Sleep Challenges in Aging and Alzheimer’s Disease

Many older adults complain that they have trouble falling asleep at night. They wake up repeatedly and can’t get back to sleep, or they feel excessively tired during the day. Changes in the brain cause older adults to spend less time in a deep, restorative stage of sleep. This causes them to wake up more easily, and feel less rested in the morning. There is a tendency for bed and rising times to “shift”, often causing a person to fall asleep earlier and then wake up too early in the morning.

Progressive neurological diseases, such as AD, accelerate these normal age-related changes. Many age-related chronic diseases, as well as the medications used to treat them, further disrupt nighttime sleep and increase daytime fatigue. When sleep difficulties are compounded with other dementia-related problems, such as wandering or agitation, caregivers can quickly become exhausted and overwhelmed. Attempts to “catch up” on lost sleep,with extended daytime naps or sleeping late on weekends, only make the situation worse. Not surprisingly, sleep disturbances are a common reason that persons with dementia are moved into nursing homes.

Improving sleep can improve the quality of life for both the person with AD and his or her caregiver, but treatment is sometimes difficult. A number of medications (including prescription sleeping pills, alcohol, over-the-counter sleep aids, or naturopathic remedies) are available to improve nighttime sleep. However, all sedating medicines can produce undesirable side effects that are particularly dangerous for older adults with dementia, such as confusion, increased risk for falls, and impaired daytime alertness. Because of these potential side effects, the National Institutes of Health have recommended that sleep medications be used only for transient or short-term sleep problems.

A number of non-medication approaches are widely recommended as an alternative to sleeping medications, including:

  • Maintain a consistent bedtime and rising time.
  • Limit daytime napping.
  • Restrict use of alcohol and caffeinated beverages.
  • Eliminate or reduce environmental factors that may interrupt sleep, such as bright lights shining into the sleeping area, pets jumping on the bed at night, television or radio noise, and bedroom temperature extremes.
  • Try a light bedtime snack or warm bath before bed to promote sleep.
  • Be aware that changes in daily routine, such as family get togethers or holidays, may worsen nighttime sleep.
  • Plan ahead and build in some quiet “catch up”time, following any out-of-theordinary scheduled activity.

As with all dementia care, it is important to find a sleep treatment plan that makes sense to the person with AD and the caregiver. The most typical plan would be one that targets factors, both relevant and modifiable, in their particular situation. For example, mildly demented patients,without any other significant behavior problems might benefit from a basic behavioral program. Such a program establishes a regular bed and rising time, and reduces daytime napping. However, some caregivers may be reluctant to eliminate patient naps, or modify existing sleep/wake routines. The hesitation comes out of fear that the change will increase their daily care giving burden, more than it will improve nighttime sleep quality. In these situations, it may be more useful to enlist the help of family or friends. They can help establish a regular nightly program to give the caregiver a needed psychological and physical break from patient supervision. For patients whose sleep problems are associated with significant disruptive behaviors, a combined approach of behavioral and medication treatment may be necessary. The type of individualized sleep program described above can be developed with the help of your family health care provider, and is more likely to be effective than a “one size fits all” approach.

The University of Washington School of Nursing, is currently conducting two sleep research studies. Both studies use non-medication treatments for improving sleep in persons with dementia who are either living in their own home with a family caregiver, or who are residents of an adult family home. If you are caring for someone with memory loss, who has sleep problems, and would like more information about either of these research studies, contact Amy Moore, M.S., Research Study Coordinator, Psychosocial and Community Health, University of Washington. Phone: 206-616-5550 or toll free 1-866- 292-4464