Ashwin Lewis
Sleep disturbances are common in people with Alzheimer's disease, and they can significantly impact their quality of life and that of their caregivers. While sleeping pills may be considered as a potential solution, they should be approached with caution. Non-drug treatments are recommended as the first line of therapy, as they can improve sleep routines and the sleeping environment without the risks associated with medications. Hypnotics and sedatives, for example, can exacerbate confusion in people with dementia. Additionally, studies have shown that sleep medications may increase the risk of falls and other adverse events, particularly in older adults. In some cases, however, a doctor may decide that the use of sleeping pills for a short period of time is appropriate, especially if the patient is at high risk of falling due to constant waking and getting up. While the decision to use sleeping pills should be carefully considered, it is important to explore non-drug options first, such as maintaining regular times for meals and bed, exposing your parent to natural daylight, and creating a relaxing bedtime routine with low lights and calming activities.
| Characteristics | Values |
|---|---|
| Should I give my Alzheimer's parent sleeping pills? | Non-drug treatments are recommended first, as sleep medications can cause serious side effects and increase the risk of falls. |
| Sleep disturbances in Alzheimer's | People with Alzheimer's often experience sleep disturbances, including difficulty falling and staying asleep, and changes in their sleep patterns. |
| Non-drug treatments | Establish a consistent sleep routine, improve the sleeping environment, reduce daytime napping, and promote relaxation through activities and scents. |
| Drug treatments | Sleeping pills like zolpidem, zaleplon, suvorexant, and Belsomra® are options, but carry risks such as impaired alertness, worsening depression, complex sleep behaviors, and respiratory issues. |
| Melatonin | Studies on its effectiveness in improving sleep for people with Alzheimer's dementia are inconclusive, with some showing no improvement and others showing marginal gains. |
| Trazodone | A low dose of this sedative antidepressant may increase total sleep time and improve sleep efficiency, but it did not reduce the number of night wakings in a small study. |
| Ramelteon | Limited information is available, and there is no evidence it is better than a placebo. |
| Risks of sleep medications | Sleep medications have been linked to an increased risk of dementia, particularly in white individuals, and may cause side effects that exacerbate dementia symptoms, such as confusion. |
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What You'll Learn
Non-drug treatments for Alzheimer's-related sleep issues
While sleeping pills and medication can be used to help people with Alzheimer's sleep, non-drug treatments should always be tried first. This is because sleep medication can cause serious side effects and increase the risk of falls, which may outweigh the benefits of treatment.
- Improve sleep routine and the sleeping environment: Keep regular times for meals and for going to bed and getting up. If the person wakes up, discourage staying in bed while awake and try to restart a small bedtime routine instead—keep the lights low, take them to the toilet, play relaxing music, or read to them to calm them down.
- Reduce daytime napping: People with Alzheimer's may feel very drowsy during the day and then be unable to sleep at night. Reducing daytime napping can help improve nighttime sleep.
- Increase physical activity during the day: Exposure to natural daylight and physical activity can help regulate the body clock and promote better sleep.
- Avoid stimulants: Avoid tea, coffee, and other stimulants such as chocolate and fizzy drinks in the late afternoon and evening. Also, avoid alcohol within three hours of bedtime to promote better sleep quality.
- Stay hydrated: Dehydration can cause added confusion and illnesses such as urinary tract infections, which can impact sleep. Drinking little and often is the best way to stay hydrated.
- Address other health conditions: Other health conditions such as heartburn, constipation, urinary tract infections, and restless leg syndrome can impact sleep. See a doctor for advice on managing these conditions.
- Scented pillow spray: A lavender-scented pillow spray can help overcome restlessness or trouble falling asleep, especially in the later stages of dementia when patients commonly respond to the sense of smell.
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The dangers of giving sleeping pills to those with Alzheimer's
People with Alzheimer's often experience changes in their sleep patterns, and scientists do not yet fully understand why this happens. However, it is known that sleep changes are caused by the impact of Alzheimer's on the brain. Sleep disturbances can be an early sign of Alzheimer's, and the link between poor sleep and Alzheimer's creates a vicious cycle: changes to the brain disrupt sleep, and poor sleep accelerates harmful changes to the brain.
