Evie Summers
Sleep problems are common in people with dementia, with up to 50% of patients suffering from some sort of sleep disruption. While medication is not recommended due to the risk of cognitive impairment, there are several non-pharmaceutical methods that can help. These include establishing a healthy sleep routine, reducing caffeine and alcohol consumption, and increasing exposure to daylight and activity during the day.
| Characteristics | Values |
|---|---|
| Drugs | Melatonin, clonazepam, pramipexole, ropinirole, rotigotine, nortriptyline, lorazepam, oxazepam, temazepam, zolpidem, zaleplon, chloral hydrate, risperidone, olanzapine, quetiapine, haloperidol, Belsomra |
| Non-drug treatments | Massage, acupuncture, inflatable compression devices, painkillers, gentle heat, increased pain medication, relieving anxiety, treating urinary problems, reducing caffeine and alcohol consumption, reducing screen time, warm baths, low lighting, calming music, gentle massage, soothing activities, warm showers, melatonin, glowing timer device, fewer daytime naps, short walks, more daylight, consistent bedtime, soothing activities, warm showers |
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What You'll Learn
Reduce caffeine, alcohol, and nicotine intake
While there is no definitive cure for sleep problems in people with dementia, certain measures can be taken to improve sleep quality. One such measure is reducing the intake of caffeine, alcohol, and nicotine.
Caffeine is a stimulant that reduces feelings of sleepiness and increases the need to urinate. As the effects of caffeine can last for several hours, it is recommended that people with dementia switch to non-caffeinated drinks from lunchtime onwards. This includes drinks such as water, milk, natural juice, or caffeine-free tea or coffee.
Alcohol should also be avoided during the evening, as it can disrupt sleep patterns. While it may help people fall asleep initially, alcohol leads to poorer sleep quality and increases the likelihood of waking up in the middle of the night.
Nicotine, often consumed through smoking, increases the heart rate and reduces feelings of sleepiness. Quitting smoking is an important step in improving sleep for people with dementia and reducing the risk of developing dementia. Smoking is a known risk factor, especially for vascular dementia, due to its harmful impact on blood vessels. However, it is important to note that nicotine itself, independent of smoking, is being studied for its potential benefits in preventing cognitive decline and dementia. Some research suggests that nicotine may improve cognition and potentially reduce the risk of dementia by interacting with nicotinic acetylcholine receptors in the brain.
In addition to reducing caffeine, alcohol, and nicotine intake, other strategies to improve sleep for people with dementia include increasing physical activity during the day, establishing a healthy sleep routine, and creating a relaxing bedtime environment with low lighting and calming music.
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Establish a healthy sleep routine
Establishing a healthy sleep routine can be highly beneficial for people with dementia. A good sleep routine can help the person feel better, be less confused, be more coordinated, and have more energy during the day. Here are some tips to establish a healthy sleep routine:
Limit Screen Time
Reducing screen time towards the end of the day can help people with dementia fall asleep more easily. Offer to record any late-evening TV programmes they want to watch, so they can watch them earlier the next day.
Engage in Calming Activities
Encourage calming and relaxing activities during the late evening to help the person get ready for sleep. A warm bath an hour or two before bedtime can help relax the body and mind. Low lighting, calming music, and gentle massage can also promote sleepiness, especially when incorporated into a regular bedtime routine.
Limit Food Intake in the Evening
It can be challenging to fall asleep after a large meal, especially if it contains a lot of sugar. Limit food intake in the evening to a healthy snack or a light meal. Consider having dessert after lunch instead of dinner and eating dinner earlier.
Limit Daytime Naps
While preventing daytime naps might not be necessary, try to regulate them. Encourage napping at the same time and place each day, for a short duration. Experiment with different times so the person is still tired at bedtime. Make it a routine to nap in a chair, rather than in bed, to promote lighter sleeping.
Plan Daily Activities
Engage in outdoor activities, such as strolls, and encourage social interactions with family and friends. Joining a specialist group, such as a dementia cafe, can also be beneficial. Exposure to natural daylight helps regulate the body clock, and physical activity can promote better sleep.
Consistent Bedtime and Wake-Up Time
Try to maintain the same bedtime and wake-up time every day. Establishing a consistent nighttime and morning routine helps signal to the person with dementia what time of day it is. This routine can include activities such as brushing teeth, playing music, or having a hot milky drink.
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Reduce screen time before bed
Sleep problems tend to become more common and severe as dementia progresses. While medication is not recommended for people with dementia, non-drug treatments can help. One way to improve sleep quality is to reduce screen time before bed.
Excess screen time can negatively impact cognition and sleep. This is true for both older and younger people, with children being particularly vulnerable to the effects of blue light. Blue light is emitted by fluorescent and LED lights, as well as electronic devices. It has been shown to reduce or delay the natural production of melatonin, a hormone that helps regulate sleep. By suppressing melatonin production, blue light can decrease feelings of sleepiness and reduce the amount of time spent in slow-wave and rapid-eye movement (REM) sleep, two vital stages of the sleep cycle.
To mitigate the negative effects of blue light, you can:
- Use your device's nighttime mode, which reduces blue light emissions and display brightness.
