How Do You Stop Dementia Patients From Getting Out Of Bed
When a caregivers sleep patterns keep getting interrupted, its very easy to feel at the end of your rope. You might even have the idea to use physical restraints to keep your parent or loved one with dementia in their beds.
Although this may sound like a good idea, it really isnt. You could erode trust in your relationship with the dementia patient, which will make caring for them in the future much more difficult.
Instead, what many caretakers do is lift the height of the bed rails in the persons bed. Raising the safety rails doesnt make it impossible for them to leave their bed, but it certainly does make it more difficult!
What Sleep Problems Can Be Caused By Dementia What Sleep Problems Can Be Caused By Dementia
Insomnia 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 Excessive daytime sleepiness.
For more information on hallucinations and delusions see Changes in perception.
Practice Good Sleep Hygiene
Sleep hygiene is the term used to describe your good pre-bedtime habits. Proper sleep hygiene is vital to making sure you get the sleep you need each night poor sleep hygiene can contribute to short sleep duration, sleep deprivation, and feeling tired during the day.
Some good sleep hygiene practices to add to your nightly routine include:
- Putting your electronic devices including smartphones, tablets, computers, and televisions away at least an hour before bedtime. The blue light emitted by these devices inhibit your bodys melatonin production, and can make it harder to fall or stay asleep.
- Give yourself time to finish your days tasks before you settle in for the night. We recommend doing this 1 to 2 hours before bed.
- Allow yourself time to relax and unwind before bed this works especially well after you complete your daily to-do list. Yoga, writing in a journal, chatting with family members, or reading a book are all great ways to relax.
- Tend to your personal hygiene, such as taking a bath or shower, washing your face, or brushing your teeth.
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Mental And Physical Activity
Enough mental and physical activity improves sleep.
Mental activity that is engaging and enjoyable. Physical exercise that elevates the heart rate. Both will improve sleep patterns in healthy people. It will also have a similar positive impact in people with dementia.
Enjoyable daytime activities can increase the production of dopamine. Dopamine is a hormone that improves mood and decreases anxiety. So, make sure you have enough physical and mental activity each day. This is also important to bring your loved one to the end of the day pleasantly tired. Not exhausted. But not with pent up energy that demands to be released.
For more information on physical and mental exercise and its impact on brain health, read Dance: Exercise your Mind and your Body.
Follow A Consistent Sleep Schedule
A consistent nighttime routine and sleep schedule can help your body train itself to be alert or tired whenever you need it to be.
To do this, make sure you go to bed at the same time every night, and wake up at the same time every morning. Its crucial that you do this daily, even on weekends, or on days where you dont have a set schedule.
This consistency helps create long-term sleep quality, so even if its tricky to get into the habit, sticking with it will be a huge help in the long run.
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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.
Medicines For Sleep Problems In Dementia
Background
People with dementia frequently experience sleep disturbances. These can include reduced sleep at night, frequent wakening, wandering at night, and sleeping excessively during the day.
These behaviours cause a lot of stress to carers, and may be associated with earlier admission to institutional care for people with dementia. They can also be difficult for care-home staff to manage.
Non-drug approaches to treatment should be tried first, However, these may not help and medicines are often used. Since the source of the sleep problems may be changes in the brain caused by dementia, it is not clear whether normal sleeping tablets are effective for people with dementia, and there are worries that the medicines could cause significant side effects .
The purpose of this review
In this updated Cochrane review, we tried to identify the benefits and common harms of any medicine used to treat sleep problems in people with dementia.
Findings of this review
We searched up to February 2020 for well-designed trials that compared any medicine used for treating sleep problems in people with dementia with a fake medicine . We consulted a panel of carers to help us identify the most important outcomes to look for in the trials.
Participants in the trazodone trial and most of those in the melatonin trials had moderate-to-severe dementia, while those in the ramelteon and orexin antagonist trials had mild-to-moderate dementia.
Shortcomings of this review
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Other Sleep Tips And Management
Caregivers of people with Alzheimers can take steps to help them manage their sleep. These include:
- Identifying any other medical conditions: Caregivers can watch the individual to see whether they have a condition that results in them waking up. For example, sleep apnea causes short pauses in breathing, and restless leg syndrome involves moving or twitching the legs uncontrollably.
- Reviewing their medication: The side effects of some prescription medications that treat Alzheimers may contribute to sleepless nights. A doctor can advise on the best time of day to take medications to ease these effects.
- Keeping the time visible: It may be beneficial for the individual to be able to see a clock that distinguishes between nighttime and daytime.
- Talking to them: If the individual gets up in the night, a caregiver can talk to them to try to find out why. It is then best to keep the person relaxed and prepare them for returning to sleep with low lighting and relaxing music that they enjoy.
- Using a bed exit pad: These wireless pads signal if the individual wanders from their bed during the night. Once a caregiver receives the alert, they can assist the individual in getting back into bed as soon as possible.
- Establishing a routine: Keeping to the same bedtime and wake time each day and putting a routine in place such as a relaxing bath or a hot, milky drink before bed can help the individual recognize the time of day.
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.
