Alzheimer’s, Dementia and Sleep

Medically reviewed by Lauren Castiello, MS, AGNP-C

Lauren is a board-certified adult-gerontology primary care nurse practitioner. Lauren has done NP clinical practicums focusing on the adolescent, adult, and geriatric populations in internal medicine, long-term care, and in outpatient oncology/bone marrow transplant. Lauren received a BA from Assumption University, a BSN from Massachusetts College of Pharmacy and Health Sciences, and her MS in Nursing from the University of Massachusetts at Lowell. She is certified by the American Academy of Nurse Practitioners (AANP).

Medically reviewed by Lauren Castiello, MS, AGNP-C

Some of the best experiences of our lives live as memories in our minds. Our memory opens the doors to the places we’ve been, people we’ve met, foods we’ve tasted, and the music we’ve heard. It also helps us survive independently in the world by helping us maintain our most basic functions. As such, it becomes a struggle when these memories, at no fault of your own, become foggy and unrecallable. 

According to the Centers for Disease Control and Prevention (CDC), Alzheimer’s Disease is the most common form of dementia and involves the progressive loss of memory, thought and language. Common in adults over 60, over six million people in the U.S. live with Alzheimer’s. As you age past 65, your chances of getting Alzheimer’s doubles within every five years. By 2060, experts anticipate that over 14 million people will be affected by the disease.

Scientists still do not understand the disease in its entirety, so sadly, there is no cure, and it has become a part of everyday life for many elderly Americans.

Alzheimer’s vs Dementia 

While Alzheimer’s may be the most known form of dementia, they are not one and the same. While Alzheimer’s is a disease, dementia is simply a set of symptoms that can lead to further issues, such as Alzheimer’s. While all Alzheimer’s patients have dementia, all dementia patients do not have Alzheimer’s.  

So, what is dementia exactly? The World Health Organization (WHO) defines it as “a syndrome in which there is deterioration in memory, thinking, behavior, and the ability to perform everyday activities.”  Dementia affects an estimated 50 million people worldwide, with around ten million new cases discovered each year.

Both dementia and Alzheimer’s can affect your life in many ways: physically, psychologically, socially, and economically. It can also affect your relationships with family, friends, and colleagues while impacting your ability to live a normal life. 

One way that dementia and Alzheimer’s can affect you the most is during the night when you are trying to sleep. Changes to sleep patterns are common, with often severe effects that include trouble sleeping and changes to the natural sleep cycle. There’s even a term for it: Sundowning. 

However, the Alzheimer’s Association says that this discomfort could be only temporary. “Nighttime restlessness doesn’t last forever. It typically peaks in the middle stages of Alzheimer’s and then diminishes as the disease progresses.” 

If you or a loved one live with a form of dementia like Alzheimer’s Disease, there are some ways to improve your sleep naturally and effectively. As the old Irish proverb goes, “A good laugh and a long sleep are the two best cures for anything.”

Alzheimer, Dementia And Sleep

Alzheimer Effects on Sleep

There are a few reasons why those with dementia suffer more at night. Of those with mild to moderate dementia, 25% experience sleep disturbances. That number doubles to 50% for patients with severe dementia. 

Studies show that up to 20% of Alzheimer’s patients can experience increased anxiety and agitation as the day progresses, known as sundowning. This is due to increased exhaustion as the day wears on. Patients are more susceptible to changes in their natural body rhythms from long, difficult days under the heavy cloak of confusion. Nightmares and dreams can cause severe disorientation, making shadows suddenly seem menacing. With reduced eyesight, confusion can send the brain into overdrive, pushing sleep farther and farther away. 

Thus, caregivers commonly experience these symptoms and issues with dementia and Alzheimer’s patients:

• Wandering and moving around
• Unable to lay still
• Yelling, screaming, crying, or calling out
• Excessive sleepiness during the day
• Frequent wakeups
• Insomnia and difficulty falling asleep
• Increase in Rapid Eye Movement (REM)
• Restless Leg Syndrome (RLS)
• Breathing disorders

Obstructive sleep apnea is also more common in those with Alzheimer’s. Since most nightmares happen during REM sleep, Alzheimer’s and dementia patients may be suffering from more vivid scary dreams and wake up feeling anxious. And if they experience Restless Leg Syndrome (RLS), their bodies can be moving and twitching long into the night, keeping sleep at bay.

Experts estimate that patients with advanced Alzheimer’s Disease spend about 40% of their nights awake.  This is largely due to daytime sleep, which, in more severe cases, can cause a complete reversal of regular sleep patterns. 

Dementia Effects on Sleep

Dementia also takes its toll on an older individual’s quality of sleep. The Alzheimer’s Society of dementia says, “As the disease progresses, the damage to a person’s brain becomes more extensive and they gradually become weaker and frailer over time.” This leads to increased sleep in later stages as the disease gradually takes over more and more. 

In earlier stages, however, it’s common for dementia patients to experience sleep impairment. One study shows that a whopping 70% of those with cognitive impairment experience sleep disturbances. 

As the brain weakens and dementia requires more effort from the body, it can leave many feeling absolutely drained during the day and in need of a nap. That daytime sleep, however, can severely impact your regular sleep patterns, especially if naps become a regular habit.

Scientists have found that this is due to changes in brain patterns, affecting one’s natural circadian rhythm. Your circadian rhythm is your body’s regular cycle of physical, mental, and behavioral changes that all fluctuate daily. For example, The National Institute of General Medical Sciences (NIGMS) identifies the light-related circadian rhythm as the one that controls your normal wakefulness patterns during the day and sleeps at night.

