Dementia and Sleep Disorders

Last updated: May 2, 2019

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The information on this website is not intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice. Read our full medical disclaimer.

Dementia is not an uncommon problem among the elderly. It can occur as a symptom of a number of diseases, like Alzheimer’s or Parkinson’s, and is usually progressive. People with dementia often suffer from one or more sleep disorders which further aggravate their state.

Fortunately sleep problems can be addressed with good sleep hygiene, medications or supplements. When treated appropriately, dementia-related sleep disorders can significantly improve.

In this article we give information about dementia; its symptoms, types, and describe the most common sleep disorders that people with dementia may suffer from. We also give an insight into treatment options and advice on how to improve the sleep of a person with dementia.

What is dementia?

Dementia is a term that describes a number of different diseases whose symptoms are cognitive impairment and memory loss. Most types of dementia are progressive, that is, they get worse with time. Dementia is not a normal part of aging and should not be mistaken for senility.

Senility includes memory loss; but also stiff joints, wrinkles, and decreased strength – all of which come naturally as a person gets older.

What are the symptoms of dementia?

Dementia symptoms may be mild, moderate or severe. People with mild dementia often appear forgetful or struggling to find words, but can live and function on their own. Those with moderate dementia may need another person’s assistance because they exhibit poor judgment, strong personality changes, and can’t perform some of their daily tasks. Severe dementia requires a full-time care provider because a person with an advanced stage of dementia can’t walk, communicate, or control bodily functions.

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Early stages of dementia show the following symptoms:

  • Short-term memory loss. You may find it difficult to remember what happened a while ago, but easily recall an event from 20 years ago.
  • Struggling to find words. Thinking for a long time trying to find the right word could be one of the early signs of dementia.

  • Repeating the same thing. Some people with dementia tend to tell the same story, ask the same question, or perform the same action several times. You may not notice if you are doing this, but people around you will.

  • Mood changes. You could feel angry or depressed often and even notice that your personality has changed.

  • Things seem unfamiliar. If you are driving, or going to places where you usually go, but forget the directions, or feel that unfamiliar people greet you, you may be suffering from memory loss.

  • Trouble getting dressed, taking a shower, etc. Things that you have done for a long time may become a challenge.

Types of dementia

Dementia may appear as a result of nerve cell loss, that is, due to neurodegenerative diseases like Alzheimer’s, for example. However, it can also be caused by other reasons like toxin exposure (lead), metabolic disorders, or structural brain disorders. Types of dementia include:

  • Alzheimer’s disease. This is the most common type of dementia, accounting for about 70% or more of all cases. It is associated with the buildup of beta-amyloid and adenosine, which cause neurotoxicity – the plaque kills nerve cells. These substances are naturally produced in the brain while we are awake, but get washed out when we sleep. Sleep deprivation causes these substances to build up, and many scientists believe there is a strong correlation between Alzheimer’s and poor sleep.

  • Vascular dementia. This type of dementia is caused by the insufficient blood flow to the brain due to stroke or clogged arteries. Vascular dementia is the second most widespread type of dementia.

  • Lewy body dementia. Lewy bodies are a type of protein deposits whose buildup causes poor motor control and thinking, along with memory loss.

  • Parkinson’s disease. This disease is characterized by the death of nerve cells which control movement and can be recognized by involuntary body tremors. It can also cause dementia – mood changes, paranoia, and poor reasoning.

There are several more types of dementia, but they do not occur frequently in the general population.

Sleep problems and dementia

Dementia is typically followed by a number of sleep problems that may be mitigated with proper treatment. If left untreated, these sleep problems can worsen the patient’s state and make taking care of them particularly difficult. Sleep problems are easily diagnosed with polysomnography.

Here are the most common sleep problems that people with dementia face.

Sundown syndrome or sundowning

As the name may suggest, this sundown syndrome is a number of symptoms that appear in the evening and continue through the night. They include irritability, aggressiveness, confusion, anxiety, and wandering. Light therapy has proven helpful with mitigating sundown symptoms.

Insomnia

Insomnia is an inability to fall asleep or stay asleep. It can be caused by circadian rhythm (biological clock) disorders, tremors in Parkinson’s, or by other sleep problems; like obstructive sleep apnea, which causes frequent awakenings. It usually results in mental decrease and daytime fatigue.

Hypersomnia or excessive daytime sleepiness

Excessive daytime sleepiness is the strong feeling of fatigue, low energy, and sleepiness that lasts for a long time, if not the entire day. Hypersomnia refers to trouble staying awake during the daytime. A very common hypersomnia disorder is narcolepsy – a sleep disorder in which a person unwillingly falls asleep, even at very inappropriate moments. Excessive daytime sleepiness exists even in the early stages of Alzheimer’s disease.

REM sleep behavior disorder (RBD)

An average person’s body is paralyzed during REM (rapid eye movement) sleep. This is because in REM we have vivid dreams, so this muscle atonia mechanism prevents us from enacting our dreams and ending up hurting ourselves and others. In REM sleep behavior disorder, the body is free to move – which makes it dangerous. Melatonin supplements can reduce these symptoms.

