Sleep Disorders in People with Alzheimer's Disease

Problems Sleeping in Alzheimer's Disease
Sleep Disorders. Credit: Kim Carson/ Getty Images

It is estimated that up to 70% of people with Alzheimer's disease will experience disruption of nighttime sleep. Practitioners recommend a variety of coping mechanisms, ranging from medication to changes in daily routines.

Why Do Sleep Disturbances Occur?

Researchers are not exactly sure why individuals with Alzheimer's disease have sleep disruptions.

Some researchers theorize that the sleep disturbances have to do with breathing problems, a common condition in individuals with Alzheimer's disease. Studies have reported that 30% to 70% of patients with Alzheimer's disease have sleep-disordered breathing. Sleep-disordered breathing is the label for a group of disorders that cause irregular breathing patterns during sleep. Sleep apnea is the most common example of this disorder.

In ways that aren't entirely understood, Alzheimer's disease also seems to affect an individual's circadian rhythm. Circadian rhythm, the natural timing system of the body, is responsible for allowing the brain to relax at night and be stimulated during the day. People with Alzheimer's disease often find it hard to sleep at night and conversely, will have difficulty staying awake during the day. A 2007 study published in the medical journal Gerontology found that people with Alzheimer's disease typically have a slightly increased core body temperature, a factor which may disrupt normal circadian rhythm. It is also thought that neuroinflammation, or inflammation in the brain, might also impact circadian rhythm.

Difficulty sleeping is often paired with an increase in symptoms such as agitation, disorientation and even repetition, such as mimicking a caregiver's words and actions, during the early evening and nighttime hours. This phenomenon is referred to as sundowning. According to the Alzheimer's Association, sundowning may be caused by exhaustion and an inability to distinguish reality from dreams.

What Can Alleviate Sleep Disruptions?

Before heading to the medicine cabinet, caregivers can try some of the following techniques:

  • If sleep-disordered breathing is suspected, consider continuous positive airway therapy. This therapy involves the use of a machine that supplies the patient with a continuous stream of air. Studies have shown this therapy to be successful among Alzheimer's disease patients.
  • Stick to a daily schedule, setting regular times for waking in the morning and sleeping at night.
  • Support a daily exercise routine, but reserve the four hours before bedtime for more quiet activities.
  • Keep TV and other screen exposure such as computers to a minimum, especially within the four-hour period before bedtime.
  • Set up a nightlight and provide a "transitional object," which helps the individual transition from day to night. This object can be a blanket, item of clothing or even a stuffed animal, but use it only at nighttime.
  • Limit use of cigarettes, caffeinated beverages and alcohol.
  • Encourage daytime exposure to sunlight.
  • Some medications can increase wakefulness, so talk to a physician or pharmacist about which medications might be disrupting sleep. Consider changing medications or the medication schedule, to avoid giving the drug in the evening.

    Can Medication Help Treat Sleep Disorders?

    The list of medications that treat sleep disorders is lengthy, and includes drugs ranging from tricyclic antidepressants, such as Pamelor or Aventyl (nortiptyline), to traditional sleeping pills like Ativan (lorazepam). Aricept (donepezil), a medication already approved to temporarily limit the progression of Alzheimer's disease, has also been shown to increase oxygen saturation in patients with Alzheimer's-related sleep disordered breathing.

    Melatonin, a naturally produced hormone, is also sometimes used with the goal of facilitating sleep in people with dementia.

    Each medication has possible side effects that should be discussed with a physician prior to beginning treatment.

    According to the Alzheimer's Association, the use of medications to induce sleep should be avoided. Sleep medications are associated with an "increased risk of falls and fractures, confusion and a decline in the ability to care for oneself." Experts advise that if such medications are used,  the smallest amount of medication needed should be used.

    As many sleep medications can be habit-forming, experts also recommend phasing out the drugs after attaining a healthy sleep schedule.

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