Mental Health Month: Sleep Disorders and Alzheimer's
Sleep problems are common among elderly people and can be problematic in people with Alzheimer's disease. They can occur at any stage of Alzheimer's.
There are three types of sleep problem which can all be interrelated. They are sleeping too much during the day, difficulty getting off to sleep and difficulty staying asleep. Sleep problems can be a sign of other illnesses such as Lewy Body dementia (see REM disorder later in this sharepost), liver disease, anxiety, depression, pain, urinary tract infection, restless leg syndrome. Diagnosis and exclusion of other disease can lead to more effective treatment.
It is important that an accurate diagnosis is made before the appropriate treatment is prescribed.
Disorientation and confusion in people with Alzheimer's is common during the night. This is not always caused by sleep problems but may well result in them. Wandering is exhausting for caregivers and can be dangerous if the person with Alzheimer's leaves their home. Frequent sleep disruption will then cause excessive napping in the day and perpetuate a cycle of disrupted sleep patterns. A night light, increasing daytime activities, and other behavioral treatments should help (See caregiver tips for sleep problems later in this sharepost). Medication may have to be considered. More information on Wandering Behavior in People with Alzheimer's
Insomnia can cause symptoms such as problems falling asleep, waking repeatedly, and waking up early. As a result people with insomnia often feel tired in the day, feel irritable and have increased problems with paying attention. Anxiety can cause chronic insomnia.
Medications for Sleep Disorders and Alzheimer's
Few studies have been carried out to evaluate sleep medication in people with dementia and few on non-pharmacological ones. Although medication can be helpful they can cause problems in people with Alzheimer's. Drugs can increase confusion, can cause increased injury through drowsiness and increased levels of dependency. Finding a medication that helps resolve sleep problems can take time in terms of finding a drug that suits the individual and causes minimal unwanted side effects.
Zolpidem (Ambien) can be helpful for people with insomnia who wake up too early. Zaleplom (Sonata) is recommended for people who have trouble falling asleep. Older benzodiazepines drugs such as Valium can cause problems because they have long lasting effects. Tradazone, an older antidepressant drug, although commonly used as a sleep aid because of its sedating qualities, can cause a significant degree of daytime confusion.
Cholinesterase inhibitors used in the treatment of mild to moderate Alzheimer's have been shown to be beneficial. The three most commonly prescribed are donepezil (approved in 1996), rivastigmine (approved in 2000), and galantamine (approved in 2001).
Caregiver Tips on Coping with Sleep Problems in People with Alzheimer's
The most effective way of treating sleep problems in Alzheimer's, besides treating an underlying disease, is through behavioral changes. For more information on behavioral, environment and effective nursing treatments see Caregiver Tips on Coping with Sleep Problems in People with Alzheimer's.
Sleep Apnea Can Cause Excessive Day Sleeping
Apnea, means an absence of breath. Sleep apnea is a disorder in which a person stops breathing during the night usually for periods of 10 seconds or longer and sometimes for as long as a minute. Treatment can be successful and can help increase levels of cognitive functioning in people with Alzheimer's.
More information on Sleep Apnea.
REM Behavior Disorder
This is a rare disorder, where a person can act out dreams that they experience during a stage of sleep called REM. They may recall very vivid dreams. Sleep walking is common, as is shouting or grunting. Sometimes they may become violent. REM behavior disorder can happen a few years prior to a diagnosis of Lewy Body dementia. Treatment with clonazepam (Klonopin) can be effective. For more information on this see How Does Lewy Body Dementia Differ from Alzheimer's?
Marc E Agronin, M.D (2004) Dementia A Practicle Guide Lippincott William and Wilkins Philadelphia