Dementia And Sleeplessness: What's The Connection?

Sleep disturbances are common in people with dementia, with up to 50% of patients experiencing them. While the exact reasons are not fully understood, dementia-related brain changes seem to affect the body's circadian rhythm, which regulates the sleep-wake cycle. This can make it difficult for people with dementia to distinguish between night and day, leading to insomnia, excessive daytime sleepiness, sundown syndrome, and other sleep problems.

Excessive daytime sleepiness in people with dementia can be caused by insufficient sleep at night, sedating medications, damage to brain cells, changes in sleep patterns, mental health conditions, and other sleep disorders such as sleep apnea. It is important to maintain a healthy sleep schedule and consult a doctor if sleep disturbances become a concern.

Sleep disturbances are common in dementia patients, with up to 50% experiencing them

Sleep disturbances can be caused by a variety of factors, including:

• Medication side effects
• Excessive napping during the day
• Chronic pain or health conditions
• Lack of physical activity or light exposure during the day
• An uncomfortable sleeping environment

Additionally, dementia can affect the production of melatonin, the sleep hormone that helps a person feel sleepy. As dementia progresses, the brain may produce less melatonin, making it harder for patients to fall asleep.

• Establish a soothing sleep environment: Ensure the room is dark, quiet, and cool, with a temperature between 60 and 67 degrees Fahrenheit.
• Limit daytime napping: Keep daytime naps to 30 minutes to prevent disruption of the sleep-wake cycle.
• Increase physical activity and sunlight exposure during the day: This can help regulate the sleep cycle.
• Establish a regular sleep routine: Consistent bedtimes and waking times can improve sleep quality.
• Avoid stimulants: Limit caffeine, alcohol, and other stimulants, especially close to bedtime.
• Treat pain and other medical conditions: Address any underlying health issues that may be impacting sleep.

Sleep problems can be caused by changes in brain function, medication, and ageing

Changes in Brain Function

Changes in the brain due to dementia can cause sleep problems. During sleep, the brain gets rid of things it doesn't need, and a lack of sleep can cause plaque-like substances to build up. Sleep helps with learning and memory, and disturbed sleep has been linked to problems in these areas. Research has shown that one night of serious sleep loss raises levels of beta-amyloid and tau, proteins linked to Alzheimer's disease. Insomnia also disrupts slow-wave sleep, which is important for learning and memory.

Medication

Medications can also cause sleep problems. For example, certain drugs can interfere with sleep, such as stimulants or diuretics. In addition, some medications can cause side effects that disrupt sleep, such as stimulants like caffeine, alcohol, sugar, and nicotine.

Ageing

Ageing is another factor that can contribute to sleep problems. Older adults experience a decrease in total sleep time, with sleep time decreasing by almost 30 minutes per decade starting in middle age. This can further exacerbate sleep problems in people with dementia.

Excessive daytime sleepiness is more common in people with Parkinson's disease dementia or Lewy body dementia

Sleep disturbances are common in people with dementia, and up to 50% of dementia patients experience them. Excessive daytime sleepiness (EDS) is more common in people with Parkinson's disease dementia or Lewy body dementia than in those with Alzheimer's disease.

People with Lewy body dementia often experience drowsiness and daytime sleepiness, even in the early stages of the disease before significant cognitive decline has occurred. They may be sleepy during the day but restless at night, with trouble falling or staying asleep. This can lead to confusion and disorientation upon waking. They may also experience hallucinations or delusions.

People with Parkinson's disease dementia may also experience excessive daytime sleepiness, and it can be severe enough that a sleep specialist may prescribe a stimulant to help the person stay awake during the day.

There are several factors that may contribute to excessive daytime sleepiness in people with dementia:

• 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

While it is important to allow people with dementia to maintain a healthy sleep schedule, it is not recommended to let them sleep whenever they want. Long naps, especially later in the afternoon, can disrupt their sleep-wake cycle and do more harm than good. However, occasional catnaps may be necessary in times of extreme exhaustion.

