Dementia patients often have problems sleeping at night. Sleep disturbances in this population can take a toll on both the family and the person with dementia. Caregivers worry about wandering, incontinence issues, possible falls and other problems.
The amount of wakefulness at night may depend on the stage of the dementia. People in the earlier stages of Alzheimer’s, for example, may sleep more or wake up confused. Later in the disease, Alzheimer’s patients tend to “nod off” more during the day and wake more at night. In the final stages of Alzheimer’s, dozing irregularly day and night is common.
The following are some proven strategies family caregivers can use to help their loved ones sleep better at night:
1) Expose the person with dementia to natural sunlight for an hour or two each morning and again in the afternoon, if possible Don’t forget sunglasses, a hat and sun screen. If sunlight is not available, or being outside is not possible, light therapy with a full spectrum light bulb may be helpful. Each of us has a set of rhythms which our body uses to regulate our systems. They are called circadian rhythms, and they help determine our wake/sleep cycles, among other things. Circadian rhythms need natural lighting to function well.
2) Caregivers should take steps to avoid caffeine and alcohol in the patient's diet. This is especially true in the late afternoon and evening, as it takes several hours for caffeine -- a stimulant -- to clear the body. Likewise, after the initial relaxation a person may feel from an alcoholic drink, there is a “bounce back” when the alcohol or caffeine acts as a stimulant, which can disturb sleep.
3) Limit daytime napping. If caregivers find their loved ones are sleepy during the day, a one hour nap is preferable to many short naps or sleeping longer than one hour.
4) Encourage exercise. Exercise helps to tire a person and brings on a relaxation response. Exercising in late afternoon, an hour or so before dinner, can help to assure a better night’s sleep.
5) Keep a regular schedule for waking and sleeping if possible. Getting up at approximately the same time each morning and retiring at the same time each night helps make bedtime a little easier.
6) A white noise machine or soft music can be used to block out any distracting noises in the home, and a small night light can be used for safety. However, lights on in the room will encourage wakefulness.
If the above steps don't seem to help, consider a physical cause for insomnia. Pain, restless leg syndrome, irregular heartbeat and even sleep apnea are a few of the physical problems that may bring on the inability to sleep well. A physician can help with the diagnosis and treatment of these problems.
To help the person with dementia who wakes at night:
1) Check to see if toileting is needed. If the person is able to toilet themselves, put a picture of a toilet on the bathroom door so they can easily find the room.
2) Make sure the person is physically comfortable: Is the room too hot or too cold? Are there enough blankets and pillows?
3) Are nightmares or hallucinations bothering the person? Comfort and reassure them.
4) Try a gentle back rub
5) For someone who seems to be disturbed by sleeping alone, put a rolled-up blanket or large stuffed animal next to them in bed.
What about medication for sleep?
As we age, our bodies change. Normally we produce a substance called melatonin, which helps us sleep. As we get older, we produce less melatonin, and sleep becomes more difficult. After checking with the physician, caregivers can obtain over-the-counter melatonin and give it about half an hour before bedtime.
Since there are side-effects to most medications, physicians are often reluctant to order sleep medications until the other strategies have been tried. The doctor may consider drugs ranging from tricyclic antidepressants such as Pamelor or Aventyl, to traditional sleeping pills. If the person with Alzheimer’s is already on Aricent, it’s good to know that it has been shown to increase oxygen saturation in patients with Alzheimer’s related sleep disturbances caused by breathing problems at night.
Caregivers should also be aware that use of sleep medications can increase the risk of falls in the elderly. Precautions should be taken to make sure there is a night light available, and all obstacles have been removed on the path to the bathroom. A bedside commode may also be helpful at night.
For more helpful hints for caregivers, go to kissesforelizabeth.com
Stephanie Zeman, MSN RN
Fairfax Station, Virginia