09 May How to help a person with Alzheimer’s sleep better
Patients with Alzheimer’s usually have trouble sleeping or experience changes to their sleep schedule. Although scientists have yet to find an explanation for this, there are treatments available that can help patients with Alzheimer’s sleep better.
Keep reading to find out which drugs and non-drug treatments are available to treat sleeping problems in patients with Alzheimer’s. Remember that you should always try non-drug treatments first.
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Common sleep changes in people with Alzheimer’s
When faced with an Alzheimer’s diagnosis, patients not only present memory problems or difficulty performing everyday tasks, but they may also show signs of behavioral changes, difficulty communicating and sleep changes.
Some sleep disorders that Alzheimer’s patients may experience can include very light sleep, trouble falling asleep and changes in sleep-wake cycles.
Patients with Alzheimer’s wake up easily, often and have trouble getting back to sleep. Brain wave studies show decreases in both dreaming and non-dreaming sleep stages.
If the patient is unable to get to sleep, they may sleepwalk, fidget, shout or call out, disrupting the sleep of their caregivers as well.
Daytime napping and other changes to the sleep-wake cycle
Alzheimer’s patients may feel sleepy during the day and be unable to sleep at night. They may feel restless or agitated in the late afternoon or early evening, an experience known as “sundowning” or “late-day confusion”.
Experts estimate that in the later stages of Alzheimer’s disease, patients spend 40% of their time in bed awake and a significant part of their day sleeping. In extreme cases, people can completely reverse the typical daytime wakefulness-nighttime sleep pattern.
Medical factors that may affect sleeping habits of Alzheimer’s patients
If an Alzheimer’s patient develops a sleep disorder, they should see their doctor for a thorough medical examination to identify the other treatable diseases that could be contributing to the problem.
Below are some examples of other diseases that can affect sleep patterns:
- Restless leg syndrome, a disorder characterized by an uncomfortable itchy or tingling feeling that causes an uncontrollable urge to move the legs.
- Sleep apnea, an abnormal breathing pattern in which people briefly stop breathing multiple times during the night, which has a negative effect on their quality of sleep.
For the sleep changes that are mainly due to Alzheimer’s, there are a number of pharmacological and non-pharmacological treatments available. Most experts strongly recommended using non-pharmacological treatments instead of medication wherever possible.
Pharmacological treatments are not recommended, as studies have found that these generally do not improve the overall quality of sleep in older adults, and they are associated with an increased likelihood of falls and other risks.
Non-pharmacological treatments for sleep changes in people with Alzheimer’s
Non-pharmacological treatments aim to improve the patient’s sleep routine and reduce napping during the day. It is recommended to try these non-drug treatments and coping strategies before taking any medication, as some sleep drugs can cause serious side effects.
Below is a list of recommendations to help improve the quality of sleep of patients with Alzheimer’s and to create a calming environment to promotes sleep:
- Maintain regular a regular schedule for meal times, bedtime and waking up
- Seek morning sunlight exposure
- Encourage regular daily exercise, preferably for 30 minutes in the morning, but never in the evening
- Avoid alcohol, caffeine, theine and nicotine
- Identify and treat any pain
- Avoid taking drugs such as tacrine, donepezil, rivastigmine or galantamine (cholinesterase inhibitors) right before bed
- Ensure bedroom temperature is comfortable
- Provide night lights and security objects
- Discourage the person from laying in bed if they are awake; their bed should only be for sleeping
- Discourage activities like watching television during periods of wakefulness
- Avoid the use of cell phones or tablets if they wake up in the night, as the bright light from the screens can stop them falling back to sleep
- There are essential oils and homeopathic remedies that can help them fall asleep and stay asleep.
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Pharmacological treatments for sleep changes in people with Alzheimer’s
In some cases, non-pharmacological treatments are not effective or the patient’s sleep changes are accompanied by nighttime behavioral disturbances. For those patients that do require medication, experts recommend that treatment should start gradually.
Drugs that induce sleep have considerable risks, especially for older people with reduced cognitive function. This type of medication increases patient’s risk of falling and fractures, and may also produce confusion and a reduced ability to look after themselves.
If you have been advised by a doctor to start your loved one with Alzheimer’s on medication to help them sleep, you should suspend its use once a regular sleep pattern has been established.
The type of drug that the doctor may prescribe to deal with sleep disorders, will take into account the behaviors that may accompany these sleep changes. The decision to take antipsychotic drugs should be made with extreme caution.
Scientific evidence shows that these drugs are associated with an increased risk of death by stroke in patients with dementia.
In fact, the FDA (US Food and Drug Administration) have told manufacturers that said drugs must come with a warning in a “black box” alerting patients about their risks, along with a reminder that they are not approved for treating symptoms of dementia.
Some examples of drugs used to treat sleep changes include:
- Tricyclic antidepressants, such as nortriptyline and trazodone.
- Benzodiazepines, such as lorazepam, oxazepam and temazepam
- “Sleeping pills”, such as zolpidem, zaleplon.
- “Atypical” antipsychotics such as risperidone, olanzapine and quetiapine
- Older, “classic” antipsychotics, such as haloperidol.
Every time you are prescribed a new drug, be sure to talk to your doctor about its benefits and risks, as well as the other options available.
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Remember that the Alzheimer’s community is growing every day. So, if you are feeling frustrated or worried about your situation, you can find support by sharing your experiences with us and other people that – like you – want to better understand how to cope with Alzheimer’s.
By sharing this article you could help someone else dealing with this disease.