Alzheimer’s: Managing sleep problems

It’s common for people with Alzheimer’s disease or other types of dementia to have sleep problems. Learn why that is and find out what you can do to help a person who has dementia get better rest.

Many older adults have trouble sleeping. But people with dementia often have an even harder time. Sleep troubles may affect up to 25% of people with mild to moderate Alzheimer’s and about 50% of people with moderate to severe Alzheimer’s. Sleep troubles tend to get worse as Alzheimer’s becomes worse.

Sleep issues can include feeling too sleepy during the day, and having trouble falling asleep and staying asleep at night. Waking up often during the night and waking too early in the morning also are common.

Some people with dementia feel a state of confusion that happens in the late afternoon and lasts into the night. This is called sundowning. It may involve feeling confused, restless, anxious and aggressive. Night wandering in this state of mind can be dangerous.

A breathing condition called obstructive sleep apnea also is more common in people with Alzheimer’s disease. Obstructive sleep apnea causes breathing to stop and start many times during sleep.

Factors that might play roles in sleep troubles and sundowning include:

• Mental and physical exhaustion at the end of the day.
• Changes in the body’s natural “clock” that typically helps people feel alert during the day and sleepy at night.
• A need for less sleep, which is common among older adults.
• Being in a place that’s new or has a confusing layout.
• Low lighting and more shadows. This can cause people with dementia to become confused and afraid.
• Pain, hunger or thirst.

Sleep troubles can affect you and your loved one with dementia. The following steps may help you both get better sleep:

• Treat other health conditions. Sometimes conditions such as depression, sleep apnea or restless legs syndrome cause sleep problems.
• Set up a routine. Try to eat, wake up and go to bed at the same times each day.
• Limit stimulants. Alcohol, caffeine and nicotine can make it harder to sleep. Limit use of these substances, especially at night. Also, don’t turn on screens such as the TV or a phone if you’re awake during the night.
• Move more during the day. Walks and other physical activities can help improve sleep at night.
• Limit daytime sleep. Avoid afternoon napping, especially long naps.
• Set a peaceful mood in the evening. Help your loved one relax by reading out loud or playing soothing music. Try not to use screens in the bedroom, including a TV. A comfortable bedroom temperature can help a person with dementia sleep well.
• Manage medicines. Some antidepressant medicines can lead to insomnia, such as venlafaxine (Effexor XR, Pristiq), fluoxetine (Prozac) and bupropion (Aplenzin, Forfivo XL, others). Medicines called cholinesterase inhibitors that can improve thinking- and behavior-related symptoms in people with Alzheimer’s also can cause insomnia. Cholinesterase inhibitors include tacrine, donepezil (Aricept), rivastigmine (Exelon) and galantamine. If your loved one with dementia takes these kinds of medicines and is having trouble sleeping, talk to a member of the healthcare team. It often helps to take the medicine no later than the evening meal.
• Think about trying melatonin. Melatonin is a lab-made version of a hormone that plays a part in sleep. It may help improve sleep and reduce sundowning in people with dementia.

• Provide proper light. Use of night lights around the home can lessen restlessness and anxiety that can happen when rooms are dark at night. Spending a bit of time outside in the sunlight might help encourage less sleep during the day and more at night. Have your loved one wear sunglasses outside.

  A treatment called bright light therapy also may help your loved one sleep better at night and feel more alert during the day. It involves sitting for a set amount of time in front of a device in a box that gives off bright light. Some experts recommend using this treatment first thing in the morning, but follow your healthcare professional’s directions.

If the person with dementia wakes during the night, stay calm — even though you might be exhausted yourself. Your loved one may sense your stress and become anxious, so don’t argue. Instead, ask what your loved one needs. Nighttime restlessness and anxiety might be caused by discomfort or pain. See if you can figure out the source of the problem, such as constipation, a full bladder, or a room that’s too hot or cold.

Gently remind your loved one that everything is okay, and that it’s night and time for sleep. If your loved one needs to pace, don’t hold your loved one back. Instead, let it happen while you make sure your loved one paces safely.

If lifestyle changes don’t help enough, ask a member of the healthcare team about medicines that bring on sleep.

Be aware that these medicines raise the risk of falls and confusion in older people who have trouble thinking, learning, remembering or making decisions. As a result, sleep medicines often aren’t recommended for this group of people.

If these medicines are prescribed, they may help your loved one get on a regular sleep schedule. Once that happens, the healthcare team likely will recommend stopping use of the medicine over time.

If you’re not getting enough sleep, ask for help with caregiving. Family members or close friends may be able to watch your loved one some nights. Or you could talk with a member of the healthcare team, a social worker or your local Alzheimer’s association to find out what help is available in your area. If you don’t think that you have the patience or energy to take care of a loved one with dementia, let your family or a healthcare professional know.