• Create a structured daily routine with a regular schedule of activities and rest times.
• Include exercise or daily walks during the day with exposure to sunlight.
• Attempt more complex tasks when the person feels more alert, and save repetitive or less concentration-intensive tasks for when they are drowsy.
• Use caffeine moderately.
• Limit or discontinue the use of alcohol and/or cannabis, as these substances can produce drowsiness and disrupt sleep at night.
• Discuss the timing of medications with a physician, as taking certain medications in the morning may help with alertness and attention during the day.
• Review medications with a healthcare provider to see if adjustments can be made to reduce the use of medications that produce drowsiness.
• Avoid waking a person with Lewy body dementia who is acting out dreams unless there are safety concerns. This can disrupt sleep continuity and lead to sleep deprivation.
• See a sleep expert to treat any underlying sleep disorders, such as sleep apnea.

Sleep-inducing medication can have negative side effects and is not recommended for long-term use

Sleep disturbances are common in people with dementia, with up to 50% of patients experiencing them. While medication can be used to help with sleep, it should be noted that older adults with dementia are more likely to experience the negative side effects of sleep-inducing drugs, and long-term use is not recommended.

Some of the negative side effects of sleep-inducing medication include an increased risk of falls, confusion, and a decline in the ability to care for oneself. Additionally, certain medications can have a higher risk of negative side effects depending on the type and quantity used. For example, a study found that white participants who "often" or "almost always" took sleep medications had a 79% higher chance of developing dementia compared to those who "never" or "rarely" used them.

Furthermore, sleep-inducing medications can interact with other medications and have unintended consequences. For instance, certain medications can cause excessive daytime sleepiness, which can then interfere with nighttime sleep and overall quality of life. It is important to be cautious when taking multiple medications and to consult a doctor or pharmacist about potential drug interactions.

In addition to the negative side effects, sleep-inducing medication can also be habit-forming. It is not safe to quit most sleep-inducing medications abruptly, and a plan for tapering off them should be developed with a doctor.

Instead of relying solely on medication, there are other strategies that can be used to improve sleep in people with dementia. These include establishing a healthy sleep routine, creating a calming bedtime routine, increasing physical activity during the day, and making changes to the sleep environment, such as reducing light and noise.

In summary, while medication can be helpful in the short term for sleep disturbances in people with dementia, it is important to be aware of the potential negative side effects and not use them for long-term management. Prioritizing non-pharmacological interventions and consulting with a doctor or pharmacist to weigh the risks and benefits of medication are recommended approaches to managing sleep disturbances in people with dementia.

Bright light therapy can help regulate the sleep-wake cycle and improve sleep efficiency

Sleep disturbances are common in people with dementia, with studies estimating that about 25% to 50% of adults with dementia experience sleep issues. Bright light therapy has been found to be beneficial in treating these sleep disturbances by helping to regulate the body's circadian rhythm, which is often disrupted in people with dementia.

Bright light therapy involves sitting in front of a light box that provides about 30 times more light than the average office light, for a set amount of time each day. Research has shown that this type of therapy can result in less daytime sleeping and increased nighttime sleeping for people with dementia. For example, a large and well-conducted research review found that bright light therapy can lead to more consolidated sleep at night and improved rhythm stability.

Another study found that bright light exposure during the morning improved nighttime sleep, increased daytime wakefulness, reduced evening agitation, and consolidated rest/activity patterns. It is important to note that the timing of light exposure is crucial, as light applied before the minimum core body temperature is reached will delay the timing of the biological clock, resulting in a later wake-up time the following day. Conversely, light applied after the minimum core body temperature is reached will advance the timing of the biological clock, leading to an earlier wake-up time.

Overall, bright light therapy has the potential to be a valuable tool in managing sleep disturbances in people with dementia, but further research is needed to fully understand its effectiveness and optimal parameters.

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