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How Dementia Affects Sleep (and How to Manage)

Individuals suffering from dementia frequently experience sleep difficulties such as sleeplessness and excessive daytime sleepiness. As dementia worsens, symptoms could get worse.

You could find that sleeping is harder than it used to be if you or a loved one has dementia. You're not dreaming this. It is a typical side effect of the illness.

People who have dementia can, however, take action to enhance their sleep and obtain more of the necessary rest. Getting more sleep might lead to fewer mishaps and falls as well as an improved attitude all around.

This article explains how dementia affects sleep and offers some solutions.


Why does dementia affect sleep?

People 55 and older generally experience a deterioration in their quality of sleep, which can be exacerbated by dementia.

Alzheimer's disease alters how your brain works and how it manages sleep. While most adults require 7 to 8 hours of sleep every night, dementia can make it difficult to meet sleep requirements. Alternatively, you can sleep too much at the incorrect moment.

Your body clock, which controls how much sleep you get depending on outside light levels and your regular daily activities, is disrupted by dementia. Additionally, dementia lessens your sensitivity to the want to sleep after waking up.

Generally, sleep pressure and your body clock work together to promote restful, regular sleep. But these processes malfunction in dementia, leading to problems sleeping.


How common are sleep disorders in people with dementia?

According to a review published in 2023, 26% of dementia patients had sleep problems of some kind.

Sleep disturbances affected 38% of individuals with dementia, according to a previous, more comprehensive assessment.


How do different types of dementia affect sleep?

Depending on the kind of dementia you have, your sleep may be affected differently. Among the prevalent forms of dementia associated with sleep disturbances are:
  • Alzheimer's disease: responsible for 60% to 80% of cases of dementia
  • Lewy body dementia (LBD), which encompasses dementia from Parkinson's illness
  • frontotemporal dementia (FTD)
  • vascular dementia
A review from 2023 found that sleep difficulties affected around half of those with LBD. On the other hand, approximately 25% of individuals with Alzheimer's disease and one-third of those with vascular dementia or FTD reported having trouble sleeping.

Studies connect the aforementioned dementias to several sleep disturbances, such as:
  • excessive daytime sleepiness
  • insomnia
  • respiratory disorders related to sleep, such as obstructive sleep apnea
  • sleep behaviour problem with rapid eye movement (REM)
  • restless legs syndrome
  • hallucinations
Let's take a closer look at a few of these.


Dementia and excessive sleeping

Older persons frequently experience daytime drowsiness, particularly those with specific forms of dementia.

According to a 2019 study, those with LBD had a daytime drowsiness rate that was more than twice as high as that of those with FTD or Alzheimer's.

Poor sleep at night is frequently the cause of excessive daytime sleepiness. Moreover, individuals with these illnesses may find it more difficult to fall asleep at night due to increased naps taken throughout the day as a result of daytime sleepiness.

The following are suggestions from experts for addressing afternoon sleepiness:
  • melatonin
  • adjusting medication
  • daytime physical activity

Dementia and prolonged sleep

According to research published in 2017, routinely sleeping for longer than nine hours at night may be an early indicator of dementia.

Hypersomnia, or excessive daytime sleepiness, can occasionally be the cause of oversleeping at night.


Dementia and not sleeping

Insomnia is a frequent sleep issue that affects people with dementia and makes it difficult to go to sleep, stay asleep, or both. You may experience anxiety, irritability, depression, or low energy when you have insomnia. Additionally, it may make it difficult to focus.

Some causes of sleeplessness in dementia patients include:
  • other medical issues, such as respiratory or urogenital issues
  • mental health issues such as anxiety or sadness
  • pain
  • medication side effects
Physicians may endeavour to identify and address the root cause of sleeplessness. They might also suggest:
  • light therapy
  • avoiding caffeine and alcohol
  • never take a snooze throughout the day.
  • melatonin
  • medications like trazodone or mirtazapine (Remeron)
  • daytime physical activity


Dementia and sleep-disordered breathing

Researchers have found that between 70% and 80% of dementia patients also suffer from sleep apnea, a disorder that causes breathing to stop and start while you're asleep. It also appears that as dementia advances, sleep apnea gets worse. Additionally, it may exacerbate daytime drowsiness and insomnia.

The common method of treating sleep apnea is to use a continuous positive airway pressure (CPAP) machine. Research published in 2023 suggests that CPAP may help dementia patients' cognition in addition to their mood and sleep quality.


Dementia and REM sleep behaviour disorder

The stage of sleep known as REM is when dreaming usually takes place. To feel well-rested, it's essential to have adequate REM sleep. Your muscles don't relax as they should when you have REM sleep behaviour disorder (RBD), which causes you to act out actions from your dreams, such as punching, kicking, or flailing.

RBD is an uncommon condition that affects 1% of people. However, it is far more prevalent in dementia patients, particularly those with LBD.

Besides taking melatonin, you might benefit from protecting your sleeping quarters. Experts advise staying away from chocolate, caffeine, and antidepressants. Also, clonazepam (Klonopin) may be prescribed by a physician.


Tips for better sleep with dementia

  • Treat underlying conditions.
  • Stay engaged with fun activities.
  • Get plenty of natural light.
  • Stay active during the day for better rest at night.
  • Stay away from caffeine, cigarettes, and alcohol.
  • Cut down on screen time near the end of the day.
  • Relax at bedtime.
  • Practice good sleep habits (also called sleep hygiene).
  • If you’re a caregiver having trouble sleeping, consider hiring a night sitter.


Dementia and sundowning

A set of symptoms known as "sundowning," or "sundowner's syndrome," are experienced by certain dementia patients in the late afternoon and early evening. Although the exact aetiology is unknown, alterations in the brain associated with dementia are probably its source.

Sundowner's syndrome typically manifests as agitation, yelling, improper behaviour, or physical or verbal aggression, usually in the evening or later.

Sundowning symptoms include:
  • hallucinations
  • insomnia
  • pacing
  • confusion
  • agitation
  • restlessness
  • wandering
  • yelling
Finding and treating the underlying reason, adopting healthy sleeping habits, and making plans around it are the best ways to handle sundowning. The following recommendations come from experts such as the Alzheimer's Association and the National Institute on Ageing:
  • Make sure to schedule crucial meetings for earlier in the day.
  • Do not overbook your schedule.
  • Establish a serene atmosphere.
  • Make the early evening leisurely.
  • Make dinner lighter and lunch heavier.
  • Go for a stroll.
  • Address the issue with your physician.

Does poor sleep cause dementia?

Dementia may be caused by inadequate sleep.

According to a 2023 study, persons over 65 who experienced sleeplessness were 51% more likely to develop dementia. The authors of the study referenced several other investigations that discovered a connection between the likelihood of getting dementia and inadequate sleep.

For instance, a 2017 study discovered a connection between young people's beta-amyloid plaque accumulation and sleep difficulties. Alzheimer's patients frequently have this kind of accumulation in their brains.


Takeaway

As of right now, dementia and the sleep disturbances it creates are incurable. Depending on the type of dementia, several sleep problems and their intensity may vary. For instance, individuals with Lewy body dementia are particularly more likely to experience excessive daytime sleepiness.

It is possible to enhance the quality of your sleep and facilitate falling asleep. The most crucial thing you can do is treat the underlying reason, which should be followed by making lifestyle adjustments that encourage sound sleeping habits.

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