. Respite care, or short-term care, gives you a chance to take a break while providing a safe environment for your loved one.
- Reduce stimulation. To allow for a calming, soothing environment, avoid loud noises or a lot of activity during the evening and night.
- Prioritize your health and rest. Taking care of a loved one with dementia and sleep problems may take a toll on your own mental health. Consider getting help from family members or exploring other care options, such as memory care, which provides 24-hour specialized care for people with memory loss.
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What Sleep Disorders Are Common In People With Dementia
People with dementia are frequently affected by sleep disorders. The following sleep disorders are found most often in older adults, but they are seen at even higher rates in people with dementia.
- Restless legs syndrome : RLS is characterized by an overwhelming desire to move the legs, especially at night. RLS is common in people with a type of dementia called Lewy body dementia.
- Periodic limb movement disorder : PLMD causes uncontrollable movements of the arms and/or legs at night. Many patients with PLMD also have RLS.
- Obstructive sleep apnea : OSA is a condition marked by nighttime airway collapse leading to brief lapses in breathing. OSA is particularly common with Alzheimers disease, occurring in 40% of patients. Having OSA also increases ones risk of developing dementia.
- REM sleep behavior disorder: REM sleep behavior disorder causes individuals to act out their dreams, sometimes in dangerous ways. It is most often found in individuals with Lewy body dementia and is sometimes the first symptom that arises with this type of dementia.
- Depression: Although depression is a mood disorder, it is associated with insomnia and other sleep disturbances. Depression is common in people with dementia, and it is seen at increasing rates as dementia progresses to more severe stages.
Do People With Dementia Sleep A Lot During The Day
Some people with dementia sleep excessively during the daytime. They may feel like they cant stay awake, and they may take long naps that interfere with nighttime sleep and overall quality of life.
Excessive daytime sleepiness is more common in people with Parkinsons disease dementia or Lewy body dementia than in those with Alzheimers. Some factors that may contribute to excessive daytime sleepiness include:
- Insufficient sleep at night
- Damage to brain cells caused by dementia
- Changes in sleep pattern caused by dementia
- Mental health conditions, such as depression
- Other sleep disorders, such as sleep apnea
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Other Sleep Disorders And Excessive Sleepiness
Some other sleep disorders that may cause excessive sleepiness include:
- Circadian rhythm sleep disorders, a group of conditions caused by problems with your body’s internal “clock.” This might cause you to fall asleep too late, wake up too early, or have a hard time adjusting to a sleep schedule. These conditions can be mild, like jetlag, or more serious.
- Periodic limb movement disorder. In this rare illness, your legs and feet, and sometimes your arms, jerk or twitch as you sleep. You may not even be aware this is happening. It’s not the same as restless legs syndrome, although some people have it along with RLS.
A sleep doctor can diagnose and treat these conditions. Depending on how serious your disorder is, they may treat it with lifestyle changes, medication, or both.
Common Causes Of Sleep Changes And Problems In People With Dementia
Its hard to manage a problem if you dont understand why it might be happening. There are several factors that can cause older adults with dementia to have sleep problems. These include:
- Sleep changes with aging. Healthy aging adults do experience changes with their sleep as they age. Sleep becomes lighter and more fragmented, with less time spent in deep REM sleep. One study also estimated that total sleep time decreases by 28 minutes per decade, starting in mid-life. Although these changes are considered a normal part of aging, lighter sleep means its easier for aging adults to be woken up or disturbed by any other sleep-related disorders or problems, such as arthritis pain at night. Aging is also associated with a shift in the circadian rhythm, so that many older adults find themselves sleepy earlier at night and hence wake up earlier in the morning. For more, see here: How Sleep Affects Health, & Changes With Aging
- Many sleep-related disorders become more frequent with aging. Common sleep-related disorders include sleep apnea and related conditions , which may affect 40-50% of seniors, as well as restless leg syndrome, which is thought to be clinically significant in 2.5% of people.
