Older people tend to have problems with sleep. Older people with dementia who live in nursing care tend to have severe problems with sleep. In a nursing home, a typical patient has neither a single hour of uninterrupted sleep nor a single hour of uninterrupted wakefulness in a typical 24-hour day. Both too much sleep and too little sleep are associated with faster loss of cognitive abilities.
Up to 60 percent of people who have dementia also have sleep apnea, which becomes a vicious cycle — sleep apnea makes dementia worse, and dementia makes sleep apnea worse. Attention, reasoning abilities, eye-muscle coordination, and memory are all worse when there is sleep apnea. And sleep apnea is linked to getting dementia at an earlier age and having dementia that progresses more quickly, in every kind of dementia, but especially in Alzheimer's and Parkinson's disease. There is evidence that in Alzheimer's lack of sleep deprives the brain of opportunities to clear out defective, tangled proteins that "strangle" neurons. But when people who have dementia are somehow able to get enough sleep, other risk factors for the disease may be canceled out.
What can family members and caregivers do to ensure that people who have dementia get enough sleep? Here are 10 suggestions:
- Make sure the dementia patient is exposed to bright light during the day. Two hours outside in the morning (7:00 to 9:00) in bright sun helps reset the biological clock for nighttime sleep. So does providing bright light during the day and just enough light for safety at night.
- Avoid caffeine (coffee, tea, or cola) after the middle of the afternoon. Avoid alcohol at night. If the dementia patient habitually has a nightcap, try offering it in the afternoon.
- When someone with dementia wakes up during the night and attempts to begin morning activities, gently remind them that it is night and reassure them that everything will be there for them in the morning.
- Make sure the patient gets some gentle exercise in the early evening, but nothing strenuous, and nothing closer than two hours to bedtime.
- If too much light comes in from outside the room, consider blackout curtains. Sleeping masks are usually not a good idea with dementia patients. Blue wavelengths of light stimulate wakefulness. Yellow wavelengths do not.
- If your patient likes to cuddle and there's no sleeping partner with whom to cuddle, consider a teddy bear or stuffed animal. Make sure there are no metal parts or buttons that can be removed or fall off during the night to prevent a strangulation hazard.
- A warm shower or bath before bed may aid relaxation. However, this needs to be an established part of the patient's routine. Changing routine to treat insomnia may cause agitation.
- Provide a safe and quiet place to sleep. Close the door to block out noise from the halls and from other patient rooms. Turn off any communal television well before bedtime, giving patients a chance to relax. Favorite shows can be watched later.
What about medications to aid sleep? Our ninth recommendation requires some background information.
There are numerous anecdotal reports and two clinical studies finding successful intervention in sleep problems in dementia by giving melatonin. This naturally occurring antioxidant tells the brain it's time to sleep. It is relatively safe when used under a doctor's supervision. It does not cause daytime drowsiness if it is taken within half an hour of the usual nightly bedtime. There is no increased risk for falls the next morning as there is with tranquilizers. There is no accelerated progression of the disease as there often is with antipsychotics. And there is reason to believe that as an antioxidant, melatonin may quench some of the oxidative processes that cause damage to neurons in dementia. Melatonin is readily available without a prescription, but only use it in dementia under a doctor's supervision.
The tenth and final recommendation for dealing with sleep issues in dementia is directed at caregivers. Don't forget that you need sleep, too. Caregivers who burn the candle at both ends to take care of their parents and their own children are particularly vulnerable to sleep deprivation. Since not getting enough sleep is a risk factor for developing dementia, if you don't want to face the same challenges in old age as your parents, be sure to get enough sleep! You will be a better son or daughter and a better mother or father if you do.