Characterized by an irreversible loss of brain function, dementia is a disease of old age that affects language, memory, problem-solving, and other cognitive functions. The disease can be categorized into different types, primarily affecting people of old age groups. It can make the brain cells sluggish and slower in their usual functions, in addition to forcing them to die off more quickly than in people without dementia. Unfortunately, the disease is not curable, but supportive treatments are available to slow down its progression and manage other issues it gives rise to.
Sleep problems in the elderly with dementia remain one of the most challenging issues in this particular population. A lack of sleep or poor quality of sleep due to this brain disorder can also exacerbate the severity of its other symptoms, making the overall picture more complex. Many caregivers of patients with dementia have identified sleep issues as the most stressful symptom of the disease. [1] Identifying these sleep issues and treating them remain an imperative part of dementia care as it significantly reduces stress for such patients while reducing cognitive decline.
Sleep and Alzheimer’s Disease: How One Affects the Other?
Circadian rhythm describes a collection of psychological and physical processes that regulate a person’s sleep-wake cycle by responding to different environmental indicators. People with dementia undergo various fundamental changes in their circadian rhythm that interrupt their sleep-wake cycle and stop them from getting quality sleep regularly.
When it comes to dementia and sleep issues, a specific part of the brain known as the suprachiasmatic nucleus is also imperative to discuss. This part of the brain is responsible for working as an internal clock and responding to cues like light. By responding to these cues, the suprachiasmatic nucleus can guide a person when to feel sleepy and stay alert. Individuals with Alzheimer’s disease, the most common form of dementia, often experience damage in their suprachiasmatic nucleus cells in addition to a decrease in their overall activity. [2] Consequently, it starts malfunctioning, making patients suffer in regulating their 24-hour sleep-wake cycle. Some may start sleeping more during the day and little at night.
Additionally, dementia can also cause changes in the overall sleep structure. When a person sleeps, their bodies go through a series of sleep stages, including the following:
- Light sleep, which includes stages one and two
- Deep sleep, which includes stage three
- Dream sleep, also known as rapid eye movement or REM sleep
REM sleep and deep sleep are the most crucial stages of sleep as they help restore the mind and body. Unfortunately, people with dementia spend considerably less time in these stages and more in the earlier stages, affecting the overall quality.
Common Sleep-Related Disorders in Dementia
Sleep disorders often hit individuals with dementia. Some of the most common ones of these disorders include the following:
- Restless legs syndrome: Also known as RLS, restless legs syndrome includes an overwhelming desire to move the legs constantly. These attacks particularly happen at night and are more common in people suffering from a certain type of dementia called Lewy body dementia.
- Obstructive sleep apnea: Also known as OSA, this sleep disorder includes frequent nighttime airway collapses that cause brief lapses in breathing. OSA is quite common in people with Alzheimer’s disease, with an incidence rate of almost 40 percent. Interestingly, having OSA can also raise a person’s risk of suffering from dementia.
- Periodic limb movement disorder: Also known as PLMD, this condition includes uncontrollable movements of legs and arms at night. Many patients with PLMD also suffer from restless legs simultaneously.
- Depression: Despite being classified as a mood disorder, depression is often associated with insomnia and other sleep-related issues. It is also common in people with dementia and can worsen as dementia progresses with age.
- REM sleep behavior disorder: This disorder may cause individuals with dementia to act out during dreams, sometimes in risky ways. The behavior is more common in people with Lewy body dementia and can be one of the earliest symptoms that arise in this condition.
Helping a Person with Dementia Sleep Better
Sleep hygiene is the first thing to focus on to help someone with dementia sleep better. It includes a collection of environmental considerations and practices promoting good sleep quality. Following are some sleep hygiene tips to follow for a person with dementia to improve their overall sleep quality and patterns:
- Stick to a regular schedule: Set a predictable sleep-wake cycle to synchronize your circadian rhythm in dementia. Invest in your bedroom environment to make it quieter, soother, and more relaxing. Consider engaging in relaxing activities before bedtime, such as reading a book or taking a bath, and avoid using electronic devices as they emit blue light, which disrupts sleep.
- Limit the number of naps: Many people are fond of taking naps during the day; however, doing so can reduce sleepiness at night. Consider skipping napping during the day or limiting them to less than 30 minutes to regulate sleep at night.
