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.