Sleep disturbances in patients with Alzheimer’s or related dementia are common. Scientists cannot fully explain why this happens, but many Alzheimer’s patients experience a change in behavior – increased confusion, agitation and anxiety – around dusk or early evening, called “sundowning.”
A Canadian scientific study found that 50% to 70% of Alzheimer’s patients have trouble sleeping. If you are a caregiver to an Alzheimer’s patient, you’ve probably already experienced sleepless nights when your ward has insomnia or wakes up and wanders in confusion. It is one of the reasons commonly cited for placing dementia patients into an institution.
There are a number of possible causes of both sundowning and poor sleep:
- Exhaustion, both the caregiver’s and the patient’s, at the end of the day
- An interruption to the patient’s internal clock caused by changes in the diseased brain
- Lower light and more shadows causing them to misinterpret and fear what they see
- Inability to separate dreams from reality
- Needing less sleep, common in the elderly
Drugs are usually not recommended for dementia and Alzheimer’s patients because they can cause more confusion during the day and increase the risk of falls. Institutions frequently use drugs anyway because it makes their job easier. For the family caregiver, try some of the following suggestions to see what works for your patient.
- Develop a bedtime routine. Everyone, from babies to healthy adults to elderly Alzheimer’s patients can benefit from ta consistent set of bedtime actions. They become cues that tell our bodies, “it’s time for sleep.” Even if we don’t consciously think about it, the body responds.
- Try to identify triggers of agitation. Sometimes the noise of television, children or simply having more people in the house can be distracting and confusing.
- Passive body heat. Help your ward take a warm nighttime bath or place a soft blanket over them about an hour before bedtime. Studies have shown that raising body temperature before bedtime counter-intuitively speeds up the body’s cool-down process and makes you feel tired.
- Bright light therapy. Concentrated and controlled exposure to very bright natural light or artificial light using special wide-spectrum bulbs in the morning (not at night) can help regulate the body’s sleep cycles and promote deep, healing sleep. Not just for Alzheimer’s and dementia, this therapy has been used to treat a variety of ailments both physical and mental, including skin disorders and wintertime depression due to lack of natural light.
- Massage therapy. A gentle massage can relieve agitation, decrease confusion, and help them relax. Human touch is a physical necessity and we sometimes forget that a loving touch can make almost anything better.
- Make the home comfortable. Keep the home at a comfortable temperature in the evening. Turn on interior lights earlier than you might otherwise to reduce the fears and agitation that sometimes come with sundowning. Provide nightlights for midnight wanderings and keep windows and doors firmly locked. Sensors and alarms can be used to alert you when your ward is moving around at night.
- Stay active during the day. Our bodies are designed for daily activity. Light exercise, social activities, and being outside stimulates the brain and promotes physical well-being.
- Avoid heavy meals, snacking and alcohol at night. Restrict caffeine to morning hours, if at all, and eat the largest meal at lunch. Late night snacks and alcohol consumption are known sleep interruptors.
- Get a medical examination to identify and treat other common causes of sleep problems in the elderly: sleep apnea, pain, restless leg syndrome, and needing to urinate. Reducing fluids after dinner (but not restricting them unduly) can help with needing to urinate several times in the night.
Non-drug therapies can reduce or even eliminate some sleep issues. Talking to others can give you new ideas and a broader community of support. The Alzheimer Society has an online support community, ALZConnected, where you can share your experiences and benefit from solutions others have found.