Tackling sleep disruption in adults living with dementia

 

Introduction

Adults living with dementia commonly experience sleep disruption. It is estimated that between one quarter and one half of those with dementia are affected.

Sleep disorders can aggravate dementia symptoms and lead to restlessness, wandering, and further harm, such as accidental falls.

Sleeping problems are also reported as a factor contributing to the institutionalisation of people with dementia.

Sleep disturbance and stage of disease

Sleeping problems become more common as the disease progresses. It is thought that sleep disorders arise as a combination of the disease, the normal changes in sleep that occur as a result of ageing, and some of the lifestyle changes evident in those living with dementia.

Types of sleep disorders

Most commonly, the usual nighttime sleep pattern is reversed, leading to more daytime slumber and frequent nighttime awakenings.

A vicious cycle can soon arise with more daytime napping to compensate for lost sleep at night.

Falls can be a sign of a sleep problem, and sleep talking or frequent leg movements can also indicate problems.

Helping to manage sleep problems 

Often, sleep disturbances can be helped without resorting to medicine. A key theme is promoting sleep hygiene with an emphasis on daytime activity and exposure to light. Maintaining a consistent schedule of meals, exercise, and bedtime can help.

Non‐drug approaches to treatment tend to be recommended. It is not clear whether normal sleeping tablets are effective for people with dementia, and there are worries that the medicines could cause significant side effects.

Maintain a regular sleep schedule

Clocks, calendars, curtains, and lighting can all help to keep someone oriented in time and distinguish between night and day. Dementia clocks specify time, day, and time slot and can be especially effective at helping individuals orient themselves in time. Programming internal house lights can also help.

Increase daytime activity

People with dementia are often not engaged in meaningful activities. Increasing daytime activities and levels of physical exercise are known to improve sleep and help correct any disturbance in the usual day-night pattern. Any activity can be useful, games, housework, or anything else that is meaningful to them.

Increase light exposure

Exposure to bright light or more natural sunlight is recommended for those with dementia and sleep problems. Studies have shown that it can extend nighttime sleep because light plays such a key role in the regulation of body sleep hormones and the sleep-wake cycle.

Review all medicines for dementia and sleep problems

It is also important to review all medicines  – prescribed drugs or over the counter treatments, including herbal remedies – as some of these can interfere with sleep.

Some medicines interfere with sleep quality because they cause vivid dreams or nightmares. Others can interfere with the sleep-wake cycle because they are likely to promote daytime sleepiness.

The role of medicines is something to discuss with a doctor or pharmacist. Sometimes changing the timing of a medicine can help to reduce side effects and promote sleep. This might be helpful if water tablets are causing frequent nighttime trips to the toilet.

Identify and manage other health problems 

Anything that is known to disturb sleep can make matters worse. Common problems like pain or indigestion can increase the chances of awakening.  Similarly, ongoing health problems like COPD or heart failure can contribute because they are often linked to nighttime coughs or breathing problems.

Ensure sleeping areas are dark and quiet

Wherever possible, it can be helpful to ensure that sleeping areas are as dark and quiet as possible, with minimal disruption. Some experts have trialled “white noise” and found it can help promote sleep in some people.

Avoid stimulants

Limit stimulants which might promote wakefullness, e.g caffeine (coffee, tea, soft drinks, and chocolate), cigarettes, and alcohol.

Consider a snack at supper time 

This can help to prevent nighttime hunger by avoiding heavy meals late in the evening and limiting liquids to reduce the risk of needing to empty a full bladder during the night.

Try a Bedtime Massage

Slow-stroke back massage at bedtime has been shown to promote sleep in nursing home residents with dementia and might be helpful at home.