Exhausted caregivers often say that one of the hardest things for them is that they can’t get quality sleep. Even caregivers who have loved ones outside of their homes can have problems since they are still on call day and night for frequent emergencies. However, it’s the Alzheimer’s caregivers who have the hardest time since Alzheimer’s disease can cause severe sleep disruption.

Experts still aren’t sure about all of the reasons for the poor sleeping patterns of people with Alzheimer’s disease. Doctors feel that there may be some change in the brain, perhaps the same as with other aging people but more intense, that cause this distressing situation.

According to the Alzheimer’s Association, brain wave studies show decreases in both dreaming and non-dreaming sleep stages. Those who cannot sleep may wander, be unable to lie still, or yell or call out, all of which disrupts the sleep of their caregivers.

Napping, too, can be a problem for people with Alzheimer’s. When a person has Alzheimer’s, particularly in the later stages, he or she is likely to drift off at any time. Since logic no longer works, trying to explain that too much daytime sleep will make for a harder night is useless. Some caregivers are able to plan activities for times when their loved ones may want to take naps, thus interrupting the desired to sleep out of boredom. That, in turn, may help ensure that their loved one is more tired at night.

Another issue with Alzheimer’s and sleep problems is a behavior called sundowning. Sundowning is still not well understood, but agitation and anxiety are hallmarks of this behavior. The term sundowning grew out of symptoms that tend to appear toward the end of the day and often carry over into the evening or even into the night, thus disrupting everyone’s sleep. For tips on managing sundowning see 10 Tips to Relieve Alzheimer's Sundowning.

Treatments for sleep disturbance

Non-drug approaches are far preferred to drugs for sleep management as drugs can have negative side effects that can worsen other aspects of Alzheimer’s disease as well as increase the risk of falls. The steps below are recommended by the National Institutes of Health as well as the Alzheimer’s Association:

• Maintain regular times for meals and for going to bed and getting up
• Seek morning sunlight exposure
• Encourage regular daily exercise, but no later than four hours before bedtime
• Avoid alcohol, caffeine and nicotine
• Treat pain
• Provide nightlights and security objects
• If the person awakens, discourage staying in bed while awake
• Use the bed only for sleep
• Discourage watching television during periods of wakefulness
• Avoid giving certain medications before bedtime. For people with Alzheimer’s, this includes cholinesterase inhibitors such as tacrine, donepezil, rivastigmine or galantamine
• Make sure the bedroom temperature is comfortable

Drug treatment should generally be used as a last resort. If needed in severe cases the effects of the drug must be carefully monitored.

Work with your loved one’s doctor if sleep deprivation is one of your problems. Ask the doctor what to watch for as far as side effects and use your own knowledge of your care receiver to help the doctor make solid decisions. You know your loved one best. If side effects outweigh advantages, tell the doctor so that the two of you can work on another approach.

Carol is a newspaper columnist and the author of Minding Our Elders: Caregivers Share Their Personal Stories. She runs award winning websites at _ www.mindingourelders.com and_www.mindingoureldersblogs.com. On Twitter, f_ollow Carol @mindingourelder and on Facebook:_ Minding Our Elders

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