Dementia and Sleep: How to Manage and Treat Sleep Problems

Changes in sleep patterns are frequent in older persons, dementia patients included. The sleep hormone melatonin, which promotes sleepiness, can be impacted by dementia. Drug interactions, inactivity, and confusion brought on by dementia are among factors that affect patients' sleep. [01] It's crucial to assist your loved one in identifying the source of their sleep disruptions so they can receive a healthy amount of rest because sleep problems exacerbate other dementia symptoms.

Starting in middle age, the amount of time older persons spend sleeping drops by almost 30 minutes every ten years.

Additionally, due to the effects of dementia on the brain, sleep issues are more prevalent in adults with dementia. In fact, research suggest that between 25% and 50% of persons with dementia have sleep problems. 

A dementia patient who is not sleeping through the night may be experiencing the following sleep problems:

:

• Difficulty staying or falling asleep. This can be caused by changes in the brain, aging, problems with the sleep cycle, side effects of medication, or other factors.
• Insomnia. Insomnia and dementia have been linked due to dementia-related effects, medications, and behavior and mood disturbances. Insomnia occurs in 25% to 33% of dementia patients.
• Sundown syndrome. This syndrome refers to increased confusion, agitation, anxiety, and aggression in dementia patients at night or in the early evening.
• Problems with movement during sleep. Dementia patients may experience restless legs syndrome, which causes an uncomfortable urge to move the legs during periods of rest, or rapid eye movement (REM) sleep behavior disorder, which makes people act out their dreams.
• Sleep talking or yelling. Dementia patients may talk in their sleep or yell at night. It’s commonly seen in certain types of dementia — especially Lewy body dementia (DLB) and vascular dementia. Dementia patients talking in their sleep may indicate a REM sleep disorder or another health condition.
• Sleep-related breathing disorders. Alzheimer’s disease patients are at a higher risk for sleep breathing disorders, specifically sleep apnea as it affects about 50% of people with Alzheimer’s.

What causes excessive daytime sleepiness?

Some dementia sufferers snooze a lot during the day. They might experience fatigue and take protracted naps that harm their ability to sleep at night and their general quality of life. People with Lewy body dementia or Parkinson's disease dementia are more likely than those with Alzheimer's disease to experience excessive daytime sleepiness (EDS).

A person with dementia may have excessive daytime sleepiness for a variety of reasons, some of which are listed below:

• Insufficient sleep at night
• Sedating medications
• Damage to brain cells caused by dementia
• Changes in sleep patterns caused by dementia
• Mental health conditions, such as depression
• Other sleep disorders, such as sleep apnea

Should you let a dementia patient sleep whenever they want?

Simply put, no. Patients with dementia should keep a regular sleep schedule for the best rest. Long naps, especially those taken later in the day, might disturb the sleep-wake cycle of your loved one and cause more harm than good. [01] However, in cases of extreme tiredness, a catnap may be required, so exercise caution when allowing modifications to your normal sleeping schedule.

Causes of sleep problems in dementia patients

Researchers and medical professionals don't fully comprehend why dementia patients don't sleep well, but they do know that abnormalities in the brain associated with dementia appear to impair the body's circadian cycle. The circadian rhythm controls a person's sleep-wake cycle and supports critical bodily, psychological, and behavioral functions during a 24-hour period.

Here are some things that can interfere with a dementia patient's circadian cycle and make it hard for them to sleep:

• Little exposure to sunlight during the day, especially in the morning
• Inactivity during the day
• Mental or physical exhaustion and stress at night
• Chronic pain
• A poor sleep environment, such as a noisy or bright room
• Medication side effects
• Diet, such as excessive caffeine, sugar, or alcohol
• Dementia-related confusion

People with dementia frequently have many factors for their sleep issues. Discuss your loved one's exact symptoms with a doctor. The doctor might inquire about your parent's sleeping patterns, prescriptions, nutrition, and any other medical issues. These data can aid a doctor in determining the cause of your loved one's sleep disturbance.

How to get dementia patients to sleep at night: 9 tips for better sleep

Increasing sleep is likely to be a top priority if you're taking care of a family one who has dementia. The mood, health, and quality of life of your loved one can all be enhanced by getting enough sleep, as can your own. You can prevent nocturnal dementia episodes by learning how to encourage good habits throughout the day and how to comfort dementia sufferers at night. The following advice can help you keep dementia sufferers in bed at night.

