How Will Poor Sleep Affect Health And Wellbeing
A person who doesnt get enough good-quality sleep is likely to be tired, irritable, have a low mood and be less able to think clearly. It can also make them more likely to fall or have an accident. This can make caring for them more difficult.
If the stress of caring is making you unwell, talk to your GP. You should try to get as much good-quality sleep as possible.
Looking after yourself as a carerLooking after yourself as a carer .
Good quality sleep is important for both carers and people living with dementia. Read our advice on looking after yourself as a carer.
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 .
How Circadian Rhythms Are Affected
The buildup of the protein-comprised plaque that is associated with Alzheimer’s disease and other forms of dementia is thought to cause a disruption in the suprachiasmatic nucleus in the brain.
The suprachiasmatic nucleus is known for its association with maintaining regular sleep patterns via circadian rhythms, though this is mostly based on the presence of light or dark sensory cues. It is difficult to empirically prove that the plaque buildup has an effect on the way circadian rhythms work in dementia patients, mostly because an autopsy is necessary to investigate the presence in the brain. Once a patient has died, they have usually surpassed the stage in which circadian rhythms are affected.
Since a patient is typically in the middle stages of a degenerative brain disease, he or she is usually aware that his or her sleeping habits have become abnormal.
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Keeping A Sleep Journal
When keeping a journal or diary, try to keep track of things like the number, length, and timing of naps during the day. Also keep note of the time that the person with dementia goes to bed at night and rises in the morning. How many times the person wakes up at night is also important, along with details such as what time these awakenings occur, and for how long.
Also mark down what the person does after awakening in the night. For example how many trips to the bathroom did the person make, and at what times. Also make note of any unusual nighttime activity such as wandering and rummaging.
Be sure to keep records of anything you give or do before bed to help the person sleep or reduce agitation.
You can use this general guide to rate the persons sleep at night:
- A difficult night means very little or no sleep. Figure anything less than 2 hours. A poor night which means little sleep, generally 2-4 hours.
- A fair night which means multiple, brief awakenings lasting less than 30 minutes and a total nights sleep of more than 4 hours.
- Finally, a good night, with only a brief awakening of less than 30 minutes and a total nights rest of more than 4 hours.
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 .
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Why Might A Person With Dementia Not Sleep Well
For a person with dementia, getting enough sleep can be a challenge. Sleeping well can be difficult for a person aged over 55, as the parts of the brain that control sleep may not work as well. An older person is likely to go to sleep earlier and may have difficulty sleeping through the night as much as they used to.
For more information, see Keeping active and involved. For ideas for enjoyable and engaging activities, see The Activities handbook.
Sleep Six To Eight Hours Each Night
In the first study, researchers at Harvard Medical School studied more than 2,800 individuals ages 65 and older participating in the National Health and Aging Trends Study to examine the relationship between their self-report of sleep characteristics in 2013 or 2014, and their development of dementia and/or death five years later. Researchers found that individuals who slept fewer than five hours per night were twice as likely to develop dementia, and twice as likely to die, compared to those who slept six to eight hours per night. This study controlled for demographic characteristics including age, marital status, race, education, health conditions, and body weight.
In the second study, researchers in Europe examined data from almost 8,000 participants from a different study and found that consistently sleeping six hours or less at age 50, 60, and 70 was associated with a 30% increase in dementia risk compared to a normal sleep duration of seven hours. The mean age of dementia diagnosis was 77 years. This study controlled for sociodemographic, behavioral, cardiometabolic, and mental health factors, although most participants were white, better educated, and healthier than the general population. In addition, approximately half of the participants had their sleep duration measured objectively using a wearable accelerometer a device that tracked their sleep using body movements which confirmed the questionnaire data.
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Complications Of Alzheimer’s Disease And Sleep
Sleep disturbance can lead to a number of complications in people with Alzheimer’s disease, including the following:
- Cognitive decline: Poor sleep can worsen cognitive symptoms in people with Alzheimer’s disease.
- Increased risk of falls: People with Alzheimer’s disease who have sleep problems are at an increased risk of falling.
- Mood changes: Sleep disturbance can lead to mood changes, such as irritability, depression, and anxiety.
- Stress: The stress associated with sleep disturbance may worsen Alzheimer’s symptoms.
How To Support Good Overall Sleep
Thereâs a host of simple lifestyle changes we can all incorporate into our daily routines to ensure weâre setting ourselves up for a good nightâs sleep and these are no different for people with Alzheimerâs.
Maintaining a daytime routine in which wake time, meals and bed time are fairly consistent is a good first step. This may not always be simple to implement for someone who has Alzheimerâs, but keeping mealtimes as regular as possible can provide some level of routine.
Getting adequate exposure to sunlight is also important in helping to keep your body clock regulated, so spending some time outside every day when possible is a good idea.
Take time to exercise each day. This can be as simple as going for a nice walk, which also ticks the box of getting exposure to sunlight! Regular exercise helps to create a sleep debt and can help you sleep better at night.
Avoid caffeine, alcohol and nicotine in the evening as these all stimulate the body and mind when it needs to be winding down.
Limit screentime in the hour before bed. This includes TVs, computer, tablets and smart phones, which all emit blue light and can interfere with sleep.
Create a consistent and relaxing night-time routine to help relax and unwind before bed. Whether itâs taking a bath or reading a nice book before bed, a regular bedtime wind-down routine can set you up for a good nightâs rest.
