Causes Of Sleeping Problems In Dementia
There are numerous underlying causes that can contribute to sleep changes in dementia. These causes include:
- Brain changes that occur in dementia
- Other illnesses the patient may have, including angina, congestive heart failure, or diabetes
- Pain which could be a result of arthritis
- Urinary tract infections or the frequent need to urinate, especially at night
- Disturbing dreams
Is Excessive Sleeping Part Of The Vascular Dementia Stages
My mother is sleeping all night and virtually all day apart from a couple of hours. Does this happen as part of one of the stages?
She is not incontinent or aggressive and eats well when she is awake. She hasn’t forgotten our names but is starting to forget places , for example, she didn’t recognise the town she was brought up in and her short term memory is appalling.
I just don’t know what stage she is at, she was diagnosed about 4 years ago.
My husband has vascular dementia diagnosed 3 years ago. He is sleeps 11 hours at night and sleeps away most of the day in his chair. He doesnt want to be bothered to wake up. This scares me and Im not sure if I should try to keep him awake or just let him sleep.
My Mother does this too. After meals, right back to bed or her recliner. I was scared meds needed adjusting but it’s progression of disorder. This is everyday except when she agrees to let me take her to a local Sr Center for lunch with friends. We have games, puzzles, etc. She refuses any outdoor activity.
My husband was diagnosed 4 years ago too, He sleeps alot too. He’ll go to sleep about 7:30 and sleep until 9 or 10. Takes naps in afternoon too.
Sounds like later stages to me.
They Wake Up A Lot During The Night To Use The Loo And I’m Worried They May Get Lost Or Confused Should I Wake Up Too To Help Them
It is normal that older people will need to use the loo more often during the night. This can be difficult if a person also has dementia as they might forget why they’re up, where the toilet is or that they should go back to bed. Start by looking at your parents drinking and eating habits. If they are eating and drinking large amounts in the evening this will increase the need for them to visit the toilet. Limit their intake from late afternoon and enjoy a main meal at lunch. Next make the route to and from the toilet as clear as possible by using signs and plug-in nightlights. Try using pictures if it helps. It might also help to make the lights in the bathroom motion activated for when they get there. If you are still worried or you find they still get lost, it may be that you will have to help them. A monitor or bed-exit sensor will help you to wake up when you need to.
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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.
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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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.
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.
Shop Warm Motion Sensor Wall Lights on the Complete Care Shop from £9.43
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Common Sleep Disorders Include
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
Other Sleep Issues In People With Dementia
Sundowning is a phenomenon in which individuals with dementia experience increased agitation later in the day and in the evening. The symptoms of sundowning include confusion, anxiety, wandering, and yelling. Sundowning can contribute to insomnia and other sleep problems when these behaviors continue into the night. Possible causes of sundowning include the circadian rhythm changes that occur in dementia, as well as fatigue, depression, and pain.
People with dementia may also talk, yell, or cry out at night if they cannot sleep. Some dementia patients have a tendency to wander away from their homes, which can be especially dangerous at night. In dementia patients with REM sleep behavior disorder, shouting, grabbing, jumping, and other behaviors are related to dream enactment during sleep.
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What Can Help Someone With Dementia Sleep Better
Sleep hygiene is the primary treatment for sleep concerns in people with dementia. Sleep hygiene is a collection of practices and environmental considerations that promote good sleep quality. The following sleep hygiene tips may help a person with dementia improve their sleep patterns:
Some of these sleep hygiene practices may be difficult for someone with dementia. For example, it may not be possible to control the bedroom noise level in a nursing home or assisted living facility. Consider adding a white noise machine to mask outside noise. A person with dementia may also have a difficult time maintaining a regular bedtime due to napping or varied daily activities, but keeping wake time consistent can still help to stabilize the circadian rhythm. A physician or sleep specialist is in a good position to provide individualized sleep hygiene recommendations for a specific situation.
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 carer
Good quality sleep is important for both carers and people living with dementia. Read our advice on looking after yourself as a carer.
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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.
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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Why Dementia Patients Dont Sleep
Sleep is a common source of stress for dementia patients caregivers and family members. Understanding the factors that cause the person with dementia to have sleep problems can help you manage this problem and make care easier for both you and your loved one.
Sleep changes come with aging. Healthy adults also experience changes in sleep patterns as they age. These sleep changes are considered a normal part of aging, as aging is associated with changes in the circadian rhythm .
However, in people with dementia, these changes are more common. The brain deterioration caused by dementia affects the brains ability to sleep and causes problems with circadian rhythm.
Research shows that sundown syndrome causes as many as 20 percent of patients with Alzheimers to experience increased anxiety, confusion, and agitation as the evening approaches. Many persons with dementia also experience restlessness and changes in their sleep during the night.
The disruption in your loved ones sleep-wake cycle may lead to other behavioral and emotional issues.
In patients with Lewy-body dementia and Parkinsons, there is a sleep disorder known as REM sleep behavior disorder, which can cause violent movements during sleep.
Some other factors that cause dementia patients insomnia include mental and physical exhaustion at the end of the day, confusion and fear triggered by reduced lighting and increased shadows, and disorientation because of the inability to separate dreams from reality.
Rachel Thompson Admiral Nurse Professional And Practice Development Lead At Dementia Uktalks About How Dementia Affects Sleep And How Carers And Families Can Approach Sleep Disturbance And Its Possible Underlying Causes
Disturbances in sleeping patterns are common among people with dementia and can become more problematic as the condition progresses. Someone diagnosed with dementia can become increasingly restless, confused, agitated, or distressed, particularly as the sun is setting and it becomes dark outside. This is known as sundowning.
There are many different types of dementia and some people may present with a combination of types. Regardless of which type is diagnosed, each person will experience their dementia in their own unique way. All types of dementia can affect sleeping but for people with specific types of dementia particularly Lewy body dementia or Parkinsons disease dementia, sleep disturbance can be particularly common due to physical changes in the brain. For people with Lewy Body dementia this can include nightmares or night terrors and/or restless leg syndrome or uncontrolled limb movements.
Medications may also cause sleep problems, for example anti- cholinesterase inhibitor drugs such as Aricept, Exelon and Reminyl, can cause night time stimulation and dream disturbance so where possible these should not be taken in the evening. Pain is also a major contributor to sleep deprivation and is commonly unrecognised and undertreated in people with dementia. If you suspect the person with dementia may be in pain contact your GP.
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Sleep Well Top Tips For A Good Nights Rest
Everybody knows how you feel when you dont get enough sleep. Restorative and regenerating seven or eight hours a night is a good nights sleep for most of us to enable the body to do its healing. Not enough sleep leads to both physical and mental health problems. This is our guide to sleep for the elderly and tips for getting a good nights rest.
Sleep problems for the elderly
Many people accept as they get older that their quality of sleep is not nearly as good as it used to be, and this may be due to medical conditions, certain medications, pain or frequently getting up for the loo. There are plenty of things that can be done to try to improve it.
Some people cannot get to sleep, others have no problem with falling asleep but wake up in the middle of the night and have long spells awake. While others wake early 5 or 6 in the morning and cant get back to sleep at all.
Before bedtime routine
Preparing for bedtime could have a positive effect on quality of sleep. It is said to be helpful to have a routine and go upstairs at the same time each night and do the same things. Winding down and relaxing before sleeping is well worthwhile. Some people like to have a hot bath, read or listen to music to make them drowsy.
What to eat or drink before bed
However, drinks in the evening can make visits to the loo more frequent during the night.
Eating:
Getting the temperature right
Nocturnal disturbances
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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