Daytime Sleep And Dementia: Understanding The Connection

Sleep disturbances are common in people with dementia, with up to 50% of patients experiencing them. This can include insomnia, excessive daytime sleepiness, sundown syndrome, REM sleep problems, and more.

People with dementia tend to sleep frequently throughout the day and night, and time spent sleeping typically increases as dementia progresses. This is especially true for people in the later stages of the condition.

There are several reasons why people with dementia may sleep a lot during the day. Firstly, they may be making up for their inability to sleep at night. Secondly, they may feel exhausted from the mental stimulation of completing regular tasks, which can be more challenging for people with dementia. Additionally, other common dementia symptoms like wandering and time disorientation can also contribute to daytime sleepiness.

While increased sleep is generally considered a normal side effect of dementia, it can lead to issues such as depression, anxiety, and apathy. It can also affect the person's physical and mental abilities, increasing irritability, reducing attention and focus, and heightening the risk of falls.

If you are concerned about a loved one with dementia sleeping all day, it is recommended to speak to their doctor, especially if their sleep patterns change suddenly, as this could indicate an underlying problem.

Excessive daytime sleepiness may be a symptom of an underlying health condition

Other reasons for daytime sleepiness include:

• Wandering and time disorientation: Wandering often becomes more common as dementia progresses, and it can cause dementia patients to not only be awake but active throughout the night. Time disorientation affects a person’s ability to distinguish between night and day.
• Exhaustion from mental stimulation: People with dementia have a harder time than they used to with completing regular tasks, and they end up feeling exhausted from the mental stimulation of the day.
• Medication: Some medications can cause drowsiness, including antipsychotics, antihistamines, and antidepressants.
• Sundowning: It’s common for those with dementia to experience confusion and a worsening of other symptoms at night, known as sundowning. This added stress at night can make it difficult to maintain a regular sleep schedule.
• Sleep disorders: Some sleep disorders that can cause excessive daytime sleepiness include insomnia, sleep apnea, and restless leg syndrome.
• Low melatonin: As dementia progresses, the brain may start to produce less melatonin, which is important for regulating sleep/wake cycles.

If you are concerned about a dementia patient's excessive daytime sleepiness, it is recommended to speak to their doctor, especially if their sleep patterns suddenly change.

Dementia patients should maintain a healthy sleep schedule

• Treat pain and other medical conditions: Addressing chronic pain and underlying medical conditions, such as sleep apnea, can improve sleep quality. Consult a doctor for solutions and consider natural remedies like magnesium supplements for conditions such as restless leg syndrome.
• Create a soothing environment: Ensure the patient's room is dark, quiet, and cool, with a temperature between 60 and 67 degrees Fahrenheit. Using a white noise machine can also minimise external noises and agitation.
• Check for medication side effects and avoid stimulants: Some medications can interfere with sleep. Consult a doctor about potential side effects and explore alternatives or adjustments to the medication regimen. Additionally, limit stimulants like caffeine, alcohol, sugar, and nicotine, which are known for disrupting sleep.
• Encourage activity during the day: Help the patient stay physically, socially, and mentally active. Start mornings with a walk, invite friends over for lunch, and engage in mind-stimulating activities like reading or listening to music in the afternoon. Be sure to spread out activities to minimise exhaustion and confusion.
• Get some sunlight and minimise blue light exposure: Expose the patient to sunlight or bright lights soon after waking up to help regulate their sleep cycle. Use bright light therapy lamps in the morning and dim the lights in the evening to help them wind down.
• Establish a sleep schedule and routine: Aim for a consistent bedtime each night and limit daytime naps. Create a calming bedtime routine, such as dimming the lights, playing soothing music, drinking chamomile tea, and using aromatherapy to promote sleep.
• Avoid physical restraints: Instead of using physical restraints to prevent nighttime wandering, consider a speaker with a motion detector that will gently remind the patient to stay in bed.
• Use nightlights and bed sensors: Nightlights can prevent nighttime confusion or accidents, while bed alarms or sensors can alert caregivers of wandering, allowing them to guide the patient back to bed gently.

While these strategies can help improve sleep, it's important to note that sleep disturbances are common in dementia patients and may become more challenging as the disease progresses. Prioritising the patient's comfort and well-being while managing expectations is crucial for both the patient and their caregivers.

Vascular dementia is linked to sleeping a lot, sleeping too little, and other strange sleep issues

Vascular Dementia and Sleep Issues

OSA occurs when a person's upper airway either partially or completely closes during sleep, often resulting in loud snoring or coughing fits. It is common in dementia patients and can have serious complications like heart attacks and strokes. Excessive daytime sleepiness is a risk factor for vascular dementia and people with this condition are more likely to develop it.

People with vascular dementia may experience strange sleep patterns, such as sleeping during the day and staying awake at night. This can be due to time disorientation, where they are unable to distinguish between night and day. They may also be exhausted from the mental stimulation of completing simple tasks. Wandering, a common symptom of dementia, can also cause them to be active throughout the night.

Supporting a Person with Vascular Dementia

While sleeping a lot is common for people with vascular dementia and usually doesn't require medical treatment, there are steps caregivers can take to improve their quality of life. It is important to check in on the person regularly to prevent physical ailments like bed sores from developing. Gentle chair exercises may also be recommended by a doctor to counteract the extra time spent sleeping.

To help manage sleep patterns, caregivers can create a daily routine to keep the person engaged and active during the day. Avoiding caffeine and heavy meals in the evening, as well as establishing a bedtime routine, can also promote better sleep.

If there is a sudden increase in sleepiness, it is recommended to consult a doctor to rule out any underlying health conditions or infections. Medication reviews are also important, as certain medications can cause drowsiness or insomnia.

Sleep disturbances in dementia patients can cause increased irritability and reduced cognitive performance

Sleep disturbances are a common symptom of dementia, especially in the later stages of the disease. This can manifest as sleeping more frequently during the day and at night, or even a complete reversal of the normal sleep pattern, where the person stays awake all night and sleeps during the day.

These disturbances can be caused by various factors, including:

• Medications: Certain medications prescribed for dementia or other conditions can cause drowsiness or insomnia. Antidepressants, antipsychotics, and antihistamines are known to contribute to exhaustion in dementia patients.
• Fatigue: Dementia, along with other health conditions that may develop with age, can be physically draining. As the body tries to cope, it may require more sleep as part of the healing process.
• Melatonin depletion: As dementia progresses, the brain may produce less melatonin, a hormone crucial for regulating sleep-wake cycles.
• Low sleep pressure: Dementia patients may experience long periods of low activity or boredom during the day, preventing them from feeling tired at bedtime.
• Sundowning: The phenomenon of sundowning can cause confusion and a worsening of symptoms at night, making it challenging to maintain a regular sleep schedule.
• Disrupted sleep patterns: Dementia can disrupt natural sleep patterns, leading to excessive sleepiness during the day.

The impact of these disturbances can be significant. For caregivers, it can be distressing and exhausting to see their loved ones sleeping all day. Additionally, the reduced cognitive performance associated with dementia may be further exacerbated by poor sleep quality.

• Medications: As mentioned earlier, certain medications can contribute to drowsiness and insomnia. This can directly impact a person's mood and cognitive functioning.
• Fatigue: The physical exhaustion associated with dementia and other health conditions can lead to increased irritability and decreased cognitive performance.
• Melatonin depletion: Reduced melatonin levels can disrupt sleep-wake cycles, affecting a person's mood and cognitive abilities.
• Low sleep pressure: Lack of stimulating activities during the day can result in poor sleep quality at night, potentially impacting a person's mood and cognitive functioning.
• Sundowning: The confusion and symptom worsening associated with sundowning can further disrupt sleep patterns, contributing to increased irritability and reduced cognitive performance.
• Disrupted sleep patterns: When natural sleep patterns are disturbed, it can lead to excessive daytime sleepiness, which may impact a person's ability to perform cognitive tasks and regulate their mood.
• Cognitive decline: Sleep disturbances can exacerbate the progressive cognitive decline associated with worsening dementia. This includes difficulty expressing thoughts, managing tasks, and remembering events or people.
• Emotional outbursts: Sleep disturbances can trigger emotional outbursts in dementia patients, often in response to unfamiliar situations.
• Behavioral changes: As dementia progresses, behavioral disturbances may occur, including increased irritability and aggression.
• Impact on caregivers: Sleep disturbances in dementia patients can significantly affect the well-being of their caregivers, who may also experience sleep problems and a decreased quality of life. This, in turn, can impact the caregivers' ability to provide support and care, potentially exacerbating the challenges faced by dementia patients.

A healthy sleep routine can help a person with dementia feel better and be less confused

• Treat underlying conditions: Many health issues can disrupt sleep. Reduce any pain or discomfort with painkillers, gentle heat, or massage before bed. Ask a pharmacist or doctor if any medications could be causing sleep problems.
• Establish a daily routine: A consistent daily routine can help when a person with dementia has trouble with their body clock. Try to do regular activities at the same time each day. For example, go for a walk after breakfast or listen to the radio together in the afternoon. This provides a familiar routine that helps the person make sense of the time.
• Encourage physical activity: Doing enjoyable and interesting activities during the day can reduce daytime sleepiness. Physical activities like walking or gardening can improve sleep quality. Aim for at least 20-30 minutes several times a week. However, avoid too much activity in the evening, as this can make it harder to fall asleep.
• Avoid stimulants: Caffeine and other stimulants can reduce feelings of sleepiness and increase the need to use the toilet. Switch to non-caffeinated drinks from lunchtime onwards. Also, avoid cigarettes and alcohol in the evening, as nicotine increases heart rate and alcohol can disrupt sleep.
• Maintain a balanced diet and hydration: Eating a light meal several hours before bedtime can prevent hunger at night without making one feel too full to fall asleep. Drink enough fluids during the day, but cut down towards the evening to avoid frequent trips to the bathroom.
• Create a sleep-friendly environment: Make the bedroom as quiet and dark as possible, with a comfortable temperature (around 18°C). Use blackout curtains to block outside light and consider using a night light to prevent falls if the person gets up at night.
• Establish a bedtime routine: A consistent bedtime routine can signal to the person with dementia that it's time to sleep. This could include having a warm caffeine-free drink, changing into sleepwear, brushing teeth, and listening to calming music or a favourite radio programme.
• Review medication: Some dementia medications may disrupt sleep. Discuss with a doctor the best time of day to take them. Avoid giving sleeping pills to people with dementia, as these can exacerbate confusion.
• Manage daytime napping: Preventing daytime naps may not be necessary and could even worsen sleep problems. Instead, try to regulate napping by encouraging short naps at the same time and place each day, preferably in a chair instead of a bed to promote lighter sleeping.

Frequently asked questions