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.
Faqs About Dementia Sleep Problems
Caring for a patient with dementia and sleep problems is hard work. When the dementia patient is not sleeping well, it is very easy to become exhausted yourself. To give the best care, the carer needs to look after themselves. In addition to the following questions that some people have asked regarding how to get dementia patients to sleep at night, you should visit our guide on caring for someone with dementia.
Physiological Or Medical Causes
- The brain damage caused by the dementia has affected the ‘biological clock’ in the brain, which directs our sleep patterns
- Illness such as angina, congestive heart failure, diabetes or ulcers
- Pain caused by such things as arthritis
- A urinary tract infection which causes a frequent need to urinate
- ‘Restless legs’ or leg cramps which can indicate a metabolic problem
- Depression which causes early morning wakening and an inability to go back to sleep
- Side effects of medication such as diuretics
- Sleep apnoea and snoring
- A need for less sleep as a person gets older
What to try
- Discuss with the doctor stopping or changing diuretic medication if you feel this may be contributing to the problem
- Arrange a medical check-up to identify and treat physical symptoms
- Treat pain with an analgesic at bedtime if the doctor agrees
- Discuss with the doctor whether sedatives may be contributing to the problem
- Ask the doctor whether an assessment for depression may be necessary
- Ask the doctor about possible side-effects of medication
- In some situations it may be necessary to consider discussing with the doctor the appropriateness of either using tranquillising medication or sleeping medication. The latter may be helpful in the short-term to establish a better sleep cycle, but both types of medication can have negative effects, such as increased confusion
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Sleep Disorders And Dementia
Some common sleep disorders have a tie to dementia.
Insomnia. When you donât get enough sleep, parts of your brain change. Some of these areas are related to Alzheimerâs disease.
And research shows youâre more likely to be diagnosed with dementia if you have primary insomnia. Thatâs when your lack of sleep isnât caused by something else, like depression or drug use.
Your chances of getting Alzheimerâs disease go up if you have primary insomnia and you haven’t reached age 40.
Obstructed sleep apnea . You may have a higher chance of getting dementia if you have this. Itâs when the muscles in your throat relax when you sleep. If you canât breathe very well at night, your brain canât get enough air. Thatâs called hypoxia. Youâll also have broken sleep if you wake up gasping for breath.
If you have these things, it could lead to:
- Problems staying focused
- Slower motor movements that can affect moves like picking things up and writing
- Getting dementia at an earlier-than-normal age
- More serious brain issues
- Other health conditions, like stroke, diabetes, and high blood pressure
Circadian rhythm problems. People with dementia may have a shift in their sleep-wake cycle. That means theyâll feel sleepy during the day and awake at night.
Assessment Of Sleep Disturbances In Persons With Dementia
Nursing assessment is the foundation to the identification and development of any nursing care plan because it provides the evidence for the development of interventions. Assessment typically begins with an interview and a physical assessment. If your client is unable to provide a reliable sleep history, be sure to talk with his or her family member or caregiver. Ask about sleep habits, history of sleep problems, and any medications or other substances, like alcohol, that were used to promote sleep . Be sure to assess environmental, behavioral, and psychosocial factors that may be contributing to disturbed sleep.
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Is It Safe For Alzheimers Patients To Take Sleep Aids What Should I Do If I Experience Side Effects
The routine use of medications to treat sleep issues in patients with Alzheimers disease is not supported by current scientific evidence. Sleep aids carry extra risks for people with Alzheimers they can cause falls and injury, increase memory loss and confusion, and may have an overly sedative effect. Sleep aids are typically reserved for cases where all other options have been exhausted and should only be given under guidance of a physician.
Melatonin supplements have been studied as a possible option for improving sleep quality in Alzheimers patients. However, research examining the effectiveness of melatonin supplements in people with dementia has produced conflicting results. Some studies demonstrated a small benefit, increasing nighttime sleep by around 30 minutes, while other studies showed no benefit. There is also evidence to suggest that melatonin supplements may increase social withdrawal and depression in patients with dementia.
How Are Sleep Disorders Diagnosed
To make a diagnosis, your doctor will ask about your symptoms and conduct a physical examination to look for any underlying conditions. They may also ask you to complete a sleep diary for 1 to 2 weeks to learn more about your sleep patterns.
