Dementia and Sleep

The relationship between sleep and dementia is a complicated one. Researches are not sure whether poor sleep causes or worsens the symptoms of dementia or if dementia leads to poor sleep. Some studies point that both theories could be true, and that this relationship is in fact circular. 

While most people with dementia have poor sleep regularly, other people diagnosed with sleep disorders like sleep apnea and insomnia are also more likely to develop and experience the symptoms of dementia. 

Dementia refers to a group of pathological conditions. The most common form of dementia is Alzheimer’s disease. Other examples include Lewy body dementia, vascular dementia, Parkinson’s disease, Huntington’s disease, Shy-Drager syndrome, alcohol-related dementia, Creutzfeldt-Jakob disease, and AIDS-related dementia.

Dementia affects every person differently and may vary in progression. Common symptoms include: progressive loss of memory, inability to communicate properly and express specific needs, progressive loss of social and cognitive skills, etc. 

Dementia and Sleep Disorders

It has been estimated that 1 in 6 women and 1 in 10 men are likely to develop certain symptoms of dementia after the age of 55 and Alzheimer’s disease as the most common form of dementia affects nearly 60% to 70% of dementia patients.

People who are at the highest risk of developing dementia are the elderly, patients with mild cognitive impairment, and patients with neurodegenerative diseases. 

The most common symptoms of sleep disorders caused by dementia are increased daytime sleepiness, confusion and agitation also known as sundowning, nighttime wandering, etc. 

Usually those struggling with dementia experience less and less REM sleep and wake up more frequently throughout the night.

The delay of the REM phase in dementia patients is associated with reducing the time spent in the REM phase. Certain neuronal degeneration in patients with Alzheimer’s changes sleep patterns by damaging the basal forebrain and the reticular formation of the brainstem, which are two regions of the brain responsible for regulating sleep patterns.

Also around 30 to 50% of people suffering from Parkinson’s disease experience daytime sleepiness and this percentage grows as the disease advances. Parkinson’s patients often experience insomnia which constantly comes and goes throughout the course of the disease.

A recent study shows that insomniacs and senior people with sleep problems tend to have higher rates of beta-amyloid plaques in their brains than healthy sleepers, and these plaques have even been found in the brains of elderly insomniacs who have not been diagnosed with Alzheimer’s or other conditions related to dementia. 

Dementia, Sleep Apnea and Insomnia

Dementia patients often exhibit the symptoms of sleep apnea, such as temporary loss of breath during sleep or chronic snoring. Some experts believe that sleep apnea is directly connected to severe dementia, and vice versa. Although sleep apnea doesn’t directly cause dementia, the effects of persistent hypoxic conditions and sundowning can worsen the symptoms related to dementia. 

A recent research points to the link between sleep deprivation and increased risk for Alzheimer’s. Levels of amyloid-beta protein in the blood stream rise during wake periods and they decline during sleep. This protein can be found in some of the brain plaques in Alzheimer’s patients. Sleep problems may be an early indicator of dementia. Alzheimer’s patients often experience changes in their sleep patterns. 

In another study, older people who complained of restless nights, daytime sleepiness, increased use of sleep medications and other sleep aids, were much more likely to develop the symptoms of Alzheimer’s. The researcher who led this analysis suggested that problems with sleep were the strongest early indicator of Alzheimer’s disease.

Other studies found that mice implanted with amyloid-beta plaques in their brains experienced sleep disruption more than the control group. When the plaques were removed from the mice, their sleep cycles quickly returned to normal.

Diagnosing Sleep Disorders in Dementia Patients

Diagnosing sleep disorders in dementia patients can be tricky due to a large number of underlying causes, factors and common causal symptoms. Sleep disturbances in patients with dementia can be categorized in the following way:

  • Trouble falling or staying asleep (insomnia)
  • Excessive daytime sleepiness (hypersomnia)
  • Difficulty breathing during sleep (sleep apnea)
  • Excessive nighttime physical activity (restless legs syndrome)
  • Nocturnal hallucinations and behavioral problems

Dementia patients may have more complex symptoms at once which can further complicate the diagnostic process. Additionally, some sleep disorders can occur as the result of some other factors such as other conditions, side effects of certain medications, etc.

Treatment of Sleep Disorders in Dementia patients

There are various treatments that can help people with dementia and dementia-related sleep disorders and alleviate or at least reduce the symptoms. For instance, certain medications can help patients with Alzheimer’s and other dementias restore or improve their cognitive functions.

The neuronal damage in demented patients contributes to various respiratory problems during sleep. This sleep-disordered breathing can be treated with continuous positive airway pressure (CPAP) machines. CPAP therapy has been shown to decrease the sleep-disordered breathing episodes in patients with dementia from 24 to 10 per hour during sleep. In addition, this treatment also reduces daytime sleepiness in dementia patients, their snoring, elevates their moods and improves their overall quality of life.

Some doctors have also begun using therapeutic strategies such as exposure to bright light to normalize sleep patterns. Melatonin and various melatonin supplements are also a possible method of treating insomnia and other sleep disorders, and dealing with the symptoms of Alzheimer’s.

Besides this, there are many safety precautions for dementia patients aimed at reducing the risk of injury during sleep. Caregivers or family members should remove dangerous objects from the bedroom, lock all doors and windows, etc. If dementia patients are in nursing homes or other care facilities they may be given sedatives to ensure nighttime sleep.

Dealing With Dementia-Related Sleep Issues

In addition to medications and treatment, there are some steps that dementia patients can take on their own to effectively deal with the symptoms of different sleep disorders such as

  • Establishing a consistent sleep schedule – To maintain regular cicardian patterns, dementia patients should establish a consistent sleep schedule by trying to fall asleep and wake up at the same time every day. 
  • Outdoor and light therapy – Exposure to natural sunlight can help elderly people normalize their cicardian rhythm and reduce the effects of sleep disorders. Natural light therapy is also found to improve sleep patterns for people with Alzheimer’s disease.
  • Customizing diet – It is recommended that elderly people with sleep disorders supplement their meals with foods that help them sleep such as calcium that can be found in milk, cheese and other dairy products. Calcium is known for its ability to trigger the production of melatonin and cause sleepiness. Oatmeal and grains can raise blood sugar which can also lead to sleepiness. People with dementia-related sleep disorders should avoid eating too much right before bedtime and consuming alcohol and other substances that can interfere with their sleep such as tobacco and caffeine. 
  • Being physically active – Although elderly people may not be able to exercise as much and as rigorously as younger people, they can practice some light physical activity such as walking and nighttime stretching that can help them fall asleep faster, stay asleep the whole night, and improve the quality of their sleep. 
  • Creating a healthy sleeping environment – Creating and maintaining a healthy sleeping environment is crucial for relieving the symptoms of dementia-related sleep issues. Patients should get comfortable pillows and beds that will suit their specific needs and sleep preferences and help them fall asleep and stay asleep the whole night. (Read our mattress and pillow reviews to find the best mattress and pillow for your needs.) In addition, bedroom should be clean, dark, quiet, and reserved only for sleep and sex, and patients should avoid other activities there such as eating or watching television.