Understanding What Keeps Dementia Sufferers Awake At Night
April 12, 2001 — Sleep disturbance is a very common and very problematic symptom of dementia. New research indicates that causes of this sleep disturbance may differ in different kinds of dementia. Hopefully, understanding these causes will lead to better treatments.
Dementia is a term used to refer to a loss of thinking abilities. Although there are many causes of dementia, it is most often associated with aging. The most common cause of dementia associated with aging is Alzheimer’s disease, which affects approximately one in 10 people over age 65 and nearly half of those over age 85.
Guidance For Good Nutrition
To ensure a dementia patient is eating correctly, a balanced diet including various foods is key.
Meals should contain fruit, lean protein foods, low-fat dairy products, vegetables, and whole grains.
It is recommended to serve small portions of high saturated fat and cholesterol in a meal.
While some fats are healthy, its best to use butter, fatty meat cutes, lard, and solid shortening sparingly.
Also, high-sodium foods should be restricted. Replace salt with herbs or spices instead to flavor meals.
To reduce refined sugars, avoid serving processed foods. Baked goods made with fruit or sweetened with fruit juice are better alternatives.
Honey is also an optional sweetener.
How To Die In Sleep
Getting enough sleep, exercising, and eating well are what makes our bodies healthy. However, sleeping can also be dangerous. There are many things that can go wrong when you sleep and are unconscious.
This is why you may have heard of things like people dying in their sleep without any signs of illness. The dangers are also the same where seniors are concerned.
What you may not have known is that the brain remains active even as we sleep and there are so many things that are not clear about sleep. Some of the ways in which you can die in your sleep include:
- A sudden cardiac arrest
- Chronic obstructive pulmonary disease
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Nutrients To Aid Sleep
Nutrients at night-time such as melatonin can aid a deeper and better quality nights sleep. Such nutrients can also help ensure a person is getting important vitamins which can become depleted when eating a balanced diet becomes problematic. Always check with your parents GP that any supplements or nutrients you buy wont interact with current medication.
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If you are finding it particularly hard to help someone with dementia with their sleep, and its affecting your ability to care for an elderly relative, it may be a good idea to share some of the care responsibilities with a live-in carer, like those found on our best live-in care companies page.
Coping Mechanisms For People With Dementia Who Sleep A Lot
Family members and caregivers can worry a lot when a loved one with dementia starts to sleep a lot.
There are a few practical steps you can take to make the situation a little better depending on the cause of the sleepiness.
For instance, if a person with dementia is sleeping a lot because of disease progression, there is not much you can do.
However, if it is the medication they are taking that is causing them to sleep too much, you can always visit a professional doctor who will review the medicines they are taking.
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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.
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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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.
Tips For Managing Dementia End
Because individuals with advanced dementia will often have difficulty communicating, it is important that caregivers keep a close eye on their loved one for signs of pain or discomfort. These signs may include moaning or yelling, restlessness or an inability to sleep, grimacing, or sweating. This may also signal that its time to call hospice or a palliative care team to help with the pain management.
If an individual with end-stage dementia is having trouble sitting up without assistance, hospice can provide a hospital bed or other equipment to lift their head.
Perhaps the hardest thing for families is when a loved one with dementia is no longer able to eat or swallow. Because an individual with dementia is unable to understand the benefits of feeding tubes or IV drips, they will often be incredibly distressed and attempt to remove them, causing added pain and risk of infection. Instead, focusing on keeping the individual comfortable. Supporting them with mouth care to prevent their mouth from becoming dry will allow them to make their final transition in peace.
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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.
When Do Dementia Patients Stop Eating
When a patient stops or refuses to eat, things can be very depressing for the caregiver. Drinking and eating are complex and have to do with a control center that is within the brain, which controls the muscles in the throat and neck area.
Dementia affects this part of the brain as it progresses and things like choking, coughing, grimacing as one swallows, clearing the throat, movements that are exaggerated, especially of the tongue and mouth, refusing to swallow, and spitting the food can be seen. This usually happens in the later stages of the disease.