- Manually dim the display if your device does not have a nighttime mode.
- Wear blue-light-blocking glasses, which shield your eyes from blue light.
- Limit phone notifications to avoid constantly being on your phone or in front of a screen.
- Avoid using your computer or phone right before bed. Instead, put your devices away at least an hour before bedtime to give your brain a chance to wind down.
- Keep your bedroom a screen-free zone.
In addition to reducing screen time, you can improve sleep quality by:
- Establishing a relaxing bedtime routine that includes calming and relaxing activities, such as listening to calming music or taking a warm bath.
- Keeping the bedroom lights dim.
- Avoiding caffeine and other stimulants in food and drink, especially in the evening.
- Not smoking or drinking alcohol in the evening.
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Treat underlying conditions
Sleep problems tend to become more common and severe as dementia progresses. However, it is challenging to treat these sleep issues as there may be many different causes, and medication is often not very effective. Nevertheless, it is important to address underlying conditions that may be causing or worsening sleep problems in people with dementia.
Firstly, it is recommended that people with dementia who are experiencing sleep disturbances undergo a thorough medical examination to identify any treatable illnesses that may be contributing to the problem. For example, sleep apnea, an abnormal breathing pattern that causes people to briefly stop breathing many times a night, resulting in poor sleep quality, is a condition that can be treated and may improve sleep. Other health conditions that may impact sleep include restless legs syndrome, depression, arthritis, diabetes, thyroid disorders, kidney problems, and iron deficiency. Identifying and treating these underlying conditions may help to improve sleep quality.
In some cases, certain medications can cause or worsen sleep problems. For instance, drugs such as antidepressants, allergy medications, anti-sickness drugs, and antipsychotics have been linked to periodic limb movement disorder, which can interrupt sleep. Therefore, reviewing the medications the person is taking and considering alternative drugs may be beneficial. Additionally, caffeine, nicotine, and alcohol can also negatively impact sleep quality, so reducing the consumption of these substances, especially in the evening, may help improve sleep.
Establishing a healthy sleep routine can be beneficial for people with dementia. This includes reducing screen time towards the end of the day, engaging in calming and relaxing activities before bed, and creating a bedtime routine that incorporates relaxing activities such as listening to calming music or having a warm bath. Maintaining a regular daily routine can also help when a person's body clock is not functioning optimally.
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Administer melatonin supplements
Sleep medication is generally not recommended for people with dementia as it may increase confusion and the likelihood of falls. However, melatonin is a hormone that regulates sleep-wake cycles and is often used to treat sleep problems. Melatonin is available over the counter as a supplement and food additive in the US and by prescription in the EU, UK, Australia, and Canada.
Melatonin has been shown to have neuroprotective effects and may be beneficial for people with stroke-related dementia. It can improve neuroinflammation and speed up the restoration of brain tissue. Melatonin may also help reduce inflammatory factors, oxidative stress, and cell death pathways, and may help lessen cognitive impairment. A 2021 review of 22 studies found that over 12 weeks of melatonin treatment improved mini-mental state examination scores, a test that measures cognitive impairment.
However, it is important to note that the effects of melatonin on dementia are still being studied, and there is currently no conclusive evidence of its effectiveness. Some studies suggest that melatonin may not have any effect on sleep outcomes or cognition in people with Alzheimer's disease and sleep disturbances. Additionally, there is a lack of research on the long-term use of melatonin, and it may increase the risk of falls or other adverse events, especially in older adults. Melatonin may also interfere with other drugs, so it is important to consult a doctor before taking it.
If you are administering melatonin supplements to someone with dementia, it is important to be aware of the potential side effects. While serious adverse effects are rare, they can include nausea, drowsiness, decreased blood flow, and lower body temperature (hypothermia). Melatonin may also be unsafe for people with certain medical conditions, such as orthostatic hypotension, bleeding disorders, diabetes, depression, autoimmune diseases, seizure disorders, and transplant recipients.
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Frequently asked questions
Firstly, it is important to consult a doctor or healthcare professional for advice. They may suggest increasing pain medication, relieving anxiety, or treating urinary problems. You can also try establishing a healthy sleep routine, reducing caffeine and alcohol consumption, and limiting screen time towards the end of the day.
A healthy sleep routine can include soothing activities before bed, such as playing soft music, giving gentle back rubs or massages, and taking a warm bath or shower. You can also try a glowing timer device, which helps people with dementia slow their breathing and fall asleep more quickly.
Melatonin is a natural substance that can aid sleep and is available without a prescription. However, it is important to start with a low dose as too much melatonin can have the opposite effect. Always consult a doctor or pharmacist to ensure any supplements are safe to take alongside current medication.
Sleep medication is generally not recommended for people with dementia as it can increase the risk of falls and confusion. However, in severe cases, a doctor may suggest a short course of medication if non-drug treatments have been ineffective.
Caring for someone with dementia can be exhausting, especially when your sleep is disturbed. If possible, encourage daytime activities and shorter naps to promote nighttime sleep. If the person with dementia frequently wakes up at night, consider hiring a night sitter or home health aide to provide support so you can get a full night's rest.
