Daytime Sleeps: Help Or Hindrance For Alzheimer's Patients?

Sleep disturbances are common in people with Alzheimer's disease, and scientists do not fully understand why these changes occur. People with Alzheimer's may experience difficulty sleeping, daytime napping, and other shifts in their sleep-wake cycle. They may feel very drowsy during the day and then be unable to sleep at night, with experts estimating that individuals in the late stages of Alzheimer's spend about 40% of their time in bed at night awake and a significant part of their daytime sleeping. This can be distressing for friends and family, who may worry that something is wrong.

However, it is important to note that sleeping more during the day is not necessarily a cause for concern, as long as the person does not appear to be uncomfortable or distressed. In later stages of Alzheimer's, increased sleeping can be a result of the disease's progression, as the person's brain deteriorates and can no longer handle stimulation in the same way.

Sleep as an early indicator of dementia

Sleep disturbances are very common for people with dementia. While the exact link between sleep and dementia is not yet fully understood, there is some evidence to suggest that a lack of sleep may increase a person's risk of developing dementia.

People with dementia often experience changes in their sleep patterns, including difficulty sleeping, daytime napping, and other shifts in the sleep-wake cycle. They may feel very drowsy during the day and then be unable to sleep at night, or they may experience a complete reversal of their normal sleep pattern, staying awake all night and sleeping during the day.

Research has found that short sleep durations (less than seven hours) are associated with an increased risk of dementia. One study showed that individuals who slept fewer than five hours per night were twice as likely to develop dementia compared to those who slept six to eight hours. Another study found that consistently sleeping six hours or less at ages 50, 60, and 70 was associated with a 30% increase in dementia risk.

Sleep disturbances may also be an early indicator of dementia, with symptoms showing up years before a diagnosis of Alzheimer's disease, the most common form of dementia. Poor sleep may be both a cause and an effect of dementia, with the relationship possibly being circular.

In addition to increasing the risk of dementia, inadequate sleep can have other negative consequences. For example, one night of serious sleep loss can raise levels of beta-amyloid and tau, proteins linked to Alzheimer's disease. Sleep also plays an important role in learning and memory, and disturbed sleep has been linked to problems in these areas.

To improve sleep quality and reduce the risk of dementia, it is recommended to maintain a regular sleep schedule, seek morning sunlight exposure, exercise regularly, and avoid substances like alcohol, caffeine, and nicotine.

Sleep disturbances in the early stages of Alzheimer's

Sleep disturbances are a common symptom of Alzheimer's disease, with many patients experiencing changes in their sleep patterns. While scientists don't fully understand why these disturbances occur, they are believed to be a result of the impact of Alzheimer's on the brain. Sleep changes can include difficulty sleeping, daytime napping, and other shifts in the sleep-wake cycle.

In the early stages of Alzheimer's, individuals may experience insomnia, which is characterised by trouble falling and staying asleep, waking up too early, or getting poor-quality sleep. They may also develop sleep disorders such as obstructive sleep apnea (OSA) and restless legs syndrome (RLS), which can further disrupt sleep quality. Additionally, mood disorders such as depression and anxiety, which are common in patients with dementia, can contribute to sleep problems.

To improve sleep in the early stages of Alzheimer's, it is recommended to make changes to the patient's daily schedule and evening habits. Here are some strategies that may help:

• Balance the daily routine: Incorporate stimulating activities such as errands, family meals, appointments, and exercise into the morning and midday. Keep evenings calm with soothing activities like listening to music, reading aloud, or spending time with pets.
• Set a sleep schedule: Maintaining regular sleep and wake-up times can help regulate the body's internal clock, or circadian rhythm.
• Limit napping: While daytime napping is common in Alzheimer's, it can reinforce dysfunctional sleep-wake patterns, making it harder to fall and stay asleep at night.
• Increase light exposure: Light is a powerful regulator of the circadian rhythm. Spending time outside in natural light or using light therapy can help reorient the internal clock.
• Encourage physical activity: Expending energy during the day can improve sleep at night. Walking or exercising outdoors provides the dual benefits of physical activity and light exposure.
• Manage medication timing: Some medications given to Alzheimer's patients can interfere with sleep if taken late in the day. Consult a doctor about the ideal timing for administering medications to promote healthy sleep.
• Avert hallucinations: If hallucinations in the evening are delaying sleep, try lighting the room to reduce shadows in the hours leading up to bedtime. Avoid bright colours, patterns, loud sounds, and mirrors.

