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Sleeping Problems In Alzheimer's Disease

   Alzheimer patients do not sleep well. They spend less time in deep,relaxing sleep. They also dream less. Many patients sleep during the day and are awake at night. The normal rhythm of sleep and waking becomes disordered.
   There are many reasons for the altered sleep pattern. The main reason is biological. Amyloid beta protein, which is found in alzheimer brains, causes disrupted sleep-wake cycles when injected into normal animals.
   Pain may keep a patient awake. If sleep disturbance is chronic, the patient should get a full medical evaluation to rule out medical causes for sleep loss. If a patient is depressed, he or she may have trouble falling asleep. A physician should assess your patient for depression. If your physician finds evidence of depression, he or she may prescribe an antidepressant-sedative to help. Stimulants, such as caffeine, which is found in many soft drinks, tea, and coffee, may keep the patient from sleeping well. Try to limit your patient's caffeine intake after suppertime. Patients may not sleep well if they are hungry. A bedtime snack such as warm milk may help.
    There are a variety of ways to promote restful sleep for patients. Patients who are more active at night may benefit from physical exercise such as walking during the day. Some patients with mild sleep problems may sleep better with over-the-counter sleep medications, such as the antihistamine Benadryl. Consult with your physician first, and if he or she agrees,a trial of Benadryl might be in order. Use Benadryl cautiously, since this drug can increase mental confusion, lower blood pressure, induce blurred vision, or increase constipation and urinary retention in sensitive elderly patients. Check to see if the patient's sleeping room is too hot or too cold. If unsure, ask the patient if the room temperature is comfortable. Some patients become disoriented if a sleeping room is totally darkened. If that is the case with your patient, consider leaving several nightlights on during sleep time. Some patients are afraid of the dark. For these patients, in addition to a nightlight, a softly playing radio may help. Try using the gradual dimming of lights (with a dimmer switch) as a cue to announce sleep time.
    Sometimes you need to make the bedding more comfortable. Try using quilts on the bed instead of blankets. Quilts are less likely to tangle than blankets. Bed rails should be used cautiously. They may successfully restrain some patients. However, other patients may try to climb over the bed rails, which could result in an injury. In fact, it is well known that many patients are prone to falls anyway, especially in the advanced stage of the illness. You can use some sort of sensor that emits a chime or beep when the patient moves out of bed.
    A problem closely related to sleep problems in alzheimer patients is "sundown syndrome". Many patients behave well during the day,but by day's end, they become fatigued,and this makes many patients tired and irritable. Patients with sundown syndrome may be very difficult to feed at dinner, at which time they may be irritable,abusive,and refuse to eat. Patients also become more cognitively -impaired. Thinking and remembering are more difficult for them when they are tired.

    Sundown syndrome has a variety of causes, including certain cardiovascular conditions, drugs, and dehydration. Some studies have shown that daily exposure to daylight is the single best way to normalize sundown syndrome in Alzheimer patients. (Dressing the patient for outdoors should not require any special consideration beyond the normal way one dresses for existing weather conditions.) If possible, try to expose the patient to some gentle outdoor activity each day such as taking a walk. Remember to include periodic rest breaks for the patient. NOTE: In planning exercise for your patient, it is extremely important to check with the patient's physician. Make sure there are not underlying medical problems that would prohibit exercise.
    You can lessen syndrome by modifying your home. Play quiet music in the late afternoon in place of a loud radio or television. Turn lights on inside your home long before it gets dark outside. This will help adjust the patient to the end of the day. Don't allow your patient to rest in a dark room during the day. He or she may awaken and think it is early morning. Have your patient take daytime naps while sitting upright in a chair - not reclined on a bed. When a patient awakens in bed, he or she tends to think it is a new day.