1. Treat pain and other medical conditions. Getting to the root cause of chronic pain may help improve your loved one’s sleep. If a condition like sleep apnea is the problem, consult with their doctor for solutions. If restless legs syndrome is disturbing your parent’s sleep, a magnesium supplement may help.^[12] Be sure to check with your loved one’s doctor or pharmacist before introducing any new supplements.

2. Create a soothing environment. Make sure your loved one’s room is set up to promote good sleep. The room should be dark, quiet, and cool. Set the temperature between 60 and 67 degrees Fahrenheit, and consider using a white-noise machine to minimize external noises and agitation.^[13]

3. Check for medication side effects and avoid stimulants. Many people with dementia take several medications. Some of these drugs, such as stimulants or diuretics, can interfere with sleep. In fact, stimulants like caffeine, alcohol, sugar, and nicotine are known for disrupting sleep.^[14]

In some cases, it’s also possible to switch medications or change the time of day a certain drug is given to help improve sleep. Be sure to check with a doctor before making any changes to your loved one’s medication regimen.

4. Encourage activity during the day. Help your loved one stay physically, socially, and mentally active throughout the day. For example, you can start mornings with a walk, have a friend over for lunch, and play brain games in the afternoon. Remember, every day doesn’t need to be filled with multiple activities, so be sure to spread them out to minimize exhaustion and confusion.

5. Get some sunlight and minimize blue light. Get outside or into bright lights soon after waking up in the morning to help regulate the sleep cycle. Using a bright light therapy lamp in the morning has been shown to improve rest and sleep efficiency in dementia patients.^[15] Additionally, practice dimming the lights and minimizing blue light exposure in the evening to help your loved one wind down.

6. Establish a sleep schedule and routine. Try to get your loved one to go to bed at the same time each night and limit daytime naps. Creating a calming bedtime routine may also help. For example, you may dim the lights, play soothing music, make some chamomile tea, and use aromatherapy to promote sleep before bedtime.

7. Don’t use physical restraints. You may consider using restraints to prevent nighttime wandering. This may instead cause frustration and agitation, leading to more sleep disturbances. Instead, if you have a bed with guard rails, raise the rails. This may help to deter them from climbing out of bed and wandering.

8. Try a weighted blanket. Recent research has shown promising results with weighted blankets for seniors and seniors with dementia alike. Seniors reported falling asleep faster and remaining asleep, while their caregivers noted they had more energy and less anxiety during the day. A weighted blanket should equal about 10% of a senior’s weight to provide a calming effect.^[16]

9. Use nightlights and bed alarms. Nightlights in hallways and bathrooms can help prevent nighttime confusion or accidents if your loved one gets up in the night to walk around. A bed alarm can also alert caregivers of nighttime wandering, so they can stay proactive in preventing falls or injuries.

Sleep aids for dementia patients: Medications, supplements, and more

A doctor could occasionally recommend drugs to put your loved one to sleep. However, long-term use is not advised because older persons with dementia are more likely to encounter the unfavorable side effects of sleep medications. In fact, it has been found that both over-the-counter and prescription sleep aids greatly raise the risk of dementia worsening, falls, confusion, and a reduction in self-care abilities. [11][17]

It's common for doctors to give antipsychotic drugs based on the behavior's that go along with the changes in sleep patterns. Antipsychotic drugs have been related to an increased risk of stroke and death in older persons with dementia, thus this choice should be made with the utmost caution.

What is the best sleep aid for dementia patients?

There isn't a single optimal sleep aid for dementia-affected elderly. However, recent research suggests that melatonin supplementation paired with bright light therapy may enhance sleep in dementia-affected older persons. Bright light therapy regulates the circadian rhythm by using either natural light from outside or artificial light from within, which lessens the impact of dementia-related sleep problems.

Melatonin is only advised, nevertheless, after other behavioral, non-drug treatments have failed.

Melatonin is a potent hormone even though it is available over-the-counter, and it can cause dependence. Before choosing hormones like melatonin, you might also think about utilising natural therapies. Herbs like valerian root, kava, and chamomile are readily accessible in your neighbourhood health food store and have been used for centuries to encourage sound sleep.