Sleep Issues Associated with Dementia
Sleep Issues Associated with Dementia
Many people experience changes in their sleep habits with aging; however, those with dementia typically experience more severe changes. Disruptive sleep patterns tend to worsen with the severity of the dementia.
Poor sleep can contribute to agitated behavior, delirium, cognitive decline, functional impairment, falls and injuries, and increased mortality among those with dementia. Additionally, the care recipient’s poor sleep often disrupts the caregiver’s sleep and increase caregiver burden. This can have adverse consequences on the caregiver’s health and increase the likelihood of placing the care recipient in a long-term care facility.
Sleep pattern disturbances associated with dementia include decreased total sleep time, increased frequency and duration of awakenings at night, increased daytime napping, decreased dreaming and non-dreaming stages of sleep, decreased sleep efficiency, and altered sleep-wake cycle.
These changes may be due to damage or loss of cells in the brainstem regions and pathways that regulate the sleep-wake cycle. Additionally, research suggests there may be a genetic contributor to poor sleep in some people with dementia.
Issues associated with dementia and poor sleep patterns include sundowning, wandering, incontinence, pain, depression, anxiety, nightmares, hallucinations, illusions, and delusions. Consult a healthcare professional, therapist, or counselor if there are concerns about pain management, depression, anxiety, or any other underlying health problem that may be contributing to poor sleep. Here are some approaches for dealing with some of the issues that affect sleep.
- Tips for decreasing the risk of sundowning (period of worsening behavioral symptoms such as increased agitation, anxiety, aggressiveness, restlessness, confusion, or disorientation that occurs near sunset or nightfall) include:
– Limit napping.
– Encourage exercise.
– Establish a bedtime routine.
– Treat pain symptoms as much as safely possible.
– Reduce disruptive environmental factors.
– Make afternoon and evening hours less hectic.
– Reduce foods and beverages containing caffeine.
– Keep rooms adequately lit.
– Consult a physician if necessary. - Tips for dealing with wandering include:
– Try to address the reasons or triggers for wandering.
– Place locks and/or door alarms on doors.
– Dedicate a safe place for wandering.
– Keep dangerous chemicals, cleaners and objects locked away.
– Have the person with dementia wear a medical bracelet or necklace.
– If the person wanders away from home, call the police.
– Consider enrolling the person in the Alzheimer’s Association’s Safe Return® Program or similar program.
– Discuss modifying any existing medication regimen with a physician. - Tips for dealing with incontinence include:
– Plan scheduled trips to the bathroom.
– Make sure the path to the bathroom is well lit and clear.
– Leave a nightlight on in the bathroom.
– Make sure clothing is simple and easy to disrobe.
– Reduce the intake of liquids in the evening.
– Consider a bedside urinal or commode. - If the person with dementia awakens from a nightmare:
– Offer reassurance that everything is all right and everyone is safe.
– Consider using distraction if the care recipient wakes up frightened or confused. - If the person with dementia is having a hallucination (false perception) or an illusion (misinterpreted perception):
– Investigate possible environmental triggers for the altered or false perception.
– Provide reassurance the person is safe.
– Let the person talk about the hallucination or illusion.
– Avoid arguing to convince the person that the perception is not real. - If the person with dementia wakes up feeling upset:
– Speak softly and quietly using a relaxed tone.
– Do not argue with the person or ask for explanations.
– Find out if there is something s/he needs to help her/him go back to sleep. - If the person with dementia wakes up during the night, assume that s/he is disoriented.
– Orient and reassure the person.
– Remind the person that it is time for sleeping.
Dementia is associated with changes that disrupt normal sleep patterns. Poor sleep negatively affects both the care recipient and the caregiver. However, by understanding and preparing for these changes and trying some of the approaches listed above, it is possible to improve unhealthy sleep patterns. If sleep issues persist or become too difficult to manage, consider consulting a healthcare professional.
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