Overview of Alzheimer’s Sleep Problems

Significant sleep issues can go hand in hand with Alzheimer’s disease. Many individuals diagnosed with Alzheimer’s have challenges sleeping. Sleep disturbance is estimated to affect up to 25 percent of people with mild to moderate dementia and 50 percent of individuals with severe dementia. Sleep disturbances tend to get worse as dementia progresses in severity. Dementia can worsen the more a person has significant sleep disturbances. This forms something that fairly can be described as a vicious circle. 

Alzheimer’s Disease, Sundowning, and Sleep Problems

Sundowning refers to a state of confusion resulting a wide array of different types of conduct that occurs late in the afternoon and lasting into the night. Sundowning afflicts people with Alzheimer’s disease and other type of dementia. It can result in behaviors that include:

  • Anxiety
  • Aggression
  • Ignoring directions
  • Pacing
  • Wandering

It is important to make mention that sundowning is not a disease itself. Rather, sundowning is a group of symptoms that occur at a specific time of day. The exact cause of sundowning is not known. Sundowning can have a significant impact on a sufferer’s sleep. The inability to get a decent night’s sleep because of sundowning can aggravate sundowning, creating a vicious circle.

Factors that can aggravate sundowning and make sleep even more challenging include:

  • Fatigue
  • Spending a day in an unfamiliar place
  • Low lighting
  • Increased shadows
  • Disruption of the body’s “internal clock”
  • Difficulty separating reality from dreams
  • Being hungry or thirsty
  • Presence of an infection such as a urinary tract infection
  • Being bored or in pain
  • Depression

Steps to Take to Address Alzheimer’s Sleep Problems

There are a number of steps that can be taken in an effort to address Alzheimer’s sleep problems. Keep in mind that more than one underlying factor may contribute to a person’s Alzheimer’s sleep problems. Therefore, more than one of the steps discussed in this article may need to be taken to assist an individual Alzheimer’s disease with associated sleep problems.

Treat Underlying Conditions

A number of different conditions can be causing sleep problems for an individual with Alzheimer’s. These conditions and the associated sleep issues can be aggravated by Alzheimer’s disease. Therefore, treating these underlying conditions can be vital in addressing Alzheimer’s sleep problems. These underlying issues include:

  • Depression
  • Sleep apnea
  • Restless leg syndrome

Establish a Routine

Maintain regular times for essential day to day activities including:

  • Waking up
  • Bathing
  • Dressing
  • Eating
  • Going to bed

Avoid Certain Substances

It is important to avoid use of items that can interfere with sleep. It is particularly important to avoid these things later in the afternoon and into the evening. These include:

  • Alcohol
  • Caffeine
  • Nicotine 

It is also recommended to avoid screens (phone, computer, television) prior to bedtime. Not using screens at least an hour before bedtime can be helpful in enhancing the sleep of a person with Alzheimer’s disease. 

Encourage Physical Activity

Walks and other physical activities can help promote better sleep at night. Do not wait until too late in the afternoon or into the early evening for physical activity. Waiting too late in the day can have the effect of amping someone one, making it more rather than less difficult to go to sleep. 

Limit Daytime Sleep

Discourage afternoon napping. If a person with Alzheimer’s feels a nap is a must, keep it to a relatively short period of time. 

Set a Peaceful Mood in the Evening

Help the person relax by reading out loud or playing soothing music. A comfortable bedroom temperature can help the person with dementia sleep well. Generally speaking, a cooler room is preferable provided an individual with Alzheimer’s is comfortable.

Manage Medications

Some antidepressant medications, such as bupropion and venlafaxine, can lead to insomnia. Cholinesterase inhibitors, such as donepezil, can improve cognitive and behavioral symptoms in people with Alzheimer’s but also can cause insomnia. If the person with dementia is taking these kinds of medications, talk to the doctor. Administering the medication no later than the evening meal often helps.

Consider Melatonin

Melatonin might help improve sleep and reduce sundowning in people with dementia. Keep in mind that before you introduce melatonin into a person’s routine, a consultation with a doctor is necessary.

Provide Proper Light

Bright light therapy in the evening can lessen sleep-wake cycle disturbances in people with dementia. Adequate lighting at night also can reduce agitation that can happen when surroundings are dark. Regular daylight exposure might address day and night reversal problems.

The need to get proper sleep cannot be understated. The reality is that an individual diagnosed with Alzheimer’s disease might experience a swifter decline in his or her health if proper sleep is not obtained on a regular basis. If you are the caretaker of a person with Alzheimer’s disease who has sleep issues, you are wise to get that individual to his or her doctor to discuss ways in which the sleep situation can be improved.