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.
Sleep Medications And Alzheimers
If your loved oneâs doctor prescribes medicine to help them rest, theyâll probably start at the lowest dose possible and stop the drugs as soon as sleep patterns improve.
- Sleeping pills such as zaleplon and zolpidem
Doctors also sometimes prescribe drugs called antipsychotics such as risperidone . They can be helpful, but they also might increase the risk of death in some people with dementia. Youâll want to talk carefully with your loved oneâs doctor about this medicine before they take it.
Just as Alzheimerâs sleep problems can change over the years, so do the ways you can handle it. Always talk to your doctor about which options are best.
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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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Triggers For Crying And Calling Out In Dementia
A few possible reasons why your loved one is displaying this behavior include:
- Physical causes such as pain, restlessness, hunger or a need to use the bathroom
- External causes, including an environment that is too busy or loud, and a change in routine
- Psychological causes such as loneliness, boredom, anxiety, depression, and delusions
Crying and calling out in dementia can be triggered by true distress as a result of feelings of loss and being overwhelmed. At other times, crying appears to be less of a sorrowful response and more of habitual behavior.
Crying and calling out is sometimes more common in other types of dementia including vascular dementia, frontotemporal dementia, and Lewy body dementia. These behaviors may also increase later in the day due to sundowning, a condition common in dementia where behaviors and emotions escalate toward the evening.
Sometimes, a person with dementia may have a period of time when she’s screaming out loud but can’t tell you why. She may be feeling anxious or fearful, or be experiencing hallucinations or paranoia.
Finally, pseudobulbar affect can trigger excessive crying, as well as inappropriate laughter.Those with PBA might begin to cry and not know why they’re doing so.
Stage : Moderate Dementia
Patients in stage 5 need some assistance in order to carry out their daily lives. The main sign for stage 5 dementia is the inability to remember major details such as the name of a close family member or a home address. Patients may become disoriented about the time and place, have trouble making decisions, and forget basic information about themselves, such as a telephone number or address.
While moderate dementia can interfere with basic functioning, patients at this stage do not need assistance with basic functions such as using the bathroom or eating. Patients also still have the ability to remember their own names and generally the names of spouses and children.
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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
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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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.
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.
How Can Alzheimers Patients Get Better Sleep
Helping an individual with Alzheimers to sustain longer, deeper sleep can result in physical health gains and improvement of daytime symptoms that sleep loss causes, such as agitation and disorientation. In addition to treating any underlying sleep disorders that are contributing to disturbed sleep, practicing good sleep hygiene can help people with Alzheimers to sleep better. Sleep hygiene means cultivating healthy sleep habits and maintaining an environment that promotes quality sleep. Experiment with the following steps to improve sleep hygiene:
These approaches to sleep hygiene may be challenging to implement for some patients, but evidence suggests that such efforts can pay off. A study found that, compared to a control group, implementation of sleep hygiene practices, daily walks, and exposure to a lighting device resulted in a reduction in time awake at night and depression in Alzheimers patients and that these gains were sustained after six months.
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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.
Check For Other Medical Conditions
Both restless leg syndrome and sleep apnea have symptoms that willeasily make a dementia patient wake in the middle of the night.
To find out if your patient has sleep apnea, dedicate your time towatch and observe them for a while they are sleeping. It is important that youknow that someone with sleep apnea pauses when they breathe and stop breathingmomentarily.
This temporary stoppage of air can cause someone to wake up withspeed and its a frightening experience for someone sleeping close to them andwaiting for their breath to be restored.
If your patient is diagnosed with restless leg syndrome, you willnotice they twitch and move their legs uncontrollable particularly in theevenings and at night. They also experience tingling, fizzing and burningsensations. These symptoms are relieved by stretching and rubbing legs but willcertainly wake one up.
In the event that you discover that your patient has any of theseconditions, it is very necessary that you see a GP and request for help.
