Demanian Elder's Slumber: Unraveling The Mystery Of Their Sleep Patterns

Dementia patients often sleep a lot during the day, which can be distressing for their family and friends. This is especially common in the later stages of the disease, as the damage to the brain becomes more extensive, and patients gradually become weaker and frailer. As a result, even simple tasks like communicating or eating can be exhausting, leading to increased daytime sleep. Additionally, certain medications, melatonin depletion, low sleep pressure, and sundowning can also contribute to excessive sleepiness in dementia patients. While sleeping more during the day is generally not harmful, caregivers should ensure that physical ailments like bed sores do not develop and should consult a doctor if there are other concerning symptoms.

The progression of the disease: As dementia progresses, the brain deteriorates and can no longer handle stimulation, leading to increased sleep

As dementia progresses, the brain's ability to handle stimulation gradually diminishes. This deterioration leads to increased sleep as the disease advances, particularly in its later stages.

In the later stages of dementia, individuals may find even simple tasks, such as communication or eating, extremely exhausting. This increased mental fatigue results in more daytime sleep as their symptoms worsen. The brain's deterioration means it can no longer handle stimulation effectively, leading to a need for more rest.

This phenomenon is comparable to the sleep patterns of infants, who sleep most of the time, only briefly waking to eat and be alert before quickly needing more sleep. This is because their brains are working hard to process new stimuli, and the stimulation causes them to feel tired and require more rest than older children. Similarly, individuals with late-stage dementia experience excessive sleep due to their brains' deteriorating ability to process stimuli.

Additionally, the type of dementia can also influence sleep patterns. For instance, those with vascular dementia, caused by reduced blood flow to the brain, often sleep more than usual. Dementia resulting from Parkinson's disease or Lewy bodies may also cause increased daytime sleep and restless nights.

Medications can also contribute to drowsiness. Antipsychotics, antidepressants, antihistamines, and sleeping pills may all induce sleepiness in individuals with dementia.

While excessive sleep is a typical feature of late-stage dementia, it is recommended to consult a doctor if sleep patterns change suddenly, as this could indicate an issue with medication, an illness, or another complication requiring immediate attention.

Medication: Drugs such as antipsychotics, antihistamines, and antidepressants can cause drowsiness

Medication can be a significant factor in causing drowsiness in dementia patients, particularly those in the later stages of the disease. This is especially true for certain types of drugs, such as antipsychotics, antihistamines, and antidepressants.

Antipsychotics, which are commonly used to manage symptoms of psychosis in conditions like schizophrenia or bipolar disorder, are known to cause drowsiness as a side effect. This is due to their effect on neurotransmitters in the brain, particularly dopamine, which helps regulate mood. While this side effect may be welcome for those experiencing insomnia or mania, it can also interfere with daily tasks and increase the risk of falling. The severity of drowsiness can vary depending on the specific antipsychotic medication, with some classified as high, moderate, or low somnolence inducers.

Antihistamines, commonly used to treat allergy symptoms, can also cause drowsiness. This is because antihistamines block the effects of histamine, a substance released by the body during allergic reactions, which can lead to sleepiness. While non-drowsy antihistamines are available, certain types are more likely to cause sleepiness, such as chlorphenamine (Piriton), cinnarizine, diphenhydramine, hydroxyzine, and promethazine.

Additionally, antidepressants, particularly tricyclics, are known to induce drowsiness. Examples of tricyclic antidepressants that may cause sleepiness include amitriptyline (Elavil, Vanatrip), doxepin (Silenor, Sinequan), imipramine (Tofranil, Tofranil PM), and trimipramine (Surmontil).

It is important to note that medication is not the only factor contributing to increased sleep in dementia patients. The progression of the disease can cause exhaustion from performing simple tasks, and sleep disorders or pre-existing sleeping patterns may also play a role. However, if excessive sleeping occurs suddenly or is accompanied by other changes in the person's well-being, it may indicate an underlying cause that should be addressed by a healthcare professional.

Melatonin depletion: Dementia can cause a decrease in melatonin, disrupting sleep/wake cycles

Sleep disturbances are common in people with dementia, with studies estimating that about 25% to 50% of adults with dementia experience sleep disturbances. Dementia can affect the production of melatonin, the sleep hormone that helps a person feel sleepy. Melatonin is a chronobiotic substance that can influence the timing and amplitude of circadian rhythms. It is an excellent anti-inflammatory agent, reducing insulin resistance, buffering free radicals, and down-regulating pro-inflammatory cytokines, among other things.

The Link Between Melatonin and Dementia

In humans, the pineal gland is the most obvious source of circulating melatonin, and a decrease in plasma melatonin is one of the hallmarks of aging. The hormone is robustly cytoprotective with substantial antioxidant, anti-inflammatory, and immunoregulatory actions in addition to its role as a primary coordinator of circadian rhythmicity. Melatonin is secreted directly from the pineal into the third ventricle, from which it diffuses widely into brain tissue. Evidence suggests that melatonin is present in the brain at higher concentrations than in the blood and is capable of removing toxins such as Aβ from the central nervous system to protect against cognitive decline.

The Impact of Melatonin Depletion on Sleep

Melatonin plays a vital role in governing the sleep schedule. The onset of nighttime melatonin release occurs approximately two hours before an individual’s habitual bedtime and has been shown to correspond with the onset of evening tiredness. Several studies have established a linkage between plasma melatonin levels and the physiological control of circadian processes that govern sleep proclivity. A decrease in melatonin levels can, therefore, have a disruptive effect on sleep patterns.

Indeed, people with dementia often experience sleep disturbances, with some studies reporting that dementia patients sleep up to 14-15 hours a day. However, it is unlikely that all of this is good quality sleep. Instead, it is often interrupted and of poor quality, with patients experiencing insomnia, sundown syndrome, REM sleep problems, and more.

Managing Sleep Problems in Dementia Patients

While researchers and doctors don't fully understand why people with dementia don't sleep properly, they know that dementia-related brain changes seem to affect the body's circadian rhythm. To help manage sleep problems in dementia patients, caregivers can encourage physical activity, create a calming bedtime routine, and talk to a doctor about potential causes and treatments. Establishing a sleep schedule and routine, as well as creating a soothing environment, can also help improve sleep quality.

Melatonin as a Possible Treatment for Sleep Disturbances in the Elderly

Melatonin has been proposed as a treatment for sleep disturbances in the elderly. It is a potent chronobiotic with mild hypnotic properties, and studies have shown that it can sustain circadian rhythm synchronization and improve sleep efficiency. Melatonin has also been found to be effective in treating sundowning, a chronobiological dysfunction reported in Alzheimer's disease that includes symptoms such as disordered thinking, a reduced ability to pay attention to external stimuli, agitation, wandering, and perceptual and emotional abnormalities.

However, the effectiveness of melatonin as a treatment for sleep disturbances in dementia patients is still under investigation, with some studies showing positive results while others showing no significant effects. More research is needed to determine the optimal dosage and timing of melatonin administration to achieve the desired therapeutic effects.

Low sleep pressure: Dementia patients may experience low activity during the day, impacting their ability to feel tired at night

People with dementia often experience changes in their sleep patterns. This may manifest as excessive daytime sleepiness, where they feel like they can't stay awake and take long naps that interfere with their nighttime sleep.

Low sleep pressure in dementia patients can be caused by various factors, including insufficient sleep at night, sedating medications, damage to brain cells caused by dementia, mental health conditions such as depression, and other sleep disorders such as sleep apnea.

• Encourage physical activity during the day: Help your loved one stay physically active by suggesting walks or light exercises. Social activities and mentally stimulating tasks can also help keep them engaged during the day.
• Establish a soothing bedtime routine: Create a calming environment in their bedroom by keeping it dark, quiet, and cool. Set the temperature between 60 and 67 degrees Fahrenheit, and consider using a white noise machine to minimize external disturbances.
• Avoid stimulants and check for medication side effects: Limit their intake of stimulants like caffeine, alcohol, sugar, and nicotine, which are known for disrupting sleep. Also, review their medications with their doctor to identify any side effects that may impact sleep.
• Get exposure to sunlight and minimize blue light: Get your loved one outside or into bright lights soon after they wake up to help regulate their sleep cycle. Dim the lights and minimize blue light exposure in the evening to promote winding down before bedtime.
• Create a consistent sleep schedule and routine: Establish a regular bedtime and limit daytime naps to improve their sleep-wake cycle. A calming bedtime routine with activities like drinking chamomile tea or listening to soothing music can also help.
• Address pain and other medical conditions: Treating chronic pain and managing conditions like sleep apnea can improve their sleep. Consult their doctor for advice on specific conditions and consider supplements like magnesium for issues like restless leg syndrome.
• Use nightlights and bed sensors: Nightlights can prevent confusion and accidents if they get up at night, while bed sensors can alert caregivers of nighttime wandering so they can guide them back to bed gently.

It's important to note that while these strategies can help improve sleep for dementia patients, more research is needed to fully understand the complex relationship between sleep and dementia.

Sundowning: Confusion and worsened symptoms at night can disrupt sleep schedules

Sundowning, or sundown syndrome, is a form of confusion that begins late in the day and often carries into the night. While it's often associated with people who have various types of dementia, such as Alzheimer's disease, it can also affect people without dementia when they are coping with the aftermath of anaesthesia or other medical issues.

Symptoms of Sundowning

Symptoms of sundowning tend to come on in the late afternoon and can last into the night. Signs of sundowning include:

• Insomnia
• Anxiety
• Pacing
• Hallucinations
• Paranoia
• Confusion
• Delusions
• Agitation
• Irritability
• Restlessness

Causes of Sundowning

Scientists don't know what causes sundowning, but it's believed that it has to do with dementia-related brain changes impacting a person's circadian rhythm, which is the internal, biological clock that regulates sleep and other bodily processes. An upset in the circadian rhythm may throw sleep cycles out of whack, leading to agitation and other sundowning symptoms.

Factors that may exacerbate sundowning include:

• Disrupted circadian rhythms (sleep-wake cycles)
• Insomnia or other common sleep disorders
• Side effects of medications
• Problems with seeing the difference between reality and dreams
• Fatigue (tiredness)
• Overstimulation from a busy day
• Low lighting and increased shadows combined with low vision
• Confusion in regards to dreams and reality
• Overstimulation during the day
• Not enough exposure to sunlight during the day
• Moving to a new environment or hospitalisation

Tips for Managing Sundowning

While there aren't targeted treatments for sundowning, there are several strategies that may reduce a loved one's symptoms:

• Remove causes of confusion
• Plan activities during daylight hours
• Keep their schedule consistent
• Maintain familiar surroundings
• Limit caffeine late in the day
• Offer an early dinner
• Provide comfortable sleeping arrangements
• If you are caring for an individual who has a hard time sleeping, sundowning may be caused by fatigue. Melatonin is a gentle and natural food supplement that often helps people with sleep issues to fall and stay asleep.

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