Scientists have discovered that disturbed sleep patterns may indicate Alzheimer’s years before symptoms occur, and Alzheimer’s can cause changes in the brain that affect patients’ internal clocks. Many Alzheimer’s caregivers have questions about whether or not sleep medications will benefit their loved ones or how to change their loved ones’ sleep-related habits: sleeping all day, staying up all night or rummaging through drawers in the middle of the night. To help you learn more about Alzheimer’s and sleep, we spoke to Karen Rose, Ph.D., a graduate professor at the University of Tennessee, College of Nursing, who researches this topic and serves on the editorial boards of the Journal of Gerontological Nursing and Research in Gerontological Nursing.
Q: “I’m considering giving my loved one an OTC (over-the-counter) sleep aid. The last three nights, he won’t go to bed. Tuesday, he was up and down all night. I’m considering trying it. The doctor prescribed Seroquel and Ativan, but they didn’t do anything. Are there any OTC aids that can help?”
A: The side effects of OTC and prescribed sleep medications can be worse than the sleep problem. The next day, a person may experience daytime drowsiness, causing him or her to be groggy and unsteady, and to have a higher risk of falling. Are the side effects worth the trade off? People answer this question differently, given their circumstances. Benzodiazepines [drugs typically used to treat anxiety or sleep problems] have been shown to cause additional cognitive decline and are bad news for older adults, as are hypnotic medications [drugs whose main role is to induce sleep]. OTC Tylenol or Benadryl also aren’t great for older adults. I understand we want a magic pill for everything, and if there was one with no side effects, then I’d say, “Sign us all up,” but that’s not the case.
However, if people have questions or concerns, they should consult their physician or health care provider. There are times when people need sleep aids. I just like to remind people that they may come with consequences.
Q: “I would love to see a discussion on sleep problems. My loved one has no sleep patterns. He lives with me, so that means I don’t sleep, either. He naps for a few hours, and then he is awake, compulsively eating for 2–3 hours. Then we repeat the cycle. Lack of sleep adds to the confusion and grumpiness. What can I do to improve this pattern?”
A: I recommend non-pharmacological methods related to sleep hygiene, or establishing a regular routine to help people sleep. Exercise helps tire a person out. Taking walks outside helps the person get sunlight, Vitamin D, and it assists with resetting the suprachiasmatic nucleus (SCN) [the brain’s circadian pacemaker for sleep that controls the sleep-wake cycle] that is activated by light. There is evidence to suggest that the later you expose people to bright light, the later at night they’ll stay up. For example, if you want someone to go to bed later in the evening, then exposing them to bright light later in the day may be helpful. Alternatively, if you want them to go to bed earlier, expose them to light earlier in the day. People should also watch caffeine intake; caffeine after noon gets tricky. I try to have caffeine before 10 a.m.
Before you put your loved one to bed, make sure that it’s quiet, dark and that you’ve helped him or her go to the bathroom so your loved one is not getting up because of having to urinate. Oftentimes, people need to use the restroom within an hour or two of going to bed, so you can get them up again to use the restroom 1–2 hours after they fall asleep, which should help them sleep all night.
Q: “What does one do when their loved one sleeps all day? Yesterday, I woke him up at 1:30 p.m., or else I think he would have slept all day. He went to bed the night before at 8:00 p.m. I consider letting him sleep, but I fear he’ll be up all night! Does anyone have suggestions?”
A: A catnap can ruin a good night’s sleep. If you nap all day, you’re less likely to sleep at night. Keep your loved one awake by engaging him or her with activities. Also, ask yourself why your loved one may be nodding off. Is he or she bored? We might become bored after watching TV too, and fall asleep. Providing activities that are meaningful and keep your loved one engaged can assist with this. Getting some exercise, like taking a walk, can be a great option.
If your loved one does nap, make sure he or she takes a consolidated nap of no more than 60 minutes right after lunch, when full. Help your loved one go to the restroom, make sure he or she is in a dark, quiet room, and put on white noise. If you don’t limit naps, your loved one may be up at night.
Q: “Why does my loved one sleep so much?”
A: Dementia patients’ circadian rhythms often get reversed, so they may be up all night and sleep all day. Also, as we age, we release less melatonin, the hormone that promotes sleep, so we have to work harder to sleep. Some Alzheimer’s patients also have sleep apnea [a sleep disorder where breathing repeatedly stops and starts]. If untreated, people will sleep during the day because they’re not resting at night.
Some studies suggest cognitive decline in older adults can be reversed by