Dementia And Sleep: Should We Let Them Sleep All Day?

Sleep disturbances are common in people with dementia, with up to 50% of patients experiencing them. While it can be distressing for family and friends, it is quite normal for a person with dementia, especially in the later stages, to spend a lot of their time sleeping. This can be due to a number of factors, including medication side effects, damage to brain cells, changes in sleep patterns caused by dementia, mental health conditions, and other sleep disorders.

Excessive daytime sleepiness is more common in people with Parkinson's disease dementia or Lewy body dementia than in those with Alzheimer's disease. It is recommended that dementia patients maintain a healthy sleep schedule for optimal rest, as long naps can disrupt their sleep-wake cycle.

If your parent is sleeping all day, it is advised to consult a doctor to rule out any other causes and to improve their quality of life.

Excessive daytime sleepiness 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 daytime sleepiness early in the disease, even before significant cognitive decline occurs. They may be sleepy during the day but restless at night, with trouble falling asleep or staying asleep. This can be exhausting and leave the person feeling like they haven't slept at all.

In comparison, daytime sleepiness in Alzheimer's disease tends to occur in the later or more advanced stages of the disease when cognitive impairment is more severe.

It's important to note that sleep problems can occur in all types of dementia and can be influenced by various factors such as medications, sleep disorders, and changes in the brain.

Factors that may contribute to excessive daytime sleepiness include insufficient sleep, sedating medications, damage to brain cells, mental health conditions, and other sleep disorders

Insufficient Sleep

Changes in sleep patterns are common in people with dementia. They may wake up often during the night and find it hard to get back to sleep. These sleep problems are thought to result from brain changes caused by the disease that affect the sleep-wake cycle.

Studies have shown that people who sleep six hours or less per night in their 50s and 60s are more likely to develop dementia later in life. Short sleep duration during midlife could increase the risk of developing dementia in the future.

Sedating Medications

Sedative medications are associated with adverse outcomes in people with dementia. At the time of diagnosis, 70.4% of patients with dementia were receiving at least one sedative medication. The use of sedative medications is linked to accelerated cognitive decline and a higher risk of hospitalisation.

Damage to Brain Cells

Dementia is characterised by changes in the brain, including the degradation of neuronal pathways that initiate and maintain sleep. These changes disrupt the body's circadian rhythm, making it harder for people with dementia to distinguish between night and day.

Mental Health Conditions

Mental health conditions, such as anxiety and depression, can contribute to excessive daytime sleepiness in people with dementia. These conditions can affect sleep patterns and lead to disturbances in the sleep-wake cycle.

Other Sleep Disorders

Other sleep disorders, such as insomnia, obstructive sleep apnea, and REM behaviour disorder, are commonly associated with dementia. These disorders can further disrupt sleep patterns and impact overall sleep quality.

Sleep disturbances are common in people with dementia due to the condition's impact on the brain

The degradation of neuronal pathways that initiate and maintain sleep also plays a role in sleep disturbances in dementia. Specifically, damage to brain regions and pathways that regulate sleep-wake cycles can impair a person's ability to fall and stay asleep. This can result in frequent nighttime awakenings, increased daytime sleep, and a decrease in slow-wave and rapid eye movement (REM) sleep.

Additionally, certain medications prescribed for dementia, such as donepezil, rivastigmine, or galantamine, can cause insomnia as a side effect. These drugs can also lead to vivid dreams or nightmares, further disrupting sleep.

To improve sleep in people with dementia, non-pharmacological interventions are often recommended as a first-line treatment. This includes improving sleep hygiene, such as limiting caffeine, increasing daytime activity, and exposing individuals to bright light or natural sunlight during the day. Maintaining a regular sleep schedule and a comfortable sleep environment are also important.

In some cases, medications may be prescribed to treat sleep disturbances in people with dementia, but these tend to have unpleasant or potentially dangerous side effects, such as dizziness and an increased risk of falls. Therefore, they are typically reserved for short-term use when sleep problems are severe.

