Home > Behavior, Caregivers, Medical issues, Sleep disturbances > Sleep Disturbances in Dementia

Sleep Disturbances in Dementia

December 3, 2012

sleeping-man

Individuals with dementia often have difficulty sleeping.  There are a number of reasons why this may be happening, that may or may not be directly due to the person’s dementia.  Sometimes the culprit can be medical or environmental issues, and the person may simply not be able to recognize the problem or do something about it because of the dementia. The solution to this problem lies in first determining what the cause is.  What is it that is causing the person to have trouble sleeping at night, when it is appropriate to do so?

It is natural, as we get older, for us to need less sleep than we did.  Retirement and a less active lifestyle can play a part here.  However, if a person is bored or not getting enough stimulation, he is liable to fall into a pattern of sleeping during the day.  The reverse is also true; if a person is feeling overwhelmed by the amount of activity going on around him, he may try to escape from that by sleeping.  Either way, if a person is sleeping too much during the day, he will not be able to sleep at night.

The person who is having trouble sleeping at night may have a medical problem that needs attention.  It could be that the dementia has attacked the particular part of the brain that acts as our biological “clock” that regulates our body’s sleep patterns.  It could be that the person is being plagued by some illness that is making it difficult for him to sleep, possibly due to pain or breathing problems.  (Common culprits here are arthritis, angina, indigestion, and others.)  If he snores and/or has leg cramps during the night, he may have sleep apnea.  Depression may also cause a person to have difficulty sleeping — in particular, he may wake up early in the morning and have trouble going back to sleep.  Some medications may also produce side effects that can interfere with sleep (for instance, diuretics that can make a person have to go to the bathroom frequently).

There are also environmental factors that can influence a person’s sleep patterns.  These can include the room temperature; if the person is too hot or too cold he may have difficulty going to sleep or may wake up during the night.  Too, sometimes dementia can interfere with the body’s internal regulatory system, or can cause the person to be overly sensitive to changes in temperature.  Changes in the environment, such as going to the hospital or  moving to a new home, may lead to disorientation and disturbed sleep.  If a person does have to get up in the night, and cannot easily locate the bathroom, this can make it difficult for him to get back to sleep.

Other things that can contribute to sleep disturbances include asking the person to go to bed too early or too late.  If he is allowed to sleep too much during the day, he can then have trouble sleeping at night.  A person who does not get enough physical exercise or cognitive stimulation during the day will often have a hard time going to sleep.  Too much caffeine or alcohol may also induce wakefulness.  If a person is hungry he may also have difficulty sleeping.  If he is agitated, whether due to an over-stimulating environment or a catastrophic reaction, he may also be wakeful into the night.

One of the first steps that should be taken when a person with dementia has trouble sleeping on a consistent basis is to have him evaluated by his doctor.  If he is taking diuretic medication, consider asking the doctor if this can be changed or if it may be given to the person earlier in the day.  Administration of a mild analgesic, such as Tylenol, may be appropriate shortly before the person goes to bed if he appears to be dealing with pain.  (Making sure that the person is positioned properly, and is free from contractures or bedsores, is also important.)  Ask the doctor if it may be appropriate to treat the person with sedatives, or sleeping medications.  Also be sure to check out whether he may be experiencing side effects from medications, or if treatment for depression may be indicated.

Caregivers should make certain that their charges are not having sleeping difficulty because of environmental factors.  Be sure to keep the environment consistent, with regards to temperature and lighting.  Is the person too hot or too cold when he wakes up?  Shadows or glare, due to inadequate lighting, can cause the person to have hallucinations, or to perceive things in the environment wrongly.  The use of night lights can help here, and can also help the person find his way to the bathroom during the night.  A bedside commode may also be helpful.  Daytime clothing should not be placed where the person can see it at night, as this may make him think it’s time to get up.  Ensure that he is getting sufficient exercise, and doesn’t just sit around doing nothing all day.

Consider cutting down on caffeine in the person’s diet, or eliminating it altogether.  (This includes chocolate.)  Alcohol intake should also be discouraged, especially later in the day.  A light snack might be helpful, shortly before bed, particularly if supper was eaten fairly early in the evening.  Or, a cup of tea or warm milk before bed may help.  If the person’s internal clock is malfunctioning, and his brain no longer gives him clues that it may be time for bed, he will need to rely on environmental cues such as dimming the lights, having the staff speak in softer tones as they go about their business, playing soft music, and so on.  A consistent evening routine will also help here.

Try to avoid any strenuous activity, starting about mid-afternoon and going into the evening.  This includes any catastrophic reactions from the person with dementia or anyone else in the environment.  If he simply refuses to go to bed, try making him comfortable in a recliner or the sofa, with a blanket and some soft music.  Chances are that he’ll drop off to sleep before long.  Allow him to wander at night, if he needs to, but be sure that the house is safe so that he won’t fall and get hurt.  A soothing back-rub or a warm cloth to the face may help.

It is important to note that, as the person progresses into the latter stages of dementia, he will need more sleep.  Disruptions in sleeping patterns or evening periods of agitation will often diminish as a person moves into a latter stage of the disease.  But, most important of all, it is important that caregivers get enough sleep themselves, so that they are better able to provide good care for their charges.

 

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