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What Happens A Few Hours To Death
When death is hours away, your elderly loved one may:
> Refuse drinks or food completely
> Stop having bowel movements and peeing
> Scowl, groan or grimace from the pain
You may also notice:
- Their eyes glaze over or tear
- Irregular heartbeat and pulse or very hard to hear
- A drop in the body temperature
- The skin on the hands, feet, or knees can become mottled blue-purple
- The breathing gets interrupted often and gasps can be heard up until they stop breathing entirely
- Drift in and out of consciousness if not already unconscious. It is important to remember that the loved one may still feel and hear you during such moments and it would be nice to talk to them and touch them so they know they are not alone.
What Causes Alzheimer’s Disease
The exact cause of Alzheimers is not known. However, several factors increase the risk of the disease.
The risk factors of Alzheimers include:
- Age: Risk increases with age, affecting 15% of people older than 65 years and 50% of people older than 85 years.
- Family history: Family member with the disease increases the risk. Inherited gene mutations also increase the probability of developing the disease.
- Gender: Women have a higher risk than men.
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I Care For More Than One Person With Dementia And Wonder How To Keep Dementia Patients Not Sleeping In Bed At Night Should I Put Them To Bed Straight Away
According to the Alzheimers Association, patients can spend up to 40% of their time lying in bed awake, this equates to sleeping too much during the day. If the patient does get up, dont try to get them back to bed. Try to restart a small bedtime routine instead of putting them straight to bed. Keep lights low, take them to the toilet, play relaxing music or read to them for a bit to calm them down.
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How Does Dementia Change Sleep Patterns
Circadian rhythm is a collection of physical and psychological processes that guide our sleep-wake cycle by responding to indicators in our environment. People with dementia experience fundamental changes in their circadian rhythm that work against getting quality sleep on a regular schedule.
The suprachiasmatic nucleus is the part of the brain that serves as our internal clock and responds to cues, such as light, to indicate when we should be alert and when we should feel sleepy. Individuals who have Alzheimers diseasethe most common type of dementiaoften have damaged cells in the SCN and decreased cellular activity in this part of the brain. The result of this dysfunction is that patients are often unable to follow a 24-hour sleep-wake cycle and instead sleep excessively during the day and sleep much less at night.
Additionally, dementia is associated with changes in sleep structure. When we sleep, our bodies cycle through a series of sleep stages, from light sleep , to deep sleep , and then dream sleep . Slow-wave sleep and REM sleep are critical parts of how sleep works to restore the body and mind. People with dementia spend less time in slow-wave sleep and REM sleep and more time in the earlier stages of sleep. This reduction of deep sleep and REM sleep can worsen as dementia progresses.
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Tau: A Direct Driver Of Cognitive Decline
In the study, Dr. Grinberg and the team analyzed the brains of 13 deceased people who had Alzheimers disease, as well as those of seven deceased individuals who had not experienced clinical neurodegeneration. The researchers obtained these samples from UCSFs Neurodegenerative Disease Brain Bank.
The team found that, in comparison with healthy brains, those affected by Alzheimers disease had a high level of tau across three regions that are key to staying awake, namely the locus coeruleus, the lateral hypothalamic area, and the tuberomammillary nucleus. Not only this, but these regions had actually lost 75% of their neurons.
Its remarkable because its not just a single brain nucleus thats degenerating, but the whole wakefulness-promoting network, notes the studys lead author, Jun Oh.
Crucially, this means that the brain has no way to compensate because all of these functionally related cell types are being destroyed at the same time, Oh explains.
For further clarification, the researchers went on to conduct a postmortem analysis of brain samples from seven people who had progressive supranuclear palsy and corticobasal disease. These are two forms of dementia that are characterized specifically by the overaccumulation of tau protein.