While sleeping pills may be tempting to use to help your parent with Alzheimer's get a good night's rest, they can be dangerous and should be avoided if possible. Sleeping pills can cause a "morning hangover" effect, exacerbating dementia symptoms such as confusion, anger, and irritability. Additionally, the use of sleeping pills is associated with a greater chance of falls, which can be particularly dangerous for older adults.
Non-drug treatments for improving sleep in people with Alzheimer's are recommended first. These include improving the sleep routine and environment, reducing daytime napping, maintaining regular times for meals and bed/wake times, and promoting exposure to natural daylight. Scented pillow sprays can also help with restlessness, and it's important to avoid tea, coffee, and other stimulants late in the day.
In some cases, a doctor may decide that sleeping pills can be used for a short period, especially if the person with Alzheimer's is at high risk of falling. The FDA has approved Belsomra® for addressing insomnia in people with mild-to-moderate Alzheimer's disease. However, possible side effects include impaired alertness and motor coordination, worsening of depression or suicidal thoughts, complex sleep behaviors, sleep paralysis, and compromised respiratory function.
While the link between sleep and Alzheimer's is clear, more research is needed to confirm the potential of sleep medications to slow or stop the progression of the disease.
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The link between sleep and Alzheimer's
Sleep disturbances are a common symptom of Alzheimer's disease. Many people with Alzheimer's experience changes in their sleep patterns, waking up more frequently and staying awake for longer periods during the night. They may also feel very drowsy during the day and then be unable to sleep at night. This can lead to restlessness or agitation in the late afternoon or early evening, a phenomenon known as "sundowning". In the later stages of Alzheimer's, individuals may spend about 40% of their time in bed at night awake, and a significant portion of their daytime sleeping. In extreme cases, there can be a complete reversal of the normal sleep-wake cycle.
The exact cause of these sleep disturbances in Alzheimer's patients is not fully understood by scientists. However, it is believed to be related to the impact of Alzheimer's on the brain, similar to changes in memory and behaviour. Additionally, certain factors, such as side effects of dementia drugs, sleep apnea, and restless leg syndrome, can contribute to sleep disturbances in this population.
Non-drug coping strategies are recommended as the first line of treatment for sleep changes in individuals with Alzheimer's. This includes improving sleep routines, maintaining regular times for meals and bedtime, reducing daytime napping, and creating a relaxing sleep environment. Exposure to natural daylight and outdoor activities can also help regulate the body clock and promote better sleep.
While sleeping pills, such as zolpidem, zaleplon, and chloral hydrate, have been used to address insomnia in people with mild-to-moderate Alzheimer's, they are generally not recommended as the primary treatment option due to potential side effects. These side effects can include impaired alertness, motor coordination issues, worsening depression, complex sleep behaviours (such as sleepwalking), sleep paralysis, and compromised respiratory function. Additionally, the "hangover" effect of sleeping medications can exacerbate symptoms of confusion, anger, and irritability in individuals with dementia.
Recent studies have suggested a potential link between sleep and the progression of Alzheimer's disease. Research has found that poor sleep is associated with higher levels of amyloid and tau proteins in the brain, which are markers of Alzheimer's disease. Conversely, a small study using the sleeping aid suvorexant showed a reduction in these Alzheimer's-related proteins. However, more research is needed to confirm the viability of using sleep medications to slow or stop the progression of Alzheimer's disease.
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The side effects of sleeping pills
Sleep disturbances are a common symptom of Alzheimer's disease, but it is recommended that non-drug treatments are tried before medication. Sleep medications can cause serious side effects, and the risk of falls and other dangers may outweigh the benefits of treatment.