Managing sleep problems for Alzheimer's patients

Alzheimer's disease often affects a person's sleeping habits. People with Alzheimer's may experience a range of sleep problems, including:

• Sleeping a lot or not enough
• Waking up many times during the night
• Napping a lot during the day
• Restlessness, agitation, irritability, and confusion as daylight begins to fade, known as "sundowning"

It is important to note that sleep disturbances in Alzheimer's patients may be caused by the disease itself or other factors such as medical conditions or medications. Therefore, it is recommended to consult a healthcare provider to identify the underlying causes and determine the most appropriate treatment approach.

Non-drug treatments:

• Maintain regular times for meals, sleep, and wakefulness.
• Encourage morning sunlight exposure and regular daily exercise, but not too close to bedtime.
• Avoid alcohol, caffeine, and nicotine.
• Ensure a comfortable bedroom temperature and provide nightlights and security objects.
• Discourage staying in bed when awake and watching television during periods of wakefulness.

Medications:

In some cases, non-drug approaches may not be sufficient, and medication may be required. However, it is important to proceed with caution as sleep-inducing medications can have significant risks for older adults with cognitive impairments. Experts recommend starting with low doses and gradually increasing them if needed.

The impact of medication on sleep

Sleep disturbances are common in people with Alzheimer's disease, but the reasons are not fully understood. Sleep changes may be due to the impact of Alzheimer's on the brain, with brain wave studies showing decreases in both dreaming and non-dreaming sleep stages.

There are non-drug and drug approaches to treating sleep changes in people with Alzheimer's. Non-drug treatments are recommended as the first line of treatment as they are generally safer and can be very effective. These include maintaining a regular sleep schedule, seeking morning sunlight, exercising during the day, and avoiding certain substances like alcohol, caffeine, and nicotine.

If non-drug approaches are unsuccessful or if the sleep changes are accompanied by disruptive nighttime behaviours, medication may be considered. However, the use of sleep-inducing medications in older adults with cognitive impairment carries significant risks, including an increased risk of falls, fractures, confusion, and a decline in self-care abilities. Additionally, studies have shown that sleep medications do not generally improve overall sleep quality in older adults and may even cause serious side effects.

Some medications that may be used to treat sleep changes in Alzheimer's patients include:

• Tricyclic antidepressants (e.g., nortriptyline)
• Benzodiazepines (e.g., lorazepam, oxazepam, temazepam)
• Sleeping pills (e.g., zolpidem, zaleplon, chloral hydrate)
• Atypical antipsychotics (e.g., risperidone, olanzapine, quetiapine)
• Classical antipsychotics (e.g., haloperidol)
• Belsomra, specifically approved by the FDA for insomnia in people with mild-to-moderate Alzheimer's disease

It is important to carefully weigh the benefits and risks of any medication and to consult with a healthcare professional before starting any new treatment. Additionally, it is worth noting that sleep disturbances can also be caused by other medical conditions, such as restless leg syndrome or sleep apnea, which should be ruled out or treated accordingly.

Non-drug treatments for sleep changes

• Maintain regular times for meals, going to bed, and getting up.
• Encourage morning sunlight exposure.
• Encourage regular daily exercise, but not within four hours of bedtime.
• Avoid alcohol, caffeine, and nicotine.
• If the person is taking a cholinesterase inhibitor (e.g., tacrine, donepezil, rivastigmine, or galantamine), avoid giving the medication before bed.
• Ensure the bedroom temperature is comfortable.
• Provide nightlights and security objects.
• If the person awakens, discourage staying in bed while awake; reserve the bed for sleeping only.
• Discourage watching television during periods of wakefulness.

Frequently asked questions