Alzheimer's disease and sleep problems

If you’re in your senior years and have problems sleeping, you’re not alone. However, if you’re living with Alzheimer’s disease, getting a good night’s rest is even more difficult.

Sleeping difficulties in Alzheimer’s sufferers are a common problem. And, in Australia, Alzheimer’s disease is a significant problem: an estimated 321,600 Australians currently live with Alzheimer’s disease or another form of dementia.

Researchers believe that one of the reasons people with Alzheimer’s disease (AD) have sleep-related problems is that the illness seems to cause a reversed sleep-wake cycle (circadian rhythm). While this disturbance usually causes restlessness at night and drowsiness during the daytime, it can also manifest in other ways. This includes a reduction in the number of hours of sleep at night, often waking up after falling asleep, wandering around at night or waking up early.

Sleep-related problems are one of the most distressing symptoms of Alzheimer’s and generally worsen as the illness progresses. People with AD may also experience sleep problems due to an increase in dementia-related symptoms such as disorientation and agitation, or because of sleep-disordered breathing.

Whatever the cause, it’s important to manage sleep problems, as this could reduce overall wellbeing and lead to reduced alertness during waking hours. Remember that not getting enough deep restorative sleep will have a negative impact on both patient and caregivers.

How sleep problems are treated
There are two main ways to treat sleep disturbances in AD. Various medications are available to provide short-term relief, but some have adverse side effects and negative interactions with other drugs. For example, while the newer benzodiazepine “z-drugs” have fewer adverse events, there is some concern that older people with AD who use these medications could be at higher risk of falling.

In a recent Cochrane review of drugs used to treat sleep problems in AD, it concluded there was very little evidence to guide decisions about medicines for sleeping problems in AD. It suggested that “any medicine used should be used cautiously, with a careful assessment of how well it works, its risks and side effects in individual patients”.

A growing number of researchers and medical professionals are now focusing on the benefits of non-drug alternative methods which include sleep hygiene, sleep restriction therapy, cognitive behaviour therapy and light therapy. Ask your doctor for more information on these methods.

In the meantime, here are some tips for AS sufferers (and their caregivers) to promote better sleep:

- Get active – make sure to engage in some physical activity every day such as a walking or swimming, provided you taper down to quieter activities at least four hours before bedtime.
- Restrict your consumption of alcohol and beverages containing caffeine. If you like a drink in the evening, rather opt for non-alcoholic wine or beer.
- Limit daytime sleep – if you must nap, keep it short, doze on a couch/recliner and avoid snoozing too late in the day.
- Establish a daily schedule – set regular times to wake up and go to bed at night. It’s especially important to set a good bedtime routine by doing things the same way every night.
- Ensure your bedroom is conducive to sleeping – a comfortable bed, a favourite blanket and soft pillows close at hand, a night light if preferred and some soothing music to lull you to sleep.
- Check with your pharmacist or doctor about the best time to take your regular medications so that they don’t interfere with sleep.
- Consult your doctor if you think your sleep problems may be caused by an underlying condition such as depression, pain, restless legs or sleep-disordered breathing (e.g. obstructive sleep apnoea, when throat muscles relax during sleep and obstruct airflow through the throat and nose). After an assessment, your doctor may recommend a machine that provides a continuous stream of air, called continuous positive airway therapy (CPAP).

Need more information? Call the National Dementia Helpline on 1800 100 500.

Sources:
1. http://www.mayoclinic.org/healthy-living/caregivers/in-depth/alzheimers/art-20047832
2. R. David et al, Non-pharmacologic management of sleep disturbance in Alzheimer’s disease, The journal of nutrition, health & aging
3. http://alzheimers.about.com/lw/Health-Medicine/Conditions-and-diseases/Sleep-Disorders-and-Alzheimers-Disease.htm
4. http://summaries.cochrane.org/CD009178/medicines-for-sleep-problems-in-alzheimers-disease
5. http://www.sciencedaily.com/releases/2013/02/130218092549.htmPaving the way for better sleep in Alzheimer's.

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