Studies also show that dementia can affect your sleep with these symptoms.

• Anxiety and depression
• Restless Legs Syndrome
• Breathing disorders 
• Disorientation and fear
• Confusion and hallucinations

It’s not uncommon for people with dementia to become disoriented when they awake to use the restroom. Some may even wake up, thinking it’s time to start the day or get ready for work. When there is disorientation of this magnitude, it can be rather difficult to get back to sleep. 

How Those With Alzheimer and Dementia Receive Quality Rest

The National Institutes of Health (NIH) strongly encourages those with dementia first to pursue non-medication therapies. In fact, drugs may not help at all, with most studies showing that sleep medications can exacerbate the problem rather than help it.  

It can cause a whole new set of damages, according to the Alzheimer’s Association, which warns that “Use of sleep medications is associated with a greater chance of falls and other risks that may outweigh the benefits of treatment.

To naturally improve your sleep, here are a few expert-recommended tips to help you find sleep.

• Maintain a regular schedule. That extends far beyond just your sleep schedule. Have meals at regular times each day, with a set time for bedtime and wake up.   

• Spend your mornings in the sun. The benefits of Vitamin D have been long proven, but it can help your sleep, too. Considered light therapy, the Fisher Center for Alzheimer’s Research Foundation says that exposure to daytime sunlight helps to reset circadian rhythms upset by dementia.

“Different studies have found it to resynchronize the sleep cycle and make improvements in depression, anxiety, and behaviors such as agitation and pacing,” says Kim Butrum, Senior Vice President for Clinical Services at California senior living community Silverado. “Light could be a great non-pharmacological treatment to help improve mood and quality of life.”

• Pay attention to your fitness. Exercise can help tire the body, wearing you out for sleep. Experts recommend 150 minutes of exercise each week, which works out to roughly 30 minutes a day, five days a week. However, be careful not to work out less than four hours before bed. Otherwise, your body may not have adequate time to calm itself and prepare for sleep. 

• Avoid natural stimulants. Although enjoyable, things like alcohol, caffeine, and nicotine can all keep the body alert and interfere with your attempts to sleep.

• Avoid certain medications before bed. Some medications, such as cholinesterase inhibitors, can make it harder to fall asleep. Examples of these medications include drugs like tacrine, donepezil, rivastigmine and galantamine. Side effects have been shown to affect things like your heart rhythm, nausea and vomiting, diarrhea, leg cramps and muscle spasms. Talk to a doctor to help you determine what time of the day is best to take these medications, so they don’t interfere with sleep.

• Make your room more inviting and comfortable. Adding soothing night lights or warm lighting in your bedroom can chase away confusing shadows and make your bedroom more soothing and cozy. It doesn’t require a ton of money to upgrade your bed, either, with some excellent choices available for cheap mattresses and bed linens. 

Caregivers Tips

How Family Can Help Someone With Alzheimer and Dementia Get Better Sleep 

As a caregiver, your role is invaluable to a loved one living with dementia. In fact, researchers from the Dialogues in Clinical Neuroscience call family caregivers “the invisible second patients,” saying that their support is “critical to the quality of life” of their family members. 

HelpGuide estimates that more than 16 million caregivers in the United States alone care for someone with dementia. Dementia can be a frustrating, tortuous disease, but you can help make each day a little better as a caregiver. That can start with better sleep.

These are some things you can do as a caregiver to help your loved one sleep better.

• Stick to a schedule. People with dementia benefit considerably from a regular schedule, so try to encourage regular mealtimes and bedtimes as much as possible. This will help the body relearn normal sleep habits, leading to more sound, refreshing sleep.

• Make home inviting. It’s the little things that can transform home from a scary place into a safe, comfortable space. Make sure the bedroom and living areas are well-lit with warm lighting. Set the thermostat at a comfortable temperature for sleep, and add extra safety measures like window and door locks or smart home technology.

• Have patience and understanding. Dementia can cause confusion over the littlest things, turning the most minor of details into an enormous struggle. While it can be frustrating to you as a caregiver, it affects no one more than the person living it, so always remember to be patient and kind, even when you yourself do not understand. 

Maintaining a sleep log can help, too. You can use this journal to record episodes of insomnia or agitation, so your loved one’s medical team can more accurately diagnose and treat the disease. You can also use it to track progress or a decline in condition, offering doctors the specific information they need but so rarely receive.

Resources

When dementia or Alzheimer’s Disease is a part of your life, there are good and bad days. When you find yourself needing the extra boost of a support group, take comfort in the fact that many wonderful organizations are ready to help. 

The Bottom Line

Dementia can be very lonely as it slowly wipes the slate clean, erasing a lifetime of memories, details and faces. In many cases, it can be like a regression back to childhood, where gradually or suddenly, you find yourself unable to care for yourself adequately. 

Dementia and Alzheimer’s Disease can make it difficult to get through the day and even the night. That’s especially troublesome when you need all the rest that you can get to stay strong and fight back. Sleep allows you to recharge your batteries, giving the mind and body rest to defend themselves properly.

Whether you are living with dementia or supporting someone in their battle, you can do plenty of things to make life more manageable. You can reinforce good sleep health by making home a safe and comfortable place, including everything from warm lighting that soothes the mind to smart cameras and door locks that reinforce safety within the home. Science also shows that dementia patients benefit significantly from a routine that reinforces set mealtimes and bedtimes to promote a healthy circadian rhythm within the body.

Sleep does not have to elude you when you are living with dementia, Alzheimer’s and insomnia. A steady routine and regular reinforcement of healthy habits can have you counting those sheep sooner than later, and you may just be surprised by the health benefits that you experience along the way.