How Does Sleep Affect Dementia Risk
Experts suggest that sleep and dementia may share a bidirectional relationship. This means that while sleep could affect dementia risk and symptoms, the presence or absence of dementia also affects sleep quality. For example, one of the first Alzheimers disease symptoms in the brain is the accumulation of a protein called amyloid-beta, which eventually forms clumps called amyloid plaques. Animal studies and a small study in people have shown sleep deprivation to increase the levels of amyloid-beta in the brain. At the same time, Alzheimers patients with amyloid plaques have been shown to have worse sleep quality than Alzheimers patients who do not have amyloid plaques.
Additionally, sleep is known to be critical for our cognitive functioning and memory formation. Observational studies have shown that sleep issues are associated with cognitive decline and dementia. However, these studies do not prove a cause-and-effect relationship. Although more research is needed to better understand sleep and dementia risk, there are many proven steps you can take to improve your sleep.
What Sleep Problems Can Be Caused By Dementia
Insomnia
Insomnia includes a wide range of sleep problems, such as taking a long time to fall asleep, waking up often during the night, having nightmares and waking up early in the morning. These result in the person not getting enough good-quality sleep.
Insomnia is a common problem for people with dementia, and different causes include the following:
- The person may be struggling with pain or discomfort.
- They may have other health conditions that make sleep more difficult, such as heart or breathing problems, heartburn, constipation, urinary tract infections or incontinence.
- They may be feeling anxious, stressed or depressed.
- They may be taking medications that cause insomnia as a side effect. This is common with drugs prescribed to improve dementia symptoms, such as donepezil, rivastigmine, or galantamine.
These drugs can also lead to very vivid dreams or nightmares. If this happens, they may find taking their medication in the morning rather than at bedtime helps.
There are drugs that can help a person get to sleep more easily. However, most have unpleasant or potentially dangerous side effects, such as dizziness and an increased risk of falls. This makes them less safe for a person with dementia to take. They tend to only be prescribed for very short-term use when the person has severe sleep problems.
Excessive daytime sleepiness
For more information on hallucinations and delusions see Changes in perception.
Sleep-disordered breathing
Restless legs syndrome
Alzheimers And Sleep Disorders: Expert Answers To 6 Common Questions
Sleep issues are a well-documented symptom of many types of dementia, particularly Alzheimers disease. This presents a serious challenge for families. If a loved one with dementia isnt sleeping, then neither is their caregiver.
Quite often, the lack of sleep is what first causes a family caregiver to consider placing a loved one in a facility, says Maureen Bradley, LPN, Certified Dementia Practitioner, director of Alzheimers care programs at several skilled nursing facilities run by Royal Health Group in New England.
Sleep deprived caregivers are often plagued by many of the same questions about their loved ones odd sleeping habits: How do I get Dad to sleep through the night? Why does my loved one sleep all day? Why does Mom get so anxious around dinner time? Dementia experts provide answers to these and other common questions below.
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Is It Safe For Alzheimers Patients Yo Take Sleep Aidswhat 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.
Medicine To Help Dementia Sleep
There are many different types of medicine prescribed to help people with Dementia or Alzheimers sleep. Here are a few, along with what they are prescribed to help with. OF COURSE, consult with their doctor to find out if one of these could help with sleep problems!
- Lorazepam Ativan
- Alprazolam Xanax
- Sertraline Zoloft
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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
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:
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What To Do When Someone With Dementia Has Sleeping Problems
Speak to the persons GP or nurse if they have sleep problems that last for several weeks or more, and their sleep problem is causing them to become more unwell.
You can also speak to the community mental health nurse. A nurse or GP will try to understand whether the sleep problem is being caused by something that can be treated with drugs or other therapies for example, by increasing levels of pain medication, relieving anxiety, or treating urinary problems. Keeping a diary of when a person is having sleep problems can really help a clinician to see whats happening.
Some sleep disorders in dementia may need help from a specialist, such as a consultant geriatrician or old age psychiatrist. The GP can refer the person to a specialist. This may take some time, so try to see the GP as soon as you can.
Sleep medication is not recommended for a person with dementia. However, some doctors may suggest trying it for a short period if the sleep problem is severe, and non-drug treatments have not worked.
If the person does take sleep medication, they may become more confused and more likely to fall over the next day. Take extra care with them.
Understanding What Keeps Dementia Sufferers Awake At Night
April 12, 2001 — Sleep disturbance is a very common and very problematic symptom of dementia. New research indicates that causes of this sleep disturbance may differ in different kinds of dementia. Hopefully, understanding these causes will lead to better treatments.
