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Alzheimer’s and Sleep: Expert Answers to 6 Common Questions

Sleep issues are a well-documented side-effect of most manifestations of dementia, particularly Alzheimer's disease.

This presents a problem for caregivers; if a loved one isn't sleeping, neither are they.

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"Quite often, the lack of sleep is what first causes a caregiver to look at placing a loved one in a facility," says Maureen Bradley, L.P.N., C.D.P., director of the Alzheimer's care programs at several skilled nursing facilities run by Royal Health Group.

Many of these sleep deprived caregivers are plagued by the same questions: How do I get my dad to sleep through the night? Why does my loved one sleep all day? Why does my mom get so anxious at night?

Here are some answers to 6 of these common questions:

  1. Does Alzheimer's cause sleep problems? Yes, Alzheimer's can wreak havoc on a person's ability to fall (and stay) asleep. Suddenly adopting an irregular sleep schedule, and sleeping more than usual are both common side-effects of the disease, according to Emerson Wickwire, Ph. D., Sleep Medicine Program Director at Pulmonary Disease and Critical Care Associates in Columbia, MD. "As Alzheimer's progresses, a person's circadian rhythms tend to become desynchronized. They may become prone to dozing intermittently throughout the day, then experience difficulty sleeping at night," he says.
  2. Is my loved one "sundowning?" Sundowing refers to the collection of behaviors exhibited by someone suffering from Sundowner's syndrome, a dementia-related disorder that makes a person anxious and agitated as night falls. If your loved one is sundowning, they may become restless, pace around, shadow you, or even wander off. These behaviors typically start to occur sometime between 3:00 in the afternoon and 7:00 in the evening and may continue throughout the night, according to Bradley.
  3. Why do people with Alzheimer's have unusual sleep cycles? The precise cause of sleep problems in Alzheimer's sufferers is currently unknown, though many factors likely play a role. Wickwire points out that the disease alters the areas of the brain that regulate hormone secretion, appetite and cognitive functioning. Messing with any or all of these elements may result in restless nights. Bradley adds that some other contributors to unusual sleep cycles may include: a lack of activity during the day, or an inability to recognize a familiar environment, such as a bedroom.
  4. Is it okay to let someone with Alzheimer's sleep all day? This is a tough question to answer. At night, people with late-stage Alzheimer's spend up to 40 percent of their time lying awake in bed, according to the Alzheimer's Association. These sleepless nights typically translate to drowsy daytimes. According to Bradley, boredom is another big contributor to daylight lethargy. "Caregivers are often afraid to upset a loved one, so they just let them sleep," she says. But, letting a loved one lie in bed for too long during the day may make them more prone to waking up in the middle of the night. Bradley suggests trying to keep a loved one engaged and active during the day. It doesn't have to be anything special: adult day care activities, physical exercise, special outings, even simple errands can keep your elderly loved one engaged and active. If your loved one absolutely needs to rest, Wickwire recommends scheduling 20-30 minute naps during the day—enough to refresh them, without interfering with nighttime sleep.
  5. What about sleeping pills? "I don't like sleeping pills," says Bradley. "They put a person at risk for falls and cause them to feel hung over the next day." Indeed, research consistently indicates that, for older adults, the risks associated with prescription sleep aids outweigh the potential benefits. (Learn more about how a senior's fall risk may be increased by prescription sleep aids)
  6. How can I help a loved one with Alzheimer's sleep through the night? Unfortunately, expecting your loved one to get a solid night's sleep may be a pipe dream. But, that doesn't mean there aren't strategies you can try. In addition to keeping a person active and engaged during the day, the National Institutes of Health (NIH) urges caregivers to use other non-medical interventions, such as sticking to a routine and avoiding caffeine and alcohol, to reduce sleep problems in people with Alzheimer's. Drawing the blinds to block out nighttime darkness, making sure a loved one gets some sun exposure during the day, and crafting a sleep-inducing bedroom environment (proper temperature, comfortable bedding), are additional recommendations for getting a person with Alzheimer's to sleep sounder. If your loved one does wake up in the middle of the night, don't encourage them to try and go back to sleep. Bradley says it's better to get them started on a task, such as folding laundry, or reading a book, rather than trying to get them to stay in bed once they're awake.
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