Memory, language, problem-solving, and other cognitive processes are all affected by dementia. Dementia manifests itself in various ways, with the majority of cases affecting the elderly. When a person has dementia, their brain cells stop working properly and die off at a faster rate than they would in healthy persons. Currently, current treatments can slow the progression of dementia, but there is no known cure for the disease.
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Dementia patients are more likely to suffer from sleep disorders, which can increase or contribute to the severity of other dementia symptoms. Disrupted sleep is one of the most distressing dementia symptoms, according to caregivers. Dementia patients and their carers benefit from identifying and treating sleep disorders, which can reduce stress and prevent cognitive deterioration.
How Does Dementia Change Sleep Patterns?
In order to regulate our sleep-wake cycle, our body and mind using a series of physical and psychological processes. In people with dementia, their circadian rhythms are fundamentally altered, making it difficult to achieve a good night’s sleep on a regular basis.
For example, when we see light, the suprachiasmatic nucleus (SCN) tells us when we should be attentive and when we should be sleeping. In people with Alzheimer’s disease, the most common form of dementia, the SCN has been destroyed and the activity of the cells has reduced. Patients are typically unable to maintain a 24-hour sleep-wake cycle, and instead, sleep excessively during the day and significantly less at night as a result of this dysfunction.
Dementia is also linked to alterations in sleep patterns. Sleeping takes place in stages. The first two are termed REM (rapid eye movement) and the third is called slow-wave sleep. The last stage is called dream sleep, and it occurs at the end of deep sleep (also called rapid eye movement or REM sleep). Slow-wave sleep and rapid eye movement (REM) sleep are essential components of the restorative power of sleep. Those with dementia spend less time in slow-wave sleep and REM sleep than those without dementia and more time in the early stages of sleep. As the disease worsens, the loss of deep sleep and REM sleep might get even worse.
Normal Sleep Pattern Changes in Older Age
Healthy aging is associated with a variety of sleep-related alterations, according to the available research. This includes a shift in bedtime and waking times, as well as a longer period of time before falling asleep, as well as less time spent in slow-wave or REM sleep. Changes in sleep patterns in those with dementia are more drastic and disruptive, while they share some characteristics with those without the disease.
What Sleep Disorders Are Common in People With Dementia?
Sleep disturbances are common in those with dementia. People with dementia are more likely than the general population to suffer from the following types of sleep disturbances.
- Restless legs syndrome (RLS): Overwhelming urges to move one’s legs, especially in the middle of the night, are a hallmark of RLS. People with Lewy body dementia, a kind of dementia, are more likely to suffer from RLS.
- Periodic limb movement disorder (PLMD): When you sleep, your arms and/or legs may jerk uncontrollably. RLS is a common complication in patients with PLMD.
- Obstructive sleep apnea (OSA): In OSA, the airway collapses during the night, resulting in short pauses in breathing. 40 percent of Alzheimer’s patients have OSA, making it the most frequent form of the condition. As a result of OSA, a person’s risk of acquiring dementia is also increased.
- REM sleep behavior disorder: People who suffer from REM sleep behavior disorder act out their dreams, often in a harmful manner. Lewy body dementia is the most common cause of this symptom, and it might be the first sign of the disease.
- Depression: Insomnia and other forms of sleep deprivation are common symptoms of depression, which is a mood illness. People with dementia are more likely to suffer from depression, and the likelihood increases as the disease worsen.
Other Sleep Issues in People With Dementia
The term “sundowning” refers to the increased agitation experienced by people with dementia at the end of the day and in the evening. Confusion, anxiety, wandering, and yelling are all signs of sundowning. Insomnia and other sleep disorders can be exacerbated if sundowning habits are carried on late into the night. These include exhaustion, despair, and pain, all of which can contribute to the onset of sundowning.
It is common for people with dementia to scream and shout at night because they cannot sleep. Dementia patients with a proclivity for wandering, especially at night, can put their lives in danger. Shouting, grabbing, jumping, and other activities are associated with dream enactment in dementia patients with REM sleep behavior disorder.
How Does Sleep Affect Dementia Risk?
According to some experts, there may be a reciprocal association between sleep and dementia. As a result, the quality of one’s sleep may be affected by the presence or absence of dementia. Amyloid-beta protein buildup, which eventually forms amyloid plaques in the brain, is one of the first signs of Alzheimer’s disease. Sleep deprivation has been demonstrated to raise the levels of amyloid-beta in the brain in both animal studies and limited research in humans. Amyloid plaque-related sleep problems have been documented in Alzheimer’s patients, as have those without amyloid plaques.
Sleep is also known to be essential for our cognitive health and the creation of long-term memories. Cognitive decline and dementia are linked to sleep problems, according to studies based on actual observations. These studies, on the other hand, do not prove a causal link. Dementia risk can only be better understood via greater research, but there are numerous tried-and-true techniques for improving your sleep.
What Can Help Someone With Dementia Sleep Better?
Dementia patients’ sleep problems can be alleviated by practicing good sleep hygiene. To ensure healthy sleep, it is important to follow a few simple rules. Dementia sufferers can benefit from the following suggestions for good sleep hygiene:
- Maintain a regular schedule: Predictable wake and sleep periods may assist patients with dementia to coordinate their circadian rhythms. Incorporate quiet, calming activities into your pre-bedtime routine. Avoid watching television or using electronic gadgets before bed because they might be stimulating and emit blue light that disrupts sleep.