Dementia is a term used to refer to a loss of thinking abilities. Although there are many causes of dementia, it is most often associated with aging. The most common cause of dementia associated with aging is Alzheimer’s disease, which affects approximately one in 10 people over age 65 and nearly half of those over age 85.
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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.
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.
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Treatment Of Primary Sleep Disorders
Restless legs syndrome and periodic limb movement disorder are common in LBD, especially PDD. Treatment approach is the same as idiopathic RLS and PLMD. Iron deficiency can worsen RLS and PLMD, and should be treated with supplementation. Medications typically used for RLS and PLMD such as dopamine agonists and gabapentin are effective in the demented population, however, since dopamine agonists are also prescribed for motor symptoms, treatment regimens should be coordinated between sleep medicine and dementia/movement disorders physicians.
REM sleep behavior disorder requires PSG confirmation, showing REM sleep without atonia. Behavioral precautions including removing weapons from the bedroom, moving furniture far from the bed, and putting a rug on hard floors should be advised. In cases where the patient or bed-partner are at risk of injury, both clonazepam and melatonin have been shown to be effective for reducing oneiric behaviors . Melatonin is preferred if there is concern for cognitive or sedating side effects of clonazepam. In all patients with PD, RBD should be assessed for because it is prognostically useful RBD predicts a PDD phenotype and more rapid progression. Unfortunately, treatment of RBD symptoms has not been shown to slow the progression of the underlying neurodegenerative process.
Camomile Tea Or Capsules
Results are split about whether Camomile actually works to help with sleep. One study says it does and another says it doesn’t. For sure it might be worth trying to see if it helps your loved sleep
Additional Resource :: Chamomile Tea, Will You Help Me Sleep Tonight? McGill Office of Science and Society
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Why Do Dementia Patients Not Sleep
Dementia experts arent exactly sure why dementia patients dont sleep well at night. However, there are some potential causes for sleep problems in elderly adults with dementia.
A good practice is to monitor your loved one and keep a journal to help track different habits and changes.
Here are some of the top causes of elderly adults with dementia not sleeping at night.
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.
Check the following list of questions that a group of geriatrics experts recommends for evaluating sleep problems. An additional 10 questions are contained in the journal article here.
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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Nursing Interventions For Promote Sleep In Persons With Dementia
Sustained inadequate sleep hygiene may also be a risk factor for the development of sleep deprivation in older adults. Sleep hygiene refers to a number of sleep habits that can be performed to enhance sleep . Although sleep hygiene is recommended for all older adults, there have been no studies that have specifically focused on the efficacy of sleep hygiene measures alone on improving sleep in persons with dementia. Regardless, sleep hygiene measures remain the front-line treatment for impaired sleep.
Clinical Trial Is Giving Patients Hope
That idea is currently being tested in a clinical trial of patients with PSP, using a treatment that specifically targets the overactive awake system that keeps these patients from sleeping. This approach contrasts with the traditional trial-and-error treatment with sleep medications.
At the helm of that trial is Christine Walsh, PhD, the studys other lead author, who has also worked on the study for a decade. Noting that PSP and Alzheimers are at opposite ends of the sleep-disturbance spectrum, she said she expects the research to lead to new ways of treating sleep disturbances driven by neurodegeneration.
Treatments for Alzheimers could be adjusted depending on the patients needs, bumping up the awake system while tamping down the sleep system, said Walsh, who along with Grinberg, is a member of the UCSF Weill Institute for Neurosciences.
The PSP trial is still underway, and Walsh is highly optimistic that this new approach will have better results than current medications for people with either condition. Based on the findings of the study published today, she said, Were even more hopeful that we can actually make a difference in the lives of these patients.
Funding: This work was supported by NIH grants R01AG060477, R01 AG064314, R01 AG038791, U54NS092089, K24 AG053435, K08AG058749 and K23AG038357 and the Rainwater Charity Foundation.
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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.
What Can I Do To Help My Dad With Dementia Sleep Better At Night He Suffers From Sundowning And Often Won’t Sleep Until Extremely Late
From late afternoon its important to remain calm and stick to the bedtime routine, as your dad may pick up on your stress causing him distress. Try to find a balance between your dad not being over-tired while still being tired enough for bed. This might mean experimenting with naptimes. Natural daylight is wonderful for helping to reset a disrupted body-clock, so you should consider simply sitting outdoors or next to a bright window when your dad starts to show signs of agitation or restlessness. Find more tips on how to deal with Sundowning here.
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