Dementia And Daytime Sleep: Understanding The Connection

Dementia patients often sleep a lot during the day, and this can be distressing for their loved ones, who may worry that something is wrong. This is a common feature of later-stage dementia, as the disease progresses and the person's brain becomes more extensively damaged, causing them to feel weaker and frailer. As a result, even simple tasks like communicating or eating can become exhausting, leading to increased daytime sleep. Additionally, dementia affects a person's internal clock, disrupting their sleep-wake cycle and making it difficult for them to follow a regular 24-hour sleep schedule.

Later stages of dementia

It is common for people with dementia, especially in the later stages, to spend a lot of their time sleeping during the day and at night. This can be distressing for family and friends, who may worry that something is wrong. However, it is important to know that this is a normal feature of later-stage dementia. As the disease progresses, the damage to the person's brain becomes more extensive, and they gradually become weaker and frailer. This can make even simple tasks, like communicating or eating, exhausting for them, leading to increased sleep during the day as their symptoms worsen.

The later stages of dementia can be challenging for both the person with dementia and those close to them. During this time, it is crucial to support the person in maintaining a healthy sleep routine, as this can help them feel better, be less confused, and have more energy during the day. Additionally, it is important to rule out any other potential causes of excessive sleep, such as infections, conditions, or medication side effects.

Some specific tips to help improve sleep for people with later-stage dementia include:

• Encouraging daily exercise
• Limiting naps and dozing late in the day
• Planning energy-intensive activities for earlier in the day, such as bathing in the morning or having the largest meal at midday
• Following a regular schedule by going to sleep and waking up at the same time each day
• Developing a relaxing bedtime routine with lowered lights, a cool temperature, and no electronic screens
• Avoiding alcohol and caffeine
• Using nightlights in the bedroom, hall, and bathroom to prevent confusion or disorientation
• Limiting screen time before bed and keeping noise levels low
• Incorporating bright light therapy, such as spending time outside on sunny days, to support their sleep-wake cycle

Brain deterioration and weakness

The brain's internal clock, which tells us when to be alert and when to sleep, is often impaired in people with dementia due to brain damage. This makes it difficult for them to follow a 24-hour sleep-wake cycle, leading to excessive daytime sleeping.

Additionally, people with dementia may experience drastic changes in their circadian rhythm, or sleep-wake cycle. Their brains struggle to process all the new sights, smells, and sensations, leading to increased fatigue and the need for more rest.

Dementia-related factors, such as medication and difficulty differentiating dreams from reality, can also contribute to sleep disturbances. Furthermore, underlying conditions or sleep disorders, such as restless leg syndrome, periodic limb movement disorder, and obstructive sleep apnea, can disrupt sleep at night, causing daytime sleepiness.

It is important to note that while sleeping more is common in later-stage dementia, sudden changes in sleep patterns could indicate a problem with medication, illness, or another complication that requires medical attention.

Circadian rhythm changes

Dementia can cause drastic changes to a person's circadian rhythm or sleep-wake cycle. This is due to the impairment of brain cells related to sleep cycles as a result of dementia-related brain damage. This can make it difficult for the person with dementia to follow a 24-hour sleep-wake cycle, leading to excessive daytime sleepiness and less sleep at night.

In addition to the brain damage caused by dementia, other factors can also contribute to circadian rhythm disruption. These include medications used to treat dementia symptoms, leaving lights on at night, difficulty differentiating between dreams and reality, and excessive napping during the day.

To help manage these sleep disturbances, caregivers can encourage their loved ones to stay active during the day, limit daytime napping, and incorporate light therapy, either through dedicated lamps or by spending time outside in natural sunlight.

It is important to note that while excessive daytime sleepiness is common in the later stages of dementia, if sleep patterns change suddenly, it is recommended to speak to a doctor as it could indicate a problem with medication, illness, or another complication.

Underlying conditions and sleep disorders

While excessive daytime sleeping is a common symptom of dementia, there are other factors that may be contributing to a patient's poor sleep habits. These include medications, underlying conditions, and sleep disorders.

Medications

Certain medications can cause drowsiness, including some antipsychotics, antihistamines, and antidepressants. Sleeping pills can also cause excessive sleepiness. If your loved one is taking medication to help with sleep, their dosage may need to be adjusted if it is causing them to sleep more than usual.

Underlying Conditions

Your loved one may have an underlying condition that is disturbing their sleep at night, causing them to sleep through the day. Some common conditions that can affect sleep include:

• Obstructive sleep apnea (OSA): This affects a person's breathing while they sleep, causing lapses in breathing and poor sleep quality.
• Restless legs syndrome (RLS): An overwhelming urge to move the legs, especially at night, disrupting sleep.
• Periodic limb movement disorder (PLMD): Causes uncontrollable movements of the arms or legs at night, disrupting sleep.
• Elderly depression: Can impair cognitive and physical abilities, reduce quality of life, and affect overall health, often causing sleepless nights and daytime sleepiness.

Sleep Disorders

Sleep disorders can also contribute to excessive daytime sleeping in dementia patients. One such disorder is:

Rapid eye movement (REM) sleep behavior disorder: During REM sleep, the body typically experiences temporary paralysis, allowing the brain to dream and process quietly. Someone with REM sleep behavior disorder doesn't experience this paralysis and may sleep talk or act out their dreams, causing disturbed sleep and poor sleep quality. People with Lewy body dementia are more likely to experience this disorder.

Medication

If you are concerned about the impact of medication on a person with dementia, it is recommended that you speak to a medical professional, such as a doctor or pharmacist, who can advise on medication reviews and potential side effects.

It is important to note that while medication can be a factor, there are also other reasons why people with dementia may sleep a lot during the day. This includes the progression of the disease, where the damage to the brain makes communication, eating, and understanding their surroundings exhausting. Additionally, people with dementia may experience problems with their internal body clock, which regulates sleep patterns.

Other factors that may contribute to excessive daytime sleeping include underlying conditions or sleep disorders, such as restless leg syndrome, periodic limb movement disorder, obstructive sleep apnea, and REM sleep behaviour disorder. Elderly depression is also common in people with dementia and can cause sleep disturbances.

If you are concerned about a person with dementia sleeping a lot during the day, it is recommended to seek advice from a healthcare provider, who can help identify the underlying causes and suggest appropriate solutions.

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