Home Care Agency, Bay Shore, NY
Alzheimer’s and Sleep Issues: How to Support Your Loved One
Many older adults often have difficulty with sleeping, but people living with Alzheimer’s disease have an even harder time. Sleep disturbances may affect up to 25% of people with mild to moderate dementia and 50% of people with severe dementia (Mayo Clinic.).
Factors that might contribute to sleep disturbances include mental and physical exhaustion at the end of the day, taking naps during the day, sleep schedule reversal of the usual daytime wakefulness and nighttime sleep pattern, sundowning syndrome which causes high anxiety and agitation during the hours when the sun starts to set in the later part of the day, and other health conditions such as, depression, sleep apnea, and restless leg syndrome.
Sleep disturbances can bring a whole new set of challenges for people living with Alzheimer’s. The lack of restful sleep can lead to more naps during the day and less ability to engage in activities. It can also affect the person’s moods and willingness to do their daily living activities such as personal hygiene, taking medications, eating meals, etc.
Sleep disturbances can also affect family members who live with the person and are up at night supporting and guiding their loved one while also needing to be up during the day providing support. This can quickly lead to burnout and other health issues for the family caregiver.
Non-Drug Treatments for Sleep Changes (The Alzheimer’s Association):
Non-drug treatments aim to improve sleep routine and the sleeping environment and reduce daytime napping. Non-drug coping strategies should always be tried before medications, since some sleep medications can cause serious side effects. To create an inviting sleeping environment and promote rest for a person with Alzheimer’s:
- Maintain regular times for meals and for going to bed and getting up
- Seek morning sunlight exposure
- Encourage regular daily exercise, but no later than four hours before bedtime
- Avoid alcohol, caffeine and nicotine
- Treat any pain
- If the person is taking a cholinesterase inhibitor (tacrine, donepezil, rivastigmine or galantamine), avoid giving the medicine before bed
- Make sure the bedroom temperature is comfortable
- Provide nightlights and security objects
- If the person awakens, discourage staying in bed while awake; use the bed only for sleep
- Discourage watching television during periods of wakefulness
Medications for Sleep Changes (The Alzheimer’s Association):
In some cases, non-drug approaches fail to work or the sleep changes are accompanied by disruptive nighttime behaviors. For those individuals who do require medication, experts recommend that treatment “begin low and go slow.”
The risks of sleep-inducing medications for older people who are cognitively impaired are considerable. They include increased risk for falls and fractures, confusion and a decline in the ability to care for oneself. If sleep medications are used, an attempt should be made to discontinue them after a regular sleep pattern has been established.
The type of medication prescribed by a doctor is often influenced by behaviors that may accompany the sleep changes. The decision to use an antipsychotic drug should be considered with extreme caution. Research has shown that these drugs are associated with an increased risk of stroke and death in older adults with dementia. The U.S. Food and Drug Administration (FDA) has ordered manufacturers to label such drugs with a “black box” warning about their risks and a reminder that they are not approved to treat dementia symptoms.
Examples of medications used to treat sleep changes include:
- Tricyclic antidepressants, such as nortriptyline
- Benzodiazepines, such as lorazepam, oxazepam and temazepam
- “Sleeping pills” such as zolpidem, zaleplon and chloral hydrate
- “Atypical” antipsychotics such as risperidone, onlanzapine and quetiapine
- Older “classical” antipsychotics such as haloperidol
The FDA has approved Belsomra® to address insomnia in people living with mild-to-moderate Alzheimer’s disease. Belsomra is thought to inhibit the activity of orexin, a type of neurotransmitter involved in the sleep-wake cycle. Possible side effects include, but are not limited to, risk of impaired alertness and motor coordination (including impaired driving); worsening of depression or suicidal thinking; complex sleep behaviors (such as sleep-walking and sleep-driving); sleep paralysis; and compromised respiratory function.
Any time you are prescribed a new medication, make sure to ask your health care team:
- What are the benefits of this medication?
- What are the risks of this medication?
- What other treatment options are available?
Hiring Overnight Caregivers to Help:
If non-drug and medications do not help the person to get back to a regular sleep pattern, hiring caregivers to help overnight may be necessary.
Overnight caregivers can provide assistance throughout the night hours by supporting a person with walking assistance, guidance and redirection, logging sleep activity and wake times, bringing the person comfort items such as water, blankets, pillows, etc. to help make him or her comfortable.
Please call Family First Home Companions at 631-319-3961 for more information. Overnight care services are offered throughout Long Island and surrounding communities.
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