Dementia and sleep issues

Mrs Conner was concerned about her husband, Mr Conner because in the middle of the night, he has been wondering in the house instead of sleeping, so he was evaluated by the sleep and neurological clinical. During the day, he watches TV, dozes off and on and snores. Over the past year, she noticed that he forgets appointments and names of his long time friends. He got lost driving when he was coming back from church on two occasions. Mr Conner was diagnosed with mild to moderate Alzheimer’s dementia at the clinic.

What is dementia? Dementia is a general term that describes cognitive impairment in a normal individual that is out of proportion to what is expected for that age. Dementia is a collection of symptoms that includes loss of memory, reduced attention and problem solving ability, to name a few. It is due to death or degeneration of brain cells and their connections. Alzheimer’s dementia, vascular dementia and lewy body dementia are some of the common types of dementias.

Sleep loses its quality in dementia because there is a breakdown in the natural sleep process. The processes that keep us awake also break down. Our brains keep us awake through specialized neurons and neurotransmitters. Likewise, there are specialized neurons and neurotransmitters that allow us to sleep well. There is also break down of the clock in the brain that keeps our rhythms regular (sleep and wake rhythm). So the day and night cycle is reversed or becomes chaotic. That is why people with dementia will suffer from bad sleep at night and fatigue and sleepiness during the day.

In dementia sleep loses its quality. It is replaced with multiple nighttime disruptions. To make up for lack of good sleep, individuals with dementia doze off during the day- on the couch while watching TV. Decreased activity, medications, other medical condition and aging exacerbate the sleep problems.

Dementia can take a toll on caregivers such as Mrs Conner. So getting a good night sleep is important for the individual suffering from dementia as well as the caretaker.

Tips for the caregiver that can help their loved ones

  • Help your loved one with dementia establish daily routines and habits: eating, sleeping, watching TV, walking etc. These routinized habits entrain their daily rhythm and leads to improvement in self reliance; it will ease the burden on the care taker.
  • Encourage social activities to promote wakefulness. Take them to the book store, encourage family and friends visitations.
  • Increase light exposure through sunshine during the day. Open the curtains in the house. Encourage sitting on the porch and take outdoor walks. In the winter or bad weather, you can use light therapy box (purchased on line).
  • Encourage gentle exercise such as daily walks.
  • Avoid caffeine and alcohol. Caffeine can cause insomnia and anxiety. Alcohol can disrupt the sleep architecture and worsens confusion.
  • Make sure medications are timed well so that drugs with sedating effects are taken in the evenings or nights rather than mornings. Ask the prescribing doctor or pharmacist about side effects.
  • In general, sleeping pills or drugs with sedating side effects(for example Benadryl) can worsen the confusion and increase the fall risks. Avoid them if you can.
  • Encourage scheduled naps: best in the early afternoon for no more than 1 hour and no later than 3 pm. Discourage unintended naps or dozing off such as “falling asleep watching TV”. This can lead to insomnia which causes nighttime wonderings and then sleepiness the next day.
  • If you suspect a sleep disorder such as sleep apnea, restless legs, dream enactment, sleep walking, nighttime wondering, or depression talk to your doctor. You might need to see a sleep medicine specialist and/or neurologist.