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Treating Sleep Problems in People with Dementia

As a caregiver to a person with dementia, you may find that your patient or loved one has difficulty sleeping. This is a common problem in those with dementia, and one that compromises their sense of wellbeing and keeps them from feeling alert and engaged throughout the day.

But there is hope. By working with the person living with dementia to find the right treatment, you can help restore their health and vitality.

What is Dementia?

Before you begin, it’s essential to understand what dementia actually is. Dementia affects approximately 50 million adults globally, a number that’s expected to increase to 131 million by 2050.¹

Despite the prevalence of dementia, many people are still unclear about what this term means. Contrary to popular belief, dementia isn’t a particular illness. Instead, it’s a general category encompassing a variety of forms of progressive cognitive decline, including:

Loss of one’s ability to comprehend, retain, and recall information
Loss of language and reasoning abilities
Loss of one’s sense of direction
Loss of social skills and the ability to express one’s emotions
Loss of one’s ability to accurately estimate quantities, distances, etc.

You may have heard of Alzheimer’s disease, Vascular Dementia, and Lewy Body Dementia. These are all forms of dementia.

This cognitive decline results from damage to one’s brain cells, often caused by abnormally high protein levels inside the brain. This damage prevents these cells from communicating with one another, thus compromising the patient’s ability to think, act, and express themselves. Early signs of cognitive decline include:

Short-term memory loss
Repetitive speech or behavioral patterns
Difficulty finding the right words to use when speaking or writing
Difficulty following conversations and storylines
Trouble completing routine, daily tasks
Changes in mood
A sense of apathy
Confusion
Trouble adapting to change

When it comes to treating dementia, early detection is critical. If your patient or loved one shows any of the early signs of dementia listed above, we strongly advise that they see a doctor. While dementia cannot be prevented or cured, medication and proper treatment can slow cognitive decline and help maintain their overall sense of wellbeing.

Dementia and Sleep

In addition to exhibiting symptoms of progressive cognitive decline, individuals with dementia may also experience a variety of secondary symptoms. These include:

Depression
Addictive behaviors (such as excessive alcohol use)
Thyroid problems
Vitamin deficiencies
Difficulty sleeping

Of these secondary symptoms, sleep difficulties are among the most common. In fact, you could say that the relationship between dementia and sleep is reciprocal: dementia gives rise to poor sleep, which negatively impacts one’s energy levels and alertness during the day, which in turn exacerbates the symptoms of cognitive decline.

How You Can Help

While we don’t yet know what causes these sleeping difficulties in persons with dementia, we do know that there are a variety of ways to alleviate this secondary symptom.

First, you’ll want to verify that your patient or loved one’s sleeping difficulties aren’t simply a side effect of a medication they’re taking. If that’s the case, they may need to switch to another medication brand or type.

If sleep difficulties aren’t listed as a side effect of their medication, or if switching yields no improvement, then it’s safe to assume that their sleeping difficulties are caused by their condition.

Lifestyle Changes

Once you’ve confirmed that the dementia sufferer’s sleeping difficulties arise from dementia and not some other factor, you’ll want to begin by helping them incorporate lifestyle changes to facilitate better sleep. These include:

Creating a proper sleeping environment: Your sleeping environment has a huge effect on the quality of your sleep. You can help your patient or loved one get a good night’s sleep by ensuring that their room is dark and quiet and that their thermostat is set at a comfortable temperature.
Establishing a consistent sleep schedule: When it comes to minimizing sleep difficulties, a routine is key. Establishing a consistent sleep schedule with regular bedtimes and wake-up times will help restore your patient or loved one’s natural circadian rhythm, which is responsible for regulating sleep.
Outdoor or bright light exposure: Ensuring that your patient or loved one gets plenty of sunlight each day will also help regulate their circadian rhythm and improve the quality of their sleep. (As a bonus, daily light exposure may help alleviate “sundowning,” whereby your patient or loved one becomes agitated or confused late in the day.) Encourage them to spend time outside, or, if this is not possible, install a light therapy lamp in their home or room.
Physical exercise: Encourage your patient or loved one to engage in gentle exercises, such as walking. In addition to increasing blood circulation and physical fitness, regular movement tires the body, making it easier for your patient or loved one to sleep at night.

Together, these lifestyle changes will go a long way to alleviating your patient or loved one’s sleeping difficulties, while also improving their overall quality of life.

Drug Interventions

It may be that lifestyle changes alone are not enough to alleviate your patient or loved one’s sleeping difficulties. In that case, they may also need to take a prescription drug or supplement. There are a variety of sleeping aids, sedatives, and tranquilizers available to help your patient or loved one sleep.

Unfortunately, many of these drugs have serious side effects and may worsen the declines in cognition and motor skills that persons with dementia already face. However, there are two more mild substances with fewer side effects that you may want to consider:

Melatonin: Available as a supplement, melatonin is a hormone that plays a key role in facilitating sleep. However, it is poorly regulated – studies have shown that these supplements are often of questionable quality and purity – so should only be purchased from a trusted supplier.
Trazodone: A prescription drug, Trazodone is a mildly-sedating antidepressant. Known as the sleeping pill of choice among the elderly, it appears to have fewer side effects than other sleep aids.

The Takeaway

As a caregiver, it’s your job to help your patient or loved one achieve the best possible quality of life while living with dementia. By implementing lifestyle changes and prudently instigating drug interventions, you can help your patient or loved one sleep soundly throughout the night and be ready to embrace the coming day.

References

1. Prince M, Comas-Herrera A, Knapp M, Guerchet M, Karagiannidou M. World Alzheimer report 2016: improving healthcare for people living with dementia: coverage, quality and costs now and in the future [Internet]. London, UK: Alzheimer’s Disease International; 2016 [cited 2018 November 25]. Available from: http://eprints.lse.ac.uk/67858/