- Limit naps: So, it may be a good idea to prevent napping during the day, or limit the practice to one nap lasting no more than 30 minutes.
- Engage in physical exercise: A bad night’s sleep can be harmed by exercising an hour before going to bed. Getting some exercise in the morning, on the other hand, can help you sleep better at night. Reduced napping and better general health are some benefits of using it.
- Schedule social activity: One to two hours of social activity a day improved the sleep patterns of patients with dementia, a study revealed.
- Add light exposure: The circadian rhythm is mostly regulated by light, so if you can, try to obtain some daylight throughout the day to help you sleep better at night. Because of the weather or other circumstances, you may not have as much access to natural light as you’d want, indoor bright light treatment can assist.
- Avoid stimulants: Caffeine, booze, and nicotine should all be avoided if at all feasible. Talk to a doctor about the ideal time of day to deliver medications for dementia, as some medications can interfere with sleep.
- Treat pain and sleep disorders: If a person with dementia suffers from pain, insomnia, or sadness, addressing those issues may help them sleep better. A doctor can assist in determining the best course of treatment.
- Create a calming bedroom environment: It’s easier to fall asleep in a dark, quiet place. The presence of treasured mementos in a person’s bedroom can be helpful to someone suffering from dementia. If complete darkness does not provide a sense of security, consider installing night lights.
People with dementia may find some of these sleep hygiene routines difficult. Even at a nursing home or assisted-living facility, the noise level in a bedroom may not be under the control of the residents. To reduce the impact of outside noise, think about installing a white noise machine. A person’s circadian rhythm can still be stabilized even if he or she has difficulty establishing a consistent waking time due to snoozing or a variety of daily activities. A doctor or sleep specialist can make specialized advice for sleep hygiene based on a patient’s unique situation.
The Role of Medication
For those with dementia, medications are viewed as a last-resort choice only to be used in extreme cases. Sleep aids can cause confusion, sedation, and an increased risk of falling or injuring oneself. Before administering a sleep aid to someone with dementia, see a doctor.
Common sleep problems related to dementia
People with dementia often have more difficulty falling asleep than the average senior. People with mild to moderate dementia and those with severe dementia may experience sleep disturbances. Dementia-related sleep problems tend to worsen as the disease develops.
Daytime sleepiness is a common symptom of sleep disorders, as is insomnia, which is characterized by both troubles getting asleep and staying asleep. Premature morning awakenings and frequent nighttime awakenings are both regular occurrences.
Dementia patients may also experience a phenomenon known as “sundowning” in the evening or at night. They may be angry, worried, and even violent if they are in this state. When you’re in this kind of headspace, it’s risky to go out at night.
The prevalence of obstructive sleep apnea in Alzheimer’s patients is also higher than in the general population. Breathing repeatedly stops and starts while sleeping, which could be a significant sleep condition.
A variety of factors can have an impact on the time it takes to fall asleep and the time it takes for the sun to set.
- Exhaustion and changes in the body clock at the conclusion of the workday
- Reduced sleep requirements, which are prevalent in the elderly.
- People with dementia may get anxious and confused as a result of dim illumination and increased shadows.
Supporting a good night’s sleep
Both you and the individual with dementia can suffer from sleep difficulties. For a better night’s rest:
- Treat underlying conditions. Depression, sleep apnea, and restless legs syndrome are just a few of the diseases that might interfere with a good night’s sleep.
- Establish a routine. You should stick to a schedule when it comes to eating, waking up, and sleeping.
- Avoid stimulants. Alcohol, coffee, and nicotine can all have an impact on how well you sleep. The use of these substances, particularly at night, should be limited. Avoid watching television while you’re up at night as well.
- Encourage physical activity. Physical activity, such as going for a walk, can help you get a better night’s sleep.
- Limit daytime sleep. Avoid taking a nap in the afternoon.
- Set a peaceful mood in the evening. Reading aloud or playing relaxing music might go a long way toward helping the person unwind. A person with dementia can benefit from a peaceful night’s sleep if the room temperature is just right.
- Manage medications. Bupropion and venlafaxine are two antidepressants that might cause insomnia. Some Alzheimer’s patients may benefit from using cholinesterase inhibitors, such as donepezil, although they can also cause sleeplessness. The doctor should be consulted if the dementia patient is taking these drugs. It often helps to administer the medication right before dinner.
- Consider melatonin. When it comes to getting a good night’s sleep for those with dementia, melatonin may be an option.
- Provide proper light. The sleep-wake cycle of patients with dementia can be improved by using bright light treatment in the evening. Adequate illumination in the evening can help minimize the agitation that occurs when the environment is dim. Day and night reversal issues may be alleviated by regular exposure to daylight.
When a loved one wakes during the night
Even if you’re fatigued, be cool when the person with dementia wakes up in the night. Don’t get into a debate. Instead, inquire as to what the individual needs. Discomfort or pain might be the source of nighttime agitation. Find out what’s causing the issue, such as constipation, a full bladder, or an uncomfortably hot or cold area.
Tell him or her it’s time to get some rest. Don’t constrain the person if he or she needs to pace. Allow it, but only if you can keep an eye on it.
Using sleep medications
If non-pharmacological methods fail, the doctor may prescribe sleep aids.
These drugs can raise the risk of falls and confusion in elderly patients who are cognitively challenged. The use of sedatives to induce sleep is generally discouraged for people in this category.
If you’re prescribed these drugs, your doctor probably will advise you to try to stop using them once you’ve established a regular sleep schedule.