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Why Do Alzheimer Patients Sleep So Much
Are you aware of the degenerative condition affecting the brain cells called Alzheimers disease? It is a type of dementia that affects a patients life tremendously. You can see them on TV or in the movies being portrayed as people who lose their memory and ability to speak and think for themselves. Some people may even have first-hand information about this since a loved one already has developed Alzheimers. But you may begin to question, why do Alzheimer patients sleep so much? How has this condition impacted their daily activities and their outlook on life?
Q: Mom Has Dementia And Never Sleeps As Soon As She Lies Down She Calls For Help What Can I Do I Need Some Sleep Too
A: Sleep issues and dementia often go hand in hand, especially when awareness of time and time of day deteriorate. As the rest of the household beds down, there are fewer cues and reminders about what’s going on and what to do next, which can be quite anxiety-provoking to a confused person.
In the search for reassuring stimulation, people with dementia may get up and start wandering . This behavior can be difficult to change, and may result in prescriptions for sleeping pillswhich often lead to other problems.
Before taking that step, it’s worth trying some classic “sleep hygiene” measures. Make sure your mother gets adequate exercise during the day to ensure that she’ll be tired by bedtime. To the degree possible, urge your mother to avoid sleeping during the day. Avoid heavy meals or caffeine use for several hours before bedtime. Ditto for emotionally charged discussions or upsetting television shows.
Try to establish going-to-bed routines and stick to them as best you can.
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Normal Sleep Pattern Changes In Older Age
Research has documented a number of sleep changes that occur in healthy aging adults. These include bedtimes and wake times shifting to an earlier hour, taking longer to fall asleep once in bed, experiencing fragmented sleep, sleeping fewer hours per night, and spending less time in slow-wave and REM sleep. Although these changes parallel some of the sleep challenges seen in people with dementia, the sleep pattern changes in dementia patients tend to be more dramatic and disruptive.
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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Get The Lighting Right
To aid a more restful nights sleep the bedroom should be as comfortable as possible. Using blackout curtains are a good idea during night-time to eliminate outside disturbances. Research suggests that light therapy can reduce restlessness and confusion for people with dementia. Should you wish to consider light therapy, it has been proven that violet coloured light promotes drowsiness and a full-spectrum fluorescent light used for the first two hours of the day can be settling. Light therapy that follows a regular pattern can also help with disturbed body clocks.
Safety if night wandering is a problem, or frequent visits to the loo, you will need to consider some sort of low light to prevent your parent falling in the dark. You may want to invest in a motion sensor night light. A motion sensor light automatically turns on when motion is detected within three metres. It then turns off after 30 seconds of no activity. This means that people with dementia can use the bathroom in the night or get out of bed with less risk of falling. The light is gentle and warm in order to not interrupt sleep.
Common Causes Of Sleep Changes And Problems In People With Dementia
Its hard to manage a problem if you dont understand why it might be happening. There are several factors that can cause older adults with dementia to have sleep problems. These include:
- Sleep changes with aging. Healthy aging adults do experience changes with their sleep as they age. Sleep becomes lighter and more fragmented, with less time spent in deep REM sleep. One study also estimated that total sleep time decreases by 28 minutes per decade, starting in mid-life. Although these changes are considered a normal part of aging, lighter sleep means its easier for aging adults to be woken up or disturbed by any other sleep-related disorders or problems, such as arthritis pain at night. Aging is also associated with a shift in the circadian rhythm, so that many older adults find themselves sleepy earlier at night and hence wake up earlier in the morning. For more, see here: How Sleep Affects Health, & Changes With Aging
- Many sleep-related disorders become more frequent with aging. Common sleep-related disorders include sleep apnea and related conditions , which may affect 40-50% of seniors, as well as restless leg syndrome, which is thought to be clinically significant in 2.5% of people.
Hence, its not surprising that sleep problems are so common in people with dementia! Now lets talk about what can be done to improve things.
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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