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Get An Accurate Lighting
The possibility of a good nights sleep is dependent on how comfortable the bedroom is. Getting the bedroom to be comfortable is a major effort you need to take in getting your patient to sleep at night. You can use blackout curtains at night to eliminate every form of outside disturbances.
Research on dementia patients outlines that light therapy reduces confusion and restlessness in people suffering from this condition. If you wish to consider this therapy, check for violet-colored light that enhances drowsiness and full-spectrum fluorescent light used in the first 2 hours of every day.
The essence of this is to create a reality of the different lights needed for sleep time and other activities. A light therapy following a definite pattern also helps to reset the body clock.
While using dim lights, you need to also consider safety. If you notice your patient makes a frequent visit to the toilet then you will have to consider getting a kind of low light that will illuminate the room to an extent and prevent falling in the dark.
Get Tested For Sleep Disorders
If youre sleeping through the night and you still wake up feeling exhausted, then its likely that you have a sleep disorder. Recent research indicates a strong connection between obstructive sleep apnea and Alzheimers disease.
If youre experiencing any of the following symptoms, its a good idea to talk to your doctor or a sleep expert about potential treatment options.
- Loud snoring, or sleep disordered breathing gasping, choking, or breathing cessation during sleep
- Disrupted sleep, such as waking up during the night or waking up too early in the morning
- Consistently needing more than 30 minutes to fall asleep each night
- Sleeping too little, or sleeping too much
It can be difficult to tell if youre experiencing sleep-disordered breathing, especially if you live alone. If youre not sure if your symptoms put you at risk for sleep apnea, check out our quiz. It can help you figure out your symptoms so you can discuss them with your doctor or a sleep expert.
Dont wait to get tested for sleep disorders they wont go away on their own, and the sooner you seek treatment, the sooner you can get back to sleeping well.
Related: What Makes Sleep Apnea Worse? 8 Things to Watch Out For
Theres still a lot we dont know about Alzheimers disease, but getting a good nights sleep is one of the simplest ways we can reduce our risk for the disease.
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Are You Concerned That You Or A Loved One May Have Sleep Apnea Take The Interactive Sleepiness Quiz And Share The Results With Your Doctor:
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Tips To Improve Sleep
There are things that we can all do to improve our sleep. Not only is it important for a person with dementia to get the best rest possible the caregiver needs to sleep well too. You may eventually have to talk to medical professionals to develop a sleep treatment program, but these tips can provide a good starting point.
- Keep a bedtime routine. Go to bed and wake up at the same time every day.
- As much as possible, use the bedroom for sleeping only.
Light for Light Therapy
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Treating Sleep Apnea Helps Brain Health
There is no treatment for Alzheimers disease, which means it is important to treat conditions that could make the disease or its symptoms worse. Fortunately, treatment for sleep apnea is already an option.
In addition to the other health benefits of getting a good nights sleep, usually about 7 to 8 hours, depending on the person, getting that full nights rest may decrease ones risk of getting dementia due to Alzheimers disease, says Holtzman.
However, there are clear brain health benefits to getting enough sleep. The best treatment for sleep apneacontinuous positive airway pressure or CPAP therapyalso works for people with Alzheimers disease. A 2009 study pitted the effects of three weeks of CPAP therapy against three weeks of sham CPAP in 52 people with Alzheimers disease. Sleep recordings of the participants showed that even one night of therapy resulted in a better nights sleep and three weeks translated to significantly deeper, sounder sleep ^4.
The NYU study examined the medical histories of 2,470 people to find that sleep apnea was associated with a faster decline in mental function. However, the study also showed that treating the sleep disorder could help. Those that sought treatment experienced a delay of 10 years in their diagnoses compared to those who didnt.
Another small study of 23 patients with Alzheimers disease showed that progression of dementia slowed significantly over three years when they were treated for sleep apnea ^5.
Extremely Smart Neurons Disrupted By Tau Proteins
Oh describes these neurons as extremely smart because they can produce an array of neurotransmitters and can excite, inhibit, and modulate other nerve cells.
Its a small number of neurons but their computational capabilities are incredible, Oh said. When these cells are affected by disease, it can have a huge effect on sleep.
Image by Grinberg Lab
To determine whats contributing to the degradation of these neurons in Alzheimers, the researchers looked at the brains of 33 patients with Alzheimers, 20 with PSP, and 32 volunteers whod had healthy brains through the end of life.
The team measured the amounts of two proteins often associated with the neurodegenerative process beta amyloid and tau. Which of the two is more involved in disrupting sleep has been a long-disputed question, with most researchers crediting the sleep problems to beta-amyloid accumulation.
During sleep, the brain clears out the beta amyloid that accumulates during the day. When we cant sleep, it builds up. So, Neylan said, since the PSP patients never sleep, she expected to see lots of the protein in their brains.
But it turns out that they have none, he said. These findings confirm with direct evidence that tau is a critical driver of sleep disturbances.
In patients with PSP, said Grinberg, this understanding turned the treatment paradigm on its head.
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How To Get Dementia Patients To Sleep At Night: 8 Tips For Better Sleep
If youre caring for a family member with dementia, improving sleep is probably a priority. Adequate rest can improve your loved ones mood, health, and quality of life and your own. Heres how you can help your family member with dementia get a better nights sleep.