Written by Josh Horsman
For people living with Alzheimer’s disease or any other form of Dementia, sleep can be a complex issue. The range of symptoms that come with the condition make much of daily living a challenge, but sleep is an area that is especially impacted. In fact, experts estimate that, for people with Dementia, as much as 40% of their time in bed at night is spent awake. Related issues may range from difficulty getting to sleep to disrupted and fragmented sleep patterns and drowsiness during daylight hours. A common experience for many people with Alzheimer’s, for example, is a condition known as ‘sundowning', where patients become restless or agitated in the late afternoon/evening time. All of these problems can be deeply distressing and challenging for both individuals and their caregivers and family members.
Fortunately, however, there are a range of ways in which sleep problems in people with Dementia can be treated:
There are multiple different prescription drugs which are available for the treatment of sleep problems in those with Alzheimer’s Disease and other forms of Dementia.
Some examples include:
“Sleeping pills” such as Zolpidem, Zaleplon and Chloral Hydrate
Tricyclic antidepressants, such as Nortriptyline and Trazodone
Benzodiazepines, such as lorazepam, Oxazepam and Temazepam
“Atypical” antipsychotics such as Risperidone, Onlanzapine and Quetiapine
While these treatments are relatively safe and commonly prescribed by doctors, there are some concerns about the effectiveness and the side-effects associated with such medication. Research studies into sleep and Dementia have concluded that sleep medications do not significantly improve the quality of sleep in older adults, while potentially serious side-effects of such medications includes an increased likelihood of falls.
Ultimately, for these reasons, the experts at the National Institutes for Health advise against the use of drugs to treat sleep problems in people with Dementia. However, if you or a loved-one are prescribed such medication, you should always ensure that your doctor explains to you the benefits and side-effects of the drug as well as alternatives.
Alternatively, there are a range of non-medical options for improving sleep in those with Dementia. These measures serve to create the right conditions to facilitate a peaceful, regular cycle of sleep without the potentially unwanted side-effects of medication:
Lighting: Light has a huge impact on your body clock, even more than you might think. People living with Dementia are typically less mobile and so much of their days may be spent indoors in dimly lit environments with limited exposure to natural light. This can put the circadian signals (the body’s inner clock) out of whack and disrupt sleep at night. The use of special lamps which recreate natural light and ensuring that your loved one is exposed to as much daylight as possible can help to overcome these challenges.
Physical Activity: Exercise is great for both improving our physical health and also for using up energy and tiring us out. However people living with Dementia are also less likely to be regularly physically active. Research studies into the topic have proved that physical exercise does improve sleep for people with Dementia and even suggests that this activity doesn’t need to be especially strenuous. Even something as simple as a short daily walk or in-home workout routine can be all that’s needed to make night times easier for you and your loved one.
Caffeine: A simple way of helping to regulate your sleep cycle is to limit your intake of caffeine and, crucially, try to confine your intake to the mornings and early afternoons. If you are a carer for a loved-one with Dementia who is a regular consumer of coffee or tea, for example, try substituting in a decaffeinated version or swapping out the drinks altogether in favour of water or other alternatives.
Create the Ideal Environment: Being surrounded by an environment that is conducive to good sleep is key to the regulating of the sleep cycle, especially for those with Dementia. An ideal environment means one that is bright during daylight hours but then dark and quiet during the night time.
Establish a Regular Routine: Routine is key to good sleep. If you are caring for a loved-one with Dementia, the best thing you can do for their sleep is to ensure that they have a rigid routine. People with Dementia often lose track of time and may be prone to oversleeping, but you can help by ensuring that they stick to regular sleep and wake-up times. This will ensure that their body is able to find a rhythm and their sleep-cycle can be maintained.
Limit Naps: When someone is sleeping for long periods of the daytime, it makes it more difficult for them to sleep in the evening, whether they live with Dementia or not. While those with the condition are more likely to be prone to fatigue during the day, it is important to ensure that, if you are a carer, you attempt to limit the frequency and duration of these naps in order to encourage a regular sleep-routine. Try to instead encourage them to take part in activities which are energising and stimulating.