Alzheimer’s Disease and Sleep

Alzheimer’s disease (AD) is a form of dementia, or loss of brain function. AD affects memory, thinking, speech and behavior and it gradually worsens over time. Sleep problem often go hand in hand with AD. Sleep is impacted by the loss of brain tissue which may disrupt the sleep/wake cycle, which can cause sleep problems such as nighttime wandering or agitation. Currently, scientists do not completely understand why AD patients experience sleep disturbances.

The National Institute on Aging and the National Institutes of Health estimate that 4.5 million Americans are affected with Alzheimer’s disease. The risk of developing AD increases with age, but it is not a normal part of aging. It usually begins after age 60 with the risk nearly doubling every five years after age 60, according to the U.S. Surgeon General. Because of the aging Baby Boomer population, the number of Alzheimer’s patients is expected to increase dramatically in the near future.

The quality of sleep Alzheimer’s disease patients get depends upon the stage of their disease. Early stage AD patients may sleep more than usual or wake up disoriented. Patients who are at a later stage of AD may begin to sleep during the day and wake up often at night.

Those with the more advanced stages of AD rarely sleep for long periods. Instead, they sleep irregularly throughout the entire day. The daily sleep/wake cycle, called Circadian rhythm, sometimes becomes disrupted in older adults. These interruptions are worse in AD patients, who may lose the ability to stay asleep or keep alert during the progression of the disease. The results of one study show that sleep problems may also increase agitation among AD patients.

“Sundowning,” is a term that explains the increase in the agitated, restless behavior of AD patients in the evening. Whatever the cause of sundowning, agitation and sleep problems result in increased stress for caregivers, and it is among the top reasons why AD patients are placed in nursing homes. Experts estimate that AD patients in the late stages of the disease spend approximately 40 percent of their time awake in bed at night and a considerable part of the daytime asleep. Sometimes this is so extreme that there can be a complete reversal of the wakefulness/nighttime sleep pattern.

Another possible sleep problem for Alzheimer’s disease patients is obstructive sleep apnea (OSA). OSA happens when the throat muscles relax during sleep which blocks the airway and a person stops breathing, causing them to wake up multiple times in order to resume breathing. Stanford University Medical Center found in a recent study that a gene associated with OSA is linked to a higher risk of AD, among other chronic diseases. These findings highlight the complexity of the disease and the need to treat a wide range of symptoms to give AD patients the best possible care and quality of life.

Caregivers of AD patients are also affected both physical and mentally, which may result in their own sleep problems. One recent study found an increase in the risk of heart disease for elderly caregivers of AD patients. The sleep problems caregivers experience often increase the chance of AD patients being turned over to a nursing home for care, which may ultimately allow both the caregiver and the patient to live a healthier life.

Alzheimer's Disease Symptoms

AD symptoms develop slowly and are first noticed with the loss of short term memory. Gradually, patient lose more and more of their mental capabilities, such as having difficulty remembering people, events, or how to do simple tasks. As the disease progresses, AD patients may lose the ability to recognize loved ones, speak or think clearly.

A disrupted sleep/wake cycle is another primary symptom of AD, causing the patient to be sleepy during the day and restless and alert at nighttime. This can be a dangerous problem for sufferers of AD, particularly because their caregivers are likely to be asleep at night. AD patients may also experience high levels of agitation if they don’t get adequate sleep.

The 2003 Sleep in America poll by the National Sleep Foundation found that adults with memory problems are more likely than adults without memory problems to develop insomnia symptoms. This includes difficulty falling asleep, frequent awakenings at night and waking up too early. The biggest overall complaint for insomnia sufferers is getting up to use the bathroom at night, and nearly two-third reported this problem several nights a week.

Additional AD symptoms include:

  • Forgetfulness
  • Speech problems
  • Inability to do everyday tasks such as cooking, cleaning and bathing
  • Incontinence
  • Aimless wandering
  • Losing things
  • Depression

Treatment for Alzheimer's Disease

Although there is no known cure for Alzheimer’s disease, behavioral and drug therapies may slow the progression and treat the symptoms. However, the first route of treatment should always be non-drug coping strategies. It is critical for AD patients to sleep on a regular schedule to manage the symptoms of the disease. Behavioral therapies are an important part of the treatment for AD patients. Those who awaken at night may try to avoid or limit naps.

Other ways to manage symptoms, including sleep problems, include:

  • Create an ideal sleep environment
  • Set a regular sleep/wake time every day
  • Exposure to bright light soon after waking
  • Dim light close to bedtime
  • Encourage regular exercise during the daytime
  • Maintain regular times for meals
  • Avoid caffeine or alcohol
  • Manage medications for specific time of day
  • Treat underlying conditions

Sleep Medications for Alzheimer’s Disease Patients

When non-drug coping strategies fail, experts recommend to “begin low and go slow” with implementing medications. There are considerable risks involved of giving sleep-inducing medications to older people who are cognitively impaired. This includes an increased risk of falls and fractures, confusion and less ability to care for oneself. Caregivers should attempt to discontinue medications after a normal sleep pattern is established.

Types of medications used for sleep problems in AD patients include:

  • Tricyclic antidepressants
  • Benzodiazepines
  • Sleeping pills
  • Atypical and classical antipsychotics. These should be prescribed with extreme caution, as there is an increased risk of stroke and death in older adults with dementia – the FDA ordered manufacturers to label such drugs with a “black box” warning about the risks.

The goals of treatment are likely to change during the journey through Alzheimer’s disease. Ask your doctor any questions you have about the available options and the benefits or risks of each particular treatment option.

A Note for Caregivers

Remember that if your loved one wakes during the night and is upset, you should do your best to stay calm, even though you may be sleepy yourself. Try not to argue with the Alzheimer’s disease patient and remember that s/he isn’t deliberating trying to aggravate you. Gently remind your loved one that it is time to sleep. If your loved one is wandering through the house aimlessly, guide him or her back to bed.

Remember that you need sleep, as well. If you’re not getting adequate sleep, you may not be able to adequately care for your loved one. It takes patience and energy to care for an AD patient, so you may want to ask other family members or friends to alternate nights with you. You may also seek outside help from a social worker or representative from a local Alzheimer’s association to see if there is available help in your area.

To learn more about Alzheimer's Disease and how it can affect your sleep cycle, call The Los Angeles Sleep Study Institute at 1-855-690-0563.