Sleeping pills can cause a range of side effects, including:
- Dizziness
- Nausea
- Digestive problems, including constipation, gas, heartburn, and diarrhea
- Dry mouth
- Muscle weakness
- Worsened snoring and sleep apnea
- Parasomnia, a disruptive sleep disorder that can cause dangerous behaviors while the person is still mostly asleep, such as sleepwalking, eating, talking, or driving
- Confusion and memory issues, which can be particularly dangerous for older adults, increasing the risk of falls and hip fractures
- Drowsiness lasting into the day, impacting the ability to drive, work, and complete daily tasks
- Interference with normal breathing, which can be dangerous for people with certain chronic lung problems such as asthma, emphysema, or COPD
- Addiction and dependence, with rebound insomnia occurring when the medication is stopped
- Worsening of depression or suicidal thoughts
Additionally, it is important to note that sleeping pills should not be mixed with alcohol or other sedatives due to the risk of overdose, which can be deadly.
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Alternative treatments for improving sleep
While there are medications available to help people with Alzheimer's sleep better, they often come with side effects and risks that may outweigh the benefits of treatment. Non-drug treatments are recommended by experts and the National Institutes of Health (NIH) as the first line of treatment. These non-drug treatments focus on improving sleep routines, the sleeping environment, and reducing daytime napping. Here are some alternative treatments to improve sleep for people with Alzheimer's:
Lifestyle Changes
- Regular physical activity can improve sleep quality and length, but it's important to avoid strenuous exercise close to bedtime.
- Avoid heavy meals right before bed to prevent discomfort that might disrupt sleep.
- Limit or avoid naps, especially in the late afternoon, to preserve the natural sleep-wake cycle.
- Avoid devices at night, keep the bedroom cool, and follow a consistent sleep schedule.
- Maintain regular times for meals and for going to bed and waking up.
Relaxation Techniques
- Deep breathing, meditation, light stretching, and craft activities can help calm the mind and prepare the body for sleep.
- Mindfulness and time management techniques can help reduce stress levels, a common cause of sleep difficulties.
Natural Remedies
- Melatonin supplements may help improve sleep and possibly prevent the progression of dementia, but they can interact with other medications and increase the risk of fractures.
- Magnesium supplements can help enhance sleep quality and shorten sleep duration, especially for older adults.
- Ashwagandha is an adaptogen known for its stress-relieving properties.
- Valerian root is a classic cure for insomnia, and it may help individuals fall asleep faster and improve overall sleep quality.
- Amino acids found in tea leaves can help reduce anxiety and sleeplessness.
- Ginkgo biloba, a plant extract rich in antioxidants, may help treat dementia symptoms through its anti-inflammatory effects.
- Omega-3 fatty acids, found in fish oil supplements, are thought to have potential benefits for brain health.
Therapies
- Cognitive Behavioral Therapy for Insomnia (CBT-I) is a non-pharmacological, safe, and effective treatment for insomnia that doesn't carry the same risks as sleep medications.
- Pet therapy can help reduce stress and manage symptoms without the side effects of medication.
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Frequently asked questions
It is not recommended to give your parent with Alzheimer's disease sleeping pills. Non-drug treatments are recommended first, as sleep medications can cause serious side effects and increase the risk of falls. However, if your parent constantly wakes up and is at high risk of falling, a doctor may decide that sleeping pills can be used for a short period of time.
There are several non-drug treatments that can help improve your parent's sleep. These include:
- Maintaining regular times for meals and bed and wake-up times.
- Establishing a bedtime and morning routine.
- Avoiding tea, coffee, and other stimulants in the late afternoon and evening.
- Exposing your parent to natural daylight and ensuring they get enough physical activity during the day.
- Using a scented pillow spray, such as lavender, to help overcome restlessness or trouble falling asleep.
The use of sleeping pills in people with Alzheimer's or dementia can have several risks and side effects, including:
- Exacerbating confusion, anger, and irritability.
- Increasing the risk of falls and other injuries.
- Impaired alertness and motor coordination, including impaired driving ability.
- Worsening of depression or suicidal thoughts.
- Complex sleep behaviors, such as sleepwalking and sleep-driving.
- Sleep paralysis and compromised respiratory function.