In these samples, the scientists did not find the same loss of neurons in areas connected with states of wakefulness, which suggests that this destructive loss may only occur in Alzheimers disease.
How To Monitor What Patients With Dementia Eat
Solutions to monitoring what a dementia patient eats include:
- Cutting food into bite-sized pieces: This assists the patient and makes eating easier, especially if they arent able to use utensils by themselves.
- Eating in company: By enjoying a meal together with a loved one, a patient is more likely to eat the healthy meal youve served them.
- Fortifying the prefrontal cortex: This controls a patients dietary self-restraint. Help by ensuring they avoid alcoholic beverages, sleep sufficiently, and exercise if theyre able to.
- Including plenty of protein: As far as possible, incorporate eggs, milk-based pudding, or protein powder in the patients meal.
- Puréeing their vegetables: Patients are more likely to consume softer vegetables.
If a dementia patient is overeating and youd like to help them to eat less, try the following approaches:
- Generously serve salad and vegetables: Carbohydrates and starch should take up less than half of a plate.
- Halve the original portion: Start by halving the patients original portion. Only offer them the second half should the patient request more food.
- Keep them occupied: A patient will feel less bored or lonely if they have something to do and keep busy.
- Offer healthy snacks: Make bite-sized cut pieces of fruit or other healthy nibbles easily accessible.
- Replace a second helping with a drink: Rather than offering the patient more food, give them a treat drink such as hot chocolate or a milkshake.
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Sleeping For Longer May Be An Early Sign Of Dementia
22 February 2017
Neurology: Prolonged sleep duration as a marker of early neurodegeneration predicting incident dementia
A new study by researchers in the US has suggested that a shift towards longer periods of sleep may indicate the early stages of dementia. The results are published today in the journal Neurology.
The Framingham Heart Study is a large population study that has been following a group of people and their children since 1948, producing a wealth of information about heart disease and other conditions. In this new study, the researchers looked at the existing data to understand how sleep could be linked with dementia. They looked at the self-reported sleep duration of 2,457 people in the study, to see whether variation in how long people sleep for was associated with variation in the risk of developing dementia.
The researchers looked back at how many hours of sleep participants thought they had in a day and how this changed between two points, 13 years apart. Ten years after these sleep assessments, the researchers looked to see who had developed dementia. Over the 10 years of follow up, 234 people in the study developed dementia, of which 181 were diagnosed with Alzheimers disease.
Dr Rosa Sancho, Head of Research at Alzheimers Research UK, said:
Stage : Mild Dementia
At this stage, individuals may start to become socially withdrawn and show changes in personality and mood. Denial of symptoms as a defense mechanism is commonly seen in stage 4. Behaviors to look for include:
- Difficulty remembering things about ones personal history
- Disorientation
- Difficulty recognizing faces and people
In stage 4 dementia, individuals have no trouble recognizing familiar faces or traveling to familiar locations. However, patients in this stage will often avoid challenging situations in order to hide symptoms or prevent stress or anxiety.
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Assessment Of Sleep Disturbances In Persons With Dementia
Nursing assessment is the foundation to the identification and development of any nursing care plan because it provides the evidence for the development of interventions. Assessment typically begins with an interview and a physical assessment. If your client is unable to provide a reliable sleep history, be sure to talk with his or her family member or caregiver. Ask about sleep habits, history of sleep problems, and any medications or other substances, like alcohol, that were used to promote sleep . Be sure to assess environmental, behavioral, and psychosocial factors that may be contributing to disturbed sleep.
Does Quality Of Sleep Matter For People With Dementia
The quality of a person’s sleep gradually deteriorates as they get older. They tend to get less deep or slow-wave sleep, which helps to keep the brain healthy and refreshed.
Even though a person with dementia may end up sleeping more than a typical person of their age even as much as 1415 hours a day it is unlikely to all be good quality sleep.
Sleeping a lot can also be influenced by peoples sleeping patterns before they had dementia, as some people need more sleep than others.
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