Sleep problems can be managed with lifestyle changes such as physical activity, a calming bedtime routine, and avoiding stimulants

Sleep problems in people with dementia can be distressing for both the patient and their caregivers. While medication is not very effective in treating sleep disturbances in people with dementia, lifestyle changes can help manage them. Here are some ways to improve sleep through physical activity, a calming bedtime routine, and avoiding stimulants:

Physical Activity

Promoting physical activity during the day can help manage sleep problems in people with dementia. Encourage your parent or loved one to stay physically, socially, and mentally active. For example, you can suggest a walk outdoors, invite friends or family over for a visit, or recommend joining a specialist group, such as a dementia cafe. Exposure to natural daylight is crucial for regulating the body clock, and getting outside is an excellent way to improve physical health and promote better sleep.

Physical activities, such as walking and gardening, are particularly beneficial for improving sleep quality. Aim for at least 20–30 minutes of physical activity several times a week. However, be mindful that too much activity in the evening can make it challenging to fall asleep.

Calming Bedtime Routine

Establishing a calming and consistent bedtime routine is essential for managing sleep problems in people with dementia. Here are some tips to create a soothing bedtime routine:

• Keep the bedroom dark, quiet, and cool, with a temperature between 60 and 67 degrees Fahrenheit.
• Use blackout curtains to block out outside light and reduce disturbances.
• Consider using a white noise machine to minimise external noises and agitation.
• Encourage a warm bath, low lighting, calming music, or gentle massage as part of the pre-bedtime routine.
• Include relaxing activities such as listening to soothing music, reading, or drinking chamomile tea before bed.
• Use aromatherapy or scented pillow sprays, such as lavender, which is known for its sleep-promoting properties.
• Limit screen time towards the end of the day, as the blue light from electronic devices can affect the body clock and make it harder to fall asleep.
• Avoid caffeine, alcohol, and nicotine in the late afternoon and evening, as these substances can disrupt sleep.

Avoiding Stimulants

Stimulants can significantly impact sleep quality, so it is essential to minimise their consumption, especially in the evening. Here are some tips for avoiding stimulants:

• Switch to decaffeinated drinks in the afternoon and evening, as caffeine is a stimulant that reduces feelings of sleepiness and increases the need to urinate.
• Avoid cigarettes and alcohol in the evening. Nicotine increases heart rate and reduces sleepiness, while alcohol can disrupt sleep and cause frequent urination.
• Be mindful of food and drink choices, as some fizzy drinks and even chocolate may contain enough caffeine to impact sleep.
• Ensure adequate hydration during the day but reduce fluid intake closer to bedtime to prevent frequent urination during the night.

Consult a doctor if your loved one's sleep issues are becoming difficult to manage

If your loved one's sleep issues are becoming difficult to manage, it's important to consult a doctor. They can help rule out any underlying health conditions or infections that may be causing the excessive sleepiness. For example, an infection, respiratory or cardiac issue, or negative response to medication.

Additionally, a doctor can review the person's medication and make any necessary changes. Certain medications can interfere with sleep, and it may be possible to switch medications or change the time of day they are administered. It's important to consult a doctor before making any changes to your loved one's medication.

If your loved one is in a memory care facility or assisted living facility, you can also check in with the staff to see if they have any "sleep hygiene measures" in place. These measures can include dimming lights at night, providing sound machines in bedrooms, and limiting caffeine or other stimulants in the evenings.

Creating a daily routine for your loved one and helping them stay engaged and active during daylight hours can also improve their sleep. This can include planning activities, going for walks outdoors, and visiting friends and family. It's important to spread out activities to minimize exhaustion and confusion.

Establishing a bedtime routine can also be helpful. This may include undressing, showering, and getting into bed at the same time each night. Avoiding upsetting situations, disruptive television shows, and heavy meals before bed can also aid sleep.

Keeping a "sleep diary" can help track your loved one's sleep patterns and identify any issues. This can include noting the times they go to bed and wake up, as well as how often they nap.

If your loved one has vascular dementia, there are specific treatments that can help slow the progression of the disease and improve sleep. These include blood thinners, diabetes medications, and statins (or lipid-lowering medications). In some cases, Alzheimer's disease medications may also be prescribed to manage behavioural changes.

In summary, consulting a doctor is an important step in managing your loved one's sleep issues. They can help identify and address any underlying causes and make adjustments to medication. Additionally, creating a daily routine, establishing a bedtime routine, and implementing "sleep hygiene measures" can improve your loved one's sleep quality.

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