Provide Comfort And Familiarity
Think back to the last time you were sick. Chances are you wanted to be surrounded by comforting thoughts, things, and people. For someone with dementia, the world can become a scary place. Comfort and familiarity can help them cope with this difficult time in life.
Help fill your loved ones life and home with things they find comforting. If they move into a hospital or assisted living facility, furnish the space around them with cherished items. For example, bring their favorite blanket or family photos to the new facility. This may help ease the transition and curb their sundowning symptoms.
Sitting Up In A Recliner
Like much of what Mom does, this is one we don’t understand but she has slept in a recliner chair for years now. I don’t think she likes laying down in bed because it is hard for her get back up, and on the recliner she can just launch herself right back up.
One of the benefits is that she can dose off to sleep if she gets tired and doesn’t have to officially go to bed.
If your loved one is sleeping in the same chair they sit in all day long, make sure to watch out for bed sores. Have them move around during the day so the same pressure points don’t get pushed all the time.
Dementia And Sleep: Tips For Helping Your Loved One With Dementia Sleep Better
Dementia and sleep problems often go hand in hand. The connection between dementia and sleep is a common source of stress for family caregivers. When your loved one with Alzheimers disease or another form of dementia doesnt sleep well, you probably dont get enough sleep either.
Read on to understand the causes of sleep problems in people with dementia and get tips for better sleep.
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Strategies For Dealing With Sundowners Syndrome In Seniors
You are awoken at 2:00 a.m. by the hallway light shining underneath your bedroom door and the sound of shuffling feet.
Not again , you grumble. Your father is standing outside your bedroom door looking confused. Dad? Where are you going? you ask. Your father looks blankly, mutters something, and waves you off.
Dad has Sundowners syndrome . He cant tell the difference between day and night, nor understand, Dad, its 2:00 a.m. and you should get some sleep!
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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What Are The Signs And Symptoms Of Sundowners Syndrome
Sundowners syndrome can be a tricky thing to put a finger on, as it does not have just one symptom. Any person living with Sundowners will experience or show numerous symptoms. These symptoms will become more obvious and more frequent in the late afternoon or evening.
Milder symptoms can include:
- Increased confusion
There are also more serious signs and symptoms of Sundowners syndrome. These include:
- Mood swings
- Making demands
Seniors can experience sundowners syndrome at all stages of Alzheimers. With Alzheimers or other dementia cases, sundowning symptoms typically peak at mid-stage dementia and then lessen.
When a person is up and awake overnight, that person will feel more tired, be more irritable, and lose concentration the following day. Those with Sundowners syndrome can be affected in other ways as well, such as:
- Increased mood disorders and fluctuations
- Increased me-time and more attention required during the day
Sleep Problems And Treatments For People With Dementia
If a person has sleep problems caused by dementia, they should see their GP, who may refer them to a specialist. Find out about different sleep problems and what support and care is available for a person with dementia and sleep disturbance.
Understanding sleep and night-time disturbance
All of the sleep problems on this page may be helped by following our Tips for healthy sleep. These tips should always be explored thoroughly, before trying medication.
This is because drugs and medication are not very effective at improving sleep in dementia.
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How Do The Body Clock And Sleep Pressure Work Together
Its much easier for a person to get to sleep when they have built up lots of sleep pressure during the day, and their body clock senses that its evening. This turns on both sleep systems at the same time, and should make the person feel sleepy at the right time.
If the person doesnt feel sleepy at night, their body clock may not be working well. They may also not have been awake for long enough to make the body need to sleep .
Sleep Time And Dementia
There appears to be a U-shaped curve when it comes to sleep length and cognitive decline. That means problems show up if you sleep too little or too much. But a lack of sleep is more likely to raise your chances of dementia.
Hereâs what research says about sleep time and dementia:
Short sleep . Research shows that one night of serious sleep loss raises your levels of beta-amyloid and tau. Those are proteins linked to Alzheimerâs disease. Insomnia also disrupts your slow wave sleep, which plays a part in learning and memory.
Long sleep . Itâs less clear why long sleep raises your chances of dementia. But your body may need more sleep to work well if you have another health condition, like sleep apnea or depression.
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Sleep Aids: Medications Melatonin And Dementia
In some cases, the doctor may prescribe medications to help your loved one sleep. However, older adults with cognitive impairment are more likely to experience side effects from sleep-inducing drugs, so those medications arent usually recommended for long-term use.
Some studies show melatonin may improve sleep in people with mild to moderate dementia. It may also help reduce agitation and confusion late in the day. Check with your loved ones doctor before starting any over-the-counter supplements or sleep aids.
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.
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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.
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.
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Medicines For Sleep Problems In Dementia
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
What Is The Body Clock
Our bodies sense natural light to know roughly what time of day or night it is. We also get a sense of time from routine daily activities such as mealtimes, to create a sleep and wake cycle over 24 hours.
This tells our brains when its time to go to sleep and when to wake up again .
The body clock of a person with dementia may become damaged, making it harder for them to feel awake and alert during the day, and sleepy during the evening.
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The Added Complications Of Dementia And Sleep
For most patients, sleep disorders are multifactorial meaning that there are multiple issues causing their sleep disturbances. In addition to the underlying medical conditions, fatigue, depression, anxiety, or confusion caused by dementia can make it difficult. For example, a loss of light and increased shadows in the evening can cause confusion and fear. The way that dementia affects the brain causes them to see things much differently than someone without dementia.