- Add light exposure: Light remains a primary regulator of circadian rhythm in humans. Hence, get as much natural light as possible during the day to peacefully sleep at night. Invest in indoor bright light therapy if access to light is limited for any reason, such as weather.
- Schedule social activity: Research has indicated that people experiencing dementia can improve their nighttime sleep by participating in one to two hours of daily social activity. [3]
- Keep away from stimulants: Stimulants, such as nicotine, alcohol, and caffeine, can disrupt sleep, especially when taken too close to bedtime. Hence, try to limit their use in people with dementia. If not possible, use them in the morning time.
- Try to exercise regularly: Exercising too close to bedtime often negatively affects sleep. However, getting it earlier during the day can positively benefit it, leading to a better mood and higher quality sleep every night.
- Create a relaxing bedroom environment: Ensure your bedroom is quiet, dark, and comfortable to promote sleep. Some people with dementia can benefit from keeping well-loved objects close to their bed as it helps them sleep. Those who cannot sleep in pitch dark can use night lights for security.
- Treat sleep and pain disorders: Many people with dementia are dealing with co-existing issues that may worsen their sleep, such as depression, sleep disorder, or pain. Treating them adequately with the help of a professional can also ultimately contribute to well-regulated sleep cycles.
Remember that while the sleep hygiene practices mentioned above seem easy for anyone, people with dementia may struggle to follow some of them. For instance, they may be unable to control their bedroom environment or reduce noise levels if they live in an assisted living facility or a nursing home. Similarly, a person fighting dementia may not set and maintain a regular bedtime routine due to variable daily activities or napping during the day. In such situations, a physician should provide tailored advice to help them make the most out of their night hours and get sound sleep.
FAQs
Is there a role of medication in managing dementia and sleep issues?
Medications are often the last option for people suffering from dementia and sleep issues. The risks of using these medications include sedation, increased confusion, and frequent falls and injuries. Ensure to speak with a doctor before giving a loved one with dementia any sleep aids.
Can sleep affect dementia risk?
Experts suggest that dementia and sleep share a bidirectional relationship, which means while sleep can affect dementia symptoms and risk, the disease can also affect sleep quality. For instance, one of the earliest symptoms of dementia includes the accumulation of amyloid-beta, a protein that clumps together to form amyloid plaques. Animal studies have shown that a lack of sleep can cause increased levels of amyloid-beta within the nervous system. Similarly, people with higher levels of these plaques also experience worse sleep quality than those with no plaques in the background of dementia. Sleep is also crucial for memory formation and cognitive functioning, and observational studies have shown that sleep issues can also cause dementia and cognitive decline.
What causes dementia screaming at night?
Screaming at night often occurs in people with dementia as a part of a phenomenon called sundowning. During sundowning, patients with dementia feel increased agitation during evening and night hours along with other symptoms, like yelling, wandering, anxiety, and confusion. Sundowning can also contribute to sleep issues such as insomnia, especially when it continues during the night. Some possible causes of sundowning include changes in circadian rhythm that occur as a part of dementia, along with pain, depression, and fatigue. People with dementia also yell, cry, or talk at night if they are unable to sleep, with a tendency to wander away from homes, which may prove dangerous.
What stage of dementia is sleeping all the time?
Sleeping more and more with time is a feature of late-stage dementia. With disease progression, the damage to a patient’s brain becomes more prominent and extensive, making them frailer. Consequently, they spend more time sleeping.
References
1 Rowe MA, Kelly A, Horne C, Lane S, Campbell J, Lehman B, Phipps C, Keller M, Benito AP. Reducing dangerous nighttime events in persons with dementia by using a nighttime monitoring system. Alzheimer’s & dementia. 2009 Sep 1;5(5):419-26.
2 Petit D, Gagnon JF, Fantini ML, Ferini-Strambi L, Montplaisir J. Sleep and quantitative EEG in neurodegenerative disorders. Journal of psychosomatic research. 2004 May 1;56(5):487-96.
3 Richards KC, Beck C, O’Sullivan PS, Shue VM. Effect of individualized social activity on sleep in nursing home residents with dementia. Journal of the American Geriatrics Society. 2005 Sep;53(9):1510-7.