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Report On Systematic Reviews And Meta
Because of the availability of several epidemiological studies on the association between sleep disturbances and cognitive disorders, recent systematic reviews and metaanalyses have been conducted on this topic. Almondes and collaborators5151. de Almondes KM, Costa MV, Malloy-Diniz LF, Diniz BS. Insomnia and risk of dementia in older adults: systematic review and meta-analysis. J Psychiatr Res. 2016 Jun 77:109-15. https://doi.org/10.1016/_i.jpsychires.2016.02.021 analysed five community-based prospective cohorts aiming to evaluate the risk of dementia in people with a history of insomnia. They found an association of insomnia with a significant risk of all-cause dementia .
How Dementia Affects Sleep Cycles
Sleep deprivation can be a serious threat to patients with dementia.
Although not always associated with dementia, the mental condition can cause severe disruptions in circadian rhythms and sleep patterns, leading to chronic exhaustion and bouts of confusion based on transitions from day to night.
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Foods That Promote Sleep
Some foods can actually help promote sleep. Try serving sleep-promoting foods for dinner or an evening snack.
Examples include dairy products such as cheese and milk soy products like tofu or soy milk, other beans and lentils whole grains, rice and oats and a variety of nuts and seeds, including peanuts, almonds and sunflower seeds. Proteins such as eggs, fish and poultry also help to promote sleep, as do some fruits and vegetables, including avocados, peaches, asparagus and bananas.
Keep in mind that giving the person a light snack before bedtime can prevent awakenings caused by nighttime hunger.
What Is Sleep Deprivations Link With Dementia
One night of poor sleep can cause issues with your thinking the next day. But many months or years of inadequate sleep may lead to more serious and chronic problems with your thinking. For example, one study found that people who sleep less than 4 hours a night may struggle more with their thinking, learning, and memory abilities.
Research is ongoing, but so far, a history of sleep trouble does seem to increase the risk of dementia for some people. One study suggests sleep deprivation could increase your dementia risk by 20%. In middle age, even getting less than 6 hours of sleep per night may increase your dementia risk in the future.
Scientists are beginning to probe the complex relationship between the brain changes involved in poor sleep and those in very early-stage Alzheimers. People who slept six hours or less per night in their 50s and 60s were more likely to develop dementia later in life. The findings suggest that inadequate sleep duration could increase dementia risk and emphasizes the importance of good sleep habits.
Nearly 60 percent of older adults have some kind of chronic sleep disturbance.
Its long been known that people with Alzheimers often have sleep difficulties. Now scientists are probing the link between sleep and Alzheimers earlier in the disease process and in cognitively normal adults. They wonder if improving sleep with existing treatments might help memory and other cognitive functionsand perhaps delay or prevent Alzheimers.
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Sundowning And Sleep Disorders
Sundowning is a common psychological symptom of dementia, most commonly Alzheimer’s disease, which typically develops as a new symptom in the middle stages of the condition. It is a form of confusion, generally manifesting when natural sunlight begins to fade and more shadows appear. Patients will also become frustrated with their confusion, which may result in mood swings and heightened irritability, especially with a caregiver.
Patients also often experience restlessness, especially at night, when their circadian rhythms are impaired. Patients, when trying to sleep, may find themselves experiencing a restless kind of insomnia, and may pace or wander outside of their quarters, increasing the likelihood of injury.
S To Take If Youre Experiencing Sleep Problems
Poor sleep and sleep disorders can be caused by a number of factors beyond dementia, including lifestyle and mental health issues, such as stress and anxiety and underlying medical conditions. To help reduce the risk of dementia and other health issues, its important to understand what could be causing sleep problems and learn how to improve your sleep routine.
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The Deep Cleaning Functions Of Deep Sleep
During our deepest sleep, the brain and body are hard at work carrying out some major cellular housekeeping, removing toxic products that have built up over the day. When we donât get enough deep sleep, the amount of deep cleaning time is reduced as a consequence.
Evidence that deep sleep becomes significantly reduced in Alzheimerâs â and knowing that thereâs protein accumulation in the brains of people with the disease â has led to some excellent studies looking at how deep sleep affects these protein levels.
One particularly interesting study recently shone some light onto this process by using imaging techniques to look at the brains of healthy volunteers as they slept. The researchers found that during deep sleep, our brains are flushed by waves of cerebrospinal fluid . You can see a short video clip of this here.
These waves appear every 20 seconds during deep sleep and they essentially wash over the brain, cleaning away toxic proteins such as tau and beta-amyloid. 4 So in people experiencing a reduced amount of deep sleep, levels of these cleansing waves would also be reduced.
Research has shown that sleep disturbance causes both levels of beta-amyloids and tau to rise acutely in the brain and CSF. 56
In one study, beta-amyloid increased about 5% in the participantsâ brains after losing a single night of sleep.5 The researchers additionally found that changes occured in regions that are known to be affected early in Alzheimerâs.
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.
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Approaches To Sleep Problems
Here are some general approaches for dealing with sleep issues.
First, learn about how dementia and aging affect sleep patterns. Aging can lead to a decrease in the amount of time the body spends in deep, restful sleep and an increase in the amount of light sleep. In addition, people also become more sensitive to the sleeping environment, including subtle things such as changes in room temperature. Dementia can cause more nighttime awakenings, less deep and restful sleep, more light sleep, and more daytime napping.
Second, keep a sleep journal to help identify any patterns of sleep disturbances. If you decide to consult a healthcare professional, keeping a diary for at least one to two weeks prior to the visit can help with the evaluation. To learn more about keeping a sleep journal, click on the link provided.
Lastly, talk to your healthcare professional for more information about other factors that can affect sleep including medical conditions, anxiety, depression, and current medications. You can also discuss medications and non-drug therapies that promote sleep.