Since the cause of sleep issues and dementia problems is multifactorial, you need to take a multifactorial approach to treatment as well. Start by working with their doctor to pinpoint as many underlying causes as possible. Describe the types of problems the person is experiencing. Do they have trouble going to sleep, wake up frequently, or wander during the night? Do they often nap during the day, doze off randomly, or snore loudly? Write down a complete description of their issues including the times they normally go to bed and get up.
The more information you can provide to the doctor, the more accurately he/she can diagnose the underlying conditions. They will also consider whether any current medications might be adding to the problem. Never assume that dementia is the primary cause of the sleep disturbances and that there is nothing you can do to improve the situation.
Activeness In The Day
You should come up with a plan of daily activities that will keep them busy in the day. Take a stroll, meet friends and if they are comfortable with it, join a society or club that shares the same vision and goals with your patient.
Getting them exposed to natural daylight helps to control the bodyclock and leaving the confines of the room is the best option you have toachieve good physical health.
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If You Have Questions About Alzheimer’s Check Out Webmd’s Alzheimer’s Disease Board
“We and many others have observed that patients with dementias … all have sleep disturbance,” researcher David G. Harper, PhD, tells WebMD. “It’s one of the leading reasons for institutionalization of people with dementia,” as the patient is up all night, keeping the caregiver awake. Harper, the author of the study that appears in this month’s Archives of General Psychiatry, is a research fellow in psychology in the department of geriatric psychiatry at McLean Hospital in Belmont, Mass., and Harvard University.
“Separating the dementia is really important for understanding the mechanisms of the disturbed in Alzheimer’s disease,” expert Edward O’Malley, PhD, tells WebMD. “This can really get at what the nature of that disruption is and hopefully offer treatments.”
Because sleep disturbance is the single greatest reason why caregivers feel obligated to institutionalize their loved ones with dementia, O’Malley says that this research, “can go a long way toward maintaining home care of Alzheimer’s patients.” O’Malley is director of the Sleep Disorders Center at Norwalk Hospital in Connecticut.
In healthy people, changes in body temperature occur throughout the day and night, they are controlled by the body clock in the brain, and they mimic activity cycles. In general, body temperature is lowest when activity levels are lowest, such as in the middle of the night, and body temperature is at its highest during periods of highest activity, such as in the middle of the day.
Optimize The Sleep Environment
One of the easiest ways to help your loved one sleep is to optimize their sleep environment. Keep your loved ones sleep environment dark and quiet at night to help them relax. Consider adding heavier curtains or blackout blinds to keep outside light from entering the room. Check the temperature and ensure that your loved one is not too hot or two cold. All of these factors can contribute to a comfortable sleep environment.
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Common Causes Of Sleep Change With Dementia
There are several factors that can cause older adults with dementia to have sleep problems:
- Heart and lung conditions, such as heart failure or chronic obstructive pulmonary disease
- Stomach-related conditions such as gastroesophageal reflux disease
- Chronic pain from arthritis or another cause
- Urinary conditions that make people prone to urinating at night, such as an enlarged prostate or an overactive bladder
- Mood problems, such as anxiety or depression
- Medication side effects, and substances such as alcohol
- Chronic medical conditions and medications often affect sleep. Studies have found that older adults often experience secondary sleep difficulties, which means that the sleep problems are being caused by an underlying health problem. Many people diagnosed with Alzheimers have additional chronic health problems that may be associated with sleep difficulties. Common causes of secondary sleep problems include:
- Many sleep-related disorders become more frequent with aging. Examples: sleep apnea and related conditions , which may affect 40 to 50 percent of seniors, as well as restless leg syndrome.
What The Research Tells Us
Unfortunately, there does not seem to be an easy sleep solution. Three common medications were included in the studies, including the hormone melatonin , the antidepressant trazodone and the sedative ramelteon . None of these medications significantly helped to improve sleep in people with dementia .
Although it is not as helpful to find out what doesnt work especially for people desperate for a good nights sleep these findings can help people with dementia and their caregivers avoid taking an unnecessary medication.
Besides the three drugs included in this review, we dont yet know enough about the benefits and risks of other common sleep medications to recommend them yet many people are prescribed these drugs anyway.
Until we know more, safer non-drug approaches to encourage sleep are worth a try. Some ideas include: establishing consistent daily routines regular exercise restricting naptime during the day and ensuring a comfortable, temperature controlled and soothing environment for sleeping . Light therapy – exposing people to minimum amounts of bright light during the day – might also help reset circadian rhythms and improve nighttime sleeping .
It may take some trial and error to find the right strategy. Ideally, a safe and effective plan can be put in place that allows everyone to rest easy.
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Establishing Good Habits: Going Outside
A good place to start is by considering what the person is doing during the day as this will have an effect on how tired or restless they are at night.
Some of the things that can make a person less likely to be tired at bed time are:
- Inactivity during the day. Too much sitting, and being physically and mentally inactive
- A lack of fresh air and sunlight
Many people with dementia spend a lot of time indoors, missing out on the stimulation and exercise that can help make them ready for bed at night time.
Consider things you can do to help a person with dementia go outside, such as:
- A walk around the block
- A trip to a park or garden centre
- Simply sitting in a garden, if they have mobility issues
Your mobility, and the mobility of the person with dementia, will affect how possible these options are.
If you have mobility issues, please consider asking your friends, family and neighbours to sometimes help with taking the person you care for outside for a while. Sometimes, the people around you want to help but dont know how. You might find that by suggesting they take the person out for a short walk, or simply for a sit down elsewhere, that they are glad to be of help.
In this video, Paulette Winchester-Jones provides some tips about developing good habits at bedtime.