Hence, its not surprising that sleep problems are so common in people with dementia! Now lets talk about what can be done to improve things.
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Dementia And Sleep Problems: Causes
Researchers and doctors dont understand exactly why dementia affects sleep, but up to 70% of people with cognitive impairment have sleep disturbances, according to a review of studies on disturbed sleep and dementia. Changes in the brain associated with dementia seem to affect the structure of sleep and the circadian rhythm, which helps regulate the physical, mental, and behavioral changes the body goes through in 24 hours.
Other factors that may contribute to poor sleep in dementia include:
- Less exposure to sunlight, which affects the sleep cycle
- Physical or mental exhaustion at the end of the day
- Chronic pain
- An environment that is inadequate for sleep, such as a noisy or bright room before bedtime
- Medication side effects
- Diet, such as excessive caffeine or alcohol
Sleep problems in people with dementia often have multiple causes. Talk to the doctor about your loved ones specific symptoms. The doctor may have questions about your parents sleep habits, medications, diet, and any other health conditions to diagnose whats disrupting their sleep.
Hypersomnia And Excessive Sleepiness
Hypersomnia is what doctors call a variety of conditions in which you often feel overly tired or sleep too much. It can happen because of illnesses like epilepsy or Parkinson’s disease, or mental conditions like depression. It’s also the main symptom of narcolepsy and of a condition called Kleine-Levin syndrome. Certain medications, as well as alcohol and drug abuse, can cause it as well.
Sometimes, this excessive sleepiness has no known cause. That’s called idiopathic hypersomnia.
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Restless Legs Syndrome And Sleepiness
Restless legs syndrome is a disorder characterized by unpleasant sensations in the legs and a strong urge to move them. RLS may also cause jerky leg movements every 20 to 30 seconds throughout the night. Sometimes RLS can affect other parts of the body, too.
RLS symptoms may occur or get worse while youâre at rest or sleeping. Because the symptoms are usually worse at night, they can greatly interrupt your sleep and lead to sleepiness when you need to be awake. RLS can be so bad, it is mistaken for insomnia.
Treatment for Restless Legs Syndrome
Moving your legs lessens RLS symptoms. These steps may also be enough to relieve symptoms of RLS:
- Take iron or vitamin B12 or folate supplements if your doctor says your levels are low and recommends them.
- Talk to your doctor about whether a medication or herbal remedy that youâre taking may be making symptoms worse. These could include medication that treats high blood pressure, nausea, colds, allergies, heart conditions, or depression.
- Stay away from alcohol, caffeine, and nicotine.
- Maintain a healthy diet, exercise regularly, and try relaxation techniques such as hot baths and massage.
If these steps are not enough, several types of medication are useful for treating the symptoms of restless legs syndrome or for inducing deep sleep. They include:
Signs Of Sleep Problems
Good sleep is important at any age. Experts think that when you sleep, your brain gets rid of things you don’t need. When you don’t get enough sleep, plaque-like substances build up. Sleep also helps you learn and store memories. And research shows youâre more likely to have problems doing those things if you have disturbed sleep.
Tell your doctor if you or a loved one:
- Have trouble falling asleep
- Wake up a lot at night
- Stop your sleep too early
- Get agitated in the evening
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Sleep Problems Increase As Dementia Develops
You may have noted, as I have, the recent reports in the news media about the significant increase in the suicide rate since the end of the 1990s. The rate increased more than 25% between 1999 and 2016 with increases in 49 of 50 states. I believe that some of the factors underlying this increase have to do with the increasing materialism and lack of meaning that many experience in our society. Whatever the cause, suicide can be extremely difficult to predict on the part of mental health professionals and is devastating to close family and friends who lose a loved one to suicide. It has been my experience that psychotherapy aimed at helping these family members and friends can be some of the most challenging work a therapist will ever do. While thinking about this, I recalled the tragic suicide of Robin Williams. He had struggled with depression and apparently learning that he had the early stages of dementia was so overwhelming that he chose to take his own life. For his family and many fans this was a devastating event.