The diagnosis of insomnia requires three main components:
- persistent sleep difficulty
- adequate sleep opportunity
- associated daytime dysfunction
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How Do I Know If Someone With Dementia Is Struggling To Sleep
Look for changes in the persons behaviour such as frequent waking, getting out of bed and/or increased disorientation or confusion. Deprivation and/or disturbed sleep is also a recognised risk factor for the development of delirium. Sleep can be disturbed by infections, due to an increased need to go to the toilet, dehydration and constipation as the person may be in discomfort. If you suspect these may be present an appointment should be made with the GP to investigate and treat any underlying causes.
If you do not know already, it is important to establish what is the usual pattern for people by asking the person. We are all different and people may have varying sleep patterns and need differing amounts of sleep. It is common for sleep patterns to change as we get older too. It helps to establish regular routines and offer comfort & reassurance. If people are feeling insecure and unsafe, they will feel less able to relax and get to sleep.
If someone gets up in the middle of the night, try to establish any cause for waking and think about sitting with them for a short time in a quiet environment with low lighting before guiding them back to bed. They may need to go to the toilet or be unsure about where they are. Having a night light and a clock which indicates day and night, may help orientate them and reduce distress .
Signs That Could Tell You Death Is Imminent
There are some changes that you should be able to see when the body stops to work, as it should. This is very much a part of dying. For younger people such as teenagers and children, the process is quite similar but sometimes rather hard to predict because they can remain active and can ask questions that may be too hard to answer.
For the elderly, however, it is rather straightforward at times since you can actually tell the changes they are experiencing. You can know its time to die a couple of months before death because an elderly person could:
- Tend to be more sleepy than usual
- Reduce the amount of food and drink taken
- Stay away from people or activities that they had enjoyed previously
- Talk less
When the elderly person is a few weeks to their death, they may be too drained or tired that they may not be able to leave the bed. You can notice the following:
- The elderly person may have the different wake and sleep patterns
- They lose appetite and have no desire to drink
- They dont get a lot of bowel movements or pee
- They may be in more pain than usual
- Their blood pressure, heart rate, and breathing may change
- Their temperature may fluctuate up and down, leaving the skin pale, moist, warm, or cool
- Their breathing could become congested due to build up at the back of the throat
- They may look confused or they tend to be in a daze
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Why Do Dementia Patients Sometimes Sleep So Much
Some people with dementia, especially patients in advanced stages, spend a lot of their time sleeping. As dementia progresses, the brain impairment becomes greater, causing the person to become exhausted with activities of daily living and other daily tasks and sleep more both during the day and night. For a person with advanced dementia, even a simple task like eating may be draining.
Also, some medications may contribute to your loved ones sleepiness. These include antidepressants, antihistamines, antipsychotics, and sleeping pills that may contribute to sleepiness.
Devoted Guardians’ Response to COVID-19
Devoted Guardians is actively monitoring the progression of the coronavirus, COVID-19, to ensure that we have the most accurate and latest information on the threat of the virus. As you know, this situation continues to develop rapidly as new cases are identified in our communities and our protocols will be adjusted as needed.
While most cases of COVID-19 are mild, causing only fever and cough, a very small percentage of cases become severe and may progress particularly in the elderly and people with underlying medical conditions. Because this is the primary population that Devoted Guardians serves, we understand your concerns and want to share with you how our organization is responding to the threat of COVID-19.
How To Improve Problems With Dementia And Sleep
The exact approach will depend on which underlying factors are causing the problems. Still, certain general approaches have been found to improve the sleep of many with dementia. These include:
- Outdoor light or bright light therapy during the day Bright outdoor light helps keep the circadian signals on track. For older adults who cant get outside for at least an hour per day, bright light therapy with a special lamp might help. A study found that bright light therapy in Alzheimers patients improved sleep.
- Increasing daytime physical activity Research has suggested that walking during the day can help improve nighttime sleep in people with Alzheimers.
- Optimizing environmental cues for sleep This means keeping the sleeping environment dark and quiet at night. This is especially important in nursing homes, which have sometimes been found to have staff active at night.
- Establishing a regular routine with a consistent wake-up time The ideal is to have a consistent bedtime and wake-up time, but many experts believe its best to start by focusing on a consistent wake-up time.
A research study published in 2005 found that training dementia caregivers to use these techniques in combination led to improved sleep of the care recipients with Alzheimers.
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Nutrients To Aid Sleep
Nutrients at night-time such as melatonin can aid a deeper and better quality nights sleep. Such nutrients can also help ensure a person is getting important vitamins which can become depleted when eating a balanced diet becomes problematic. Always check with your parents GP that any supplements or nutrients you buy wont interact with current medication.
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If you are finding it particularly hard to help someone with dementia with their sleep, and its affecting your ability to care for an elderly relative, it may be a good idea to share some of the care responsibilities with a live-in carer, like those found on our best live-in care companies page.
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.
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Why Dementia Patients Don’t Sleep Well
Depending on the stage of dementia the sleep pattern can change from sleeping too little to sleeping too much. As dementia progresses it is not unusual for the pattern to deteriorate. What makes things a little trickier is that dementia can make it harder for someone to communicate what is wrong. For example, they might not be able to tell you that theyre in pain. This is why it becomes even more important to pay close attention to other types of communication such as facial expression and body language. Below, we have outlined some issues which can cause dementia patients to not sleep well.
Treatment For Sleep Disturbances
Treatment for sleep disturbances include both medication and non-medication approaches. Sleep disturbances can be one of the most difficult aspects of dementia. Caregivers must also get enough sleep. Try some of the non-medication approaches listed below, or talk to your doctor regarding medication approaches.
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More Information And Resources
- Sleep Matters When Someone has Dementia. Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, October 2016. A webinar on the relationship between sleep, the environment and dementia, including tips to make your bedroom environment more conducive to sleep.
- Sleepwell. A website describing effective, non-medication approaches to managing insomnia.
- Sleep and Dementia: A report on the evidence-base for nonpharmacological sleep interventions for person with dementia. Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, February 2011. On pages six and seven of this report, you can find recommendations that may help family members living with dementia to have a better sleep. These recommendations are grouped by whether the evidence in support of these interventions are well-researched, adequate or in need of more study.
- Preventing and managing sleep disturbance. Bendigo Health. This webpage provides some recommended approaches and responses that caregivers and healthcare providers can use to help people living with dementia sleep soundly, including a flow chart for specific strategies to manage sleep disturbance.
- Caregiver Training: Sleep Disturbances. UCLA Alzheimer’s and Dementia Care Program, February 2018. This short video provides people living with dementia and caregivers with practical tools to help create a safe, comfortable environment for sleep.
What Causes Sleep Disorders In Older Adults
A primary sleep disorder means there is not another medical or psychiatric cause. Individuals of all ages can be affected by sleep disorders, including older adults.
Insomnia is one of the most common medical complaints, especially in older adults. It often coexists with medical, psychiatric, sleep, or neurological disorders.
Insomnia may also be associated with stress, medications, poor sleep habits, or changes in the sleep environment, according to
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Medications And Sleep Problems
It is also important to check medications and make sure they are not negatively affecting a persons sleep. For example, sedating medications during the day may cause a person with dementia to sleep or nap too much, resulting in more awake time at night. Or a diuretic offered too late in the day might be causing extra nighttime urination.
As a caregiver, you may simply want to know: Isnt there a medication we can give in the evening to help my parent sleep better at night?
Its true that sleeping pills, sedatives, and tranquilizers are often prescribed to help keep people with dementia quieter at night. These include antipsychotics like olanzapine, risperdal, and quetiapine, benzodiazepines such as lorazepam and temazepam, sleeping medications like zolpidem or even over-the-counter sleep aids .
Unfortunately, all these medications are likely to cause concerning side effects in people with dementia, namely a worsening sleep cognition and increased fall risk. The antipsychotics have also been associated with a higher risk of dying. What’s more, comprehensive scientific review articles conclude that in clinical trials, these drugs do not conclusively improve sleep.
That’s why experts in geriatrics recommend generally avoiding these medications, using them only as a last resort once behavioral approaches have been tried.
That said, there are a few medications that may be less risky, and are sometimes used: