Dementia And Sleep: Understanding The Connection

Sleep disturbances are common in people with dementia, with up to 50% of patients experiencing them. This can manifest as insomnia, excessive daytime sleepiness, sundown syndrome, REM sleep problems, and more. While the reasons for this are not fully understood, it is known that dementia-related brain changes affect the body's circadian rhythm, which regulates the sleep-wake cycle. As dementia progresses, especially into its later stages, patients may find even simple tasks exhausting, leading to increased sleep during the day. Additionally, certain medications, melatonin depletion, low sleep pressure, and sundowning can also contribute to excessive sleepiness. While sleeping more than usual in late-stage dementia is expected, sudden changes in sleep patterns should be discussed with a doctor.

The progression of the disease: As dementia progresses, the brain's ability to handle stimulation decreases, leading to exhaustion from simple tasks

As dementia progresses, the brain's ability to handle stimulation decreases, leading to exhaustion from simple tasks. This is because the brain is deteriorating and can no longer process stimulation in the same way it used to. As a result, patients in the later stages of dementia will often sleep a lot during the day and night.

This increased need for sleep can be distressing for family and friends, who may worry that something is wrong. However, it is quite common for people with dementia to sleep more as the disease progresses. The damage to the brain becomes more extensive, and patients gradually become weaker and frailer over time.

The simple act of communicating or trying to understand their surroundings can be exhausting for a person with dementia, leading to increased sleep during the day as their symptoms worsen. This can be compared to the sleep patterns of infants, who sleep around the clock and only wake up briefly, as their brains are working hard to process new stimuli.

In addition to the progression of the disease, there are other factors that can contribute to excessive sleepiness in dementia patients. These include medications, coexisting health conditions, melatonin depletion, low sleep pressure due to boredom or inactivity during the day, and sundowning, which refers to increased confusion and worsening of symptoms at night.

While sleeping more is generally not a cause for concern, it is recommended to speak to a doctor if the person's sleep patterns change suddenly, as this could indicate an underlying issue that needs to be addressed.

Medication: Drugs like antipsychotics, antidepressants, and antihistamines can cause drowsiness

Medication can be a significant factor in causing drowsiness in dementia patients. People with dementia often have coexisting conditions that require medications. Antipsychotics, antihistamines, and antidepressants can all cause drowsiness and excessive sleepiness. If your loved one is taking medication to help with sleep since dementia can make sleeping more difficult, his dosage may need to be adjusted if the medication is causing him to sleep more than usual.

Antipsychotics are often prescribed to treat the behavioural and psychological symptoms of dementia (BPSD). These symptoms can include aggression, agitation, and hallucinations. While antipsychotics can be helpful in managing BPSD, they can also have side effects such as drowsiness and increased risk of stroke and death in older adults with dementia. Therefore, it is important to carefully consider the benefits and risks of using antipsychotics in treating dementia patients.

Antidepressants are also commonly prescribed to people with dementia, as depression is a common coexisting condition. However, antidepressants can cause drowsiness and insomnia, further disrupting the sleep patterns of dementia patients. It is important for doctors to carefully consider the potential benefits and side effects when prescribing antidepressants to dementia patients and to monitor their sleep patterns closely.

Antihistamines are another type of medication that can cause drowsiness in dementia patients. Antihistamines are typically used to treat allergies, but they can also be prescribed for conditions such as insomnia and anxiety. While antihistamines can help with sleep, they can also cause excessive sleepiness during the day, disrupting the sleep patterns of dementia patients.

If you notice that your loved one is sleeping more than usual, it is important to speak to their doctor. A medication review may be necessary to determine if their sleep patterns are being affected by the medication they are taking. The doctor may adjust the dosage or switch to a different medication to help improve their sleep patterns.

In addition to medication, other factors can also contribute to excessive sleepiness in dementia patients. These include fatigue, melatonin depletion, low sleep pressure, and sundowning. As dementia progresses, the body may become physically exhausted from coping with the disease and other health conditions, leading to increased sleep. Additionally, the brain may start to produce less melatonin, disrupting the sleep/wake cycles.

Melatonin depletion: Dementia may cause reduced melatonin production, disrupting sleep/wake cycles

Melatonin is a hormone that regulates sleep/wake cycles and helps people feel sleepy. As dementia progresses, the brain may start to produce less melatonin, disrupting the sleep/wake cycle and causing excessive daytime sleepiness. This is more common in people with Parkinson's disease dementia or Lewy body dementia than in those with Alzheimer's disease.

Excessive daytime sleepiness can be caused by various factors, including insufficient sleep at night, sedating medications, damage to brain cells caused by dementia, changes in sleep patterns caused by dementia, mental health conditions such as depression, and other sleep disorders such as sleep apnea.

It is important to maintain a healthy sleep schedule for optimal rest. Long naps, especially later in the afternoon, can disrupt the sleep-wake cycle and interfere with nighttime sleep and overall quality of life. However, in times of extreme exhaustion, an occasional catnap may be necessary.

To improve sleep, it is recommended to treat pain and other medical conditions, create a soothing environment, check for medication side effects and avoid stimulants, encourage activity during the day, get sunlight and minimize blue light exposure, establish a sleep schedule and routine, and use nightlights and bed sensors to prevent confusion or accidents if the person gets up at night.

While sleeping more than usual is a common symptom of late-stage dementia, it is recommended to speak to a doctor if sleep patterns suddenly change, as it could indicate a problem with medication, illness, or another complication.

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 low sleep pressure, which can be caused by long periods of low activity or boredom during the day. This means they don't build up enough sleep pressure to feel tired at night. This can result in excessive daytime sleepiness, with people taking long naps that interfere with their nighttime sleep and overall quality of life.

Low sleep pressure is more common in people with vascular dementia, Parkinson's disease dementia, or Lewy body dementia. It can be managed through lifestyle changes and interventions by caregivers. For example, caregivers can encourage physical, social, and mental activity during the day, such as morning walks, social lunches, and mind-stimulating activities like reading or listening to music.

However, it's important to spread out these activities to minimize exhaustion and confusion. Creating a calming bedtime routine, such as dimming the lights and playing soothing music, can also help promote sleep. Additionally, getting morning sunlight and using bright light therapy lamps during the day can help regulate the sleep-wake cycle.

While excessive daytime sleepiness is a common symptom of dementia, especially in the later stages, it's recommended to speak to a doctor if your loved one's sleep patterns change suddenly. This could indicate an underlying health condition or a problem with medication that requires immediate attention.

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

Sundowning can be a distressing symptom of dementia, both for the person experiencing it and for those close to them. Sundowning refers to increased confusion, agitation, anxiety, and aggression in people with dementia during the night or early evening. This can make it difficult to maintain a regular sleep schedule.

The exact causes of sundowning are not well understood, but it is thought to be related to disruptions in the body's circadian rhythm, which regulates the sleep-wake cycle and other important processes across a 24-hour period. Factors that can contribute to sundowning include low exposure to sunlight during the day, especially in the morning, inactivity during the day, mental or physical exhaustion and stress at night, and a poor sleep environment (e.g., a noisy or bright room).

Additionally, medication side effects, diet (such as excessive caffeine, sugar, or alcohol intake), and dementia-related confusion can also play a role in disrupting sleep patterns. It is recommended to speak to a doctor if your loved one is experiencing sudden changes in their sleep patterns, as this could indicate an underlying problem that needs to be addressed.

To help manage sundowning and improve sleep for people with dementia, here are some strategies that caregivers can try:

• Treat any pain or other medical conditions that may be causing sleep disturbances.
• Create a soothing sleep environment by making the room dark, quiet, and cool, with a temperature between 60 and 67 degrees Fahrenheit.
• Use a white noise machine to minimize external noises and agitation.
• Check for medication side effects and avoid stimulants, such as caffeine, alcohol, sugar, and nicotine, which are known for disrupting sleep.
• Encourage activity during the day, such as morning walks, social interactions, and mind-stimulating activities like reading or listening to music.
• Get exposure to sunlight and bright lights in the morning to help regulate the sleep-wake cycle.
• Establish a consistent sleep schedule and bedtime routine, limiting daytime naps.
• Avoid using physical restraints, as these can cause frustration and agitation, leading to more sleep disturbances. Instead, consider using a speaker with a motion detector that will calmly remind the person to stay in bed.
• Use nightlights and bed sensors to prevent accidents and provide guidance if the person wanders at night.

Frequently asked questions