Restless legs syndrome (RLS)

People who have restless legs syndrome feel a constant urge to move their legs. When they don’t, they complain of feeling itchiness, pain, or pulling sensations. About 20% of Parkinson’s disease patients suffer from RLS.

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Sleep-disordered breathing and sleep apnea

Sleep-disordered breathing means that a person can’t breathe properly while sleeping. They snore loudly and may even experience complete closure of airways – which is known as sleep apnea. People who suffer from sleep apnea wake up many times a night to catch a breath because of the obstruction of oxygen flow to the brain.

Circadian Rhythm Sleep Disorders (CRSDs)

Circadian rhythm sleep disorders are related to a person’s circadian clock which does not match the normal day-night rhythm. Instead, these people may go to bed and wake up a lot earlier than others or may have a sleep pattern divided into two or three sleep periods rather than one long sleep period at night. It is common in the elderly to have such disorders due to aging and lack of physical activity.

How to treat sleep disorders in demented patients?

Physicians may perform a series of tests and questionnaires, use polysomnogram (sleep study) or other means of sleep data collection prior to sleep problem treatment.

Obstructive sleep apnea is successfully treated by positive airway pressure machine, which slows down cognitive decline and improves sleep and daytime alertness.

For restless legs syndrome; you may get iron supplements, dopamine agonists or gabapentin, all of which improve RLS symptoms. However, dopamine agonists may trigger sleep attacks in some patients.

REM sleep behavior disorder is treated with melatonin and clonazepam, but your physician may also advise extra safety precautions to reduce the risk of injuries.

If you suffer from hypersomnia your doctor may prescribe you stimulants, sodium oxybate, or anti-cataplectic agents to improve alertness. However, they may cause irritability and dependence.

In cases where drugs for dementia and Parkinson’s disrupt sleep, you can talk to your doctor about changing the time of drug intake or decreasing the amount of the medication.

Melatonin generally helps with circadian rhythm problems because it promotes sleepiness. If paired with bright light therapy during the day it can produce very beneficial results in improving one’s circadian rhythm.

How to make sleep better for someone with dementia

People who suffer from dementia typically have trouble falling asleep, tend to get up at night and may get dressed and get going somewhere; whereas during the day they may experience fatigue and sleepiness. They can take long naps at daytime.

All of this is very stressful for their caretakers who have to be alert at all times. However, there are some ways to treat sleep problems and improve the poor sleep of dementia patients. They are behavioral and environmental factors.

  • Make a strict sleep-wake schedule. For someone with an ‘untidy’ sleep schedule it may be difficult, but try to make small changes step by step. Keep the same waking time and practice good sleep hygiene at first. With time, the person you care for will adjust their sleep time to the schedule.
  • Avoid naps. Napping can replace night sleep. If it’s absolutely necessary to have them, keep naps under 20 minutes per day.
  • Mind the sleep environment. Make sure the air in the sleeping room is fresh, make sure that it is dark enough, cool (about 65°F), and quiet. All of these factors are equally important for having good sleep.
  • Use light wisely. Expose the elderly person to bright light in the morning and afternoon. This time may be used for a walk in the park or just spending time outside or by a window. Light helps adjust their circadian clock. Also, in the evenings, avoid using strong bright light because it can confuse the circadian rhythm and delay sleep onset.
  • Have physical activity during the day. Even if it’s just going for a walk or some light exercise, physical activity is highly beneficial for everyone, especially for someone with sleep problems. Physical activity increases energy levels and improves sleep quality at night.
  • Be mindful of the diet. Don’t take caffeine in the evenings and avoid alcohol. Big meals should not be eaten at night.
  • Help the demented person get oriented. Put a clock and a calendar in a visible place in the bedroom so that the person you care for can know what time it is. If they wake up at night, tell them it is sleep time and explain why they can’t go out.

The information on this website is not intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice. Read our full medical disclaimer.

Additional resources

  1. Rose K, Fagin C, et al. Sleep disturbances in dementia: What they are and what to do. J Gerontol Nurs. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3062259/ Accessed April 25, 2019.
  2. Ooms S, Ju E. Treatment of sleep disorders in dementia. Current Treatment Options in Neurology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5363179/ Accessed April 25, 2019.
  3. Kinnuen K, Vikhanova A, et al. The management of sleep disorders in dementia: an update. Current Opinion in Psychiatry. https://journals.lww.com/co-psychiatry/Fulltext/2017/11000/The_management_of_sleep_disorders_in_dementia___an.16.aspx Accessed April 25, 2019.
  4. Sleep Disorder Increases Odds of DLB by Five Times Over Alzheimer’s. LBDA. https://www.lbda.org/go/sleep-disorder-increases-odds-dlb-five-times-over-alzheimer%E2%80%99s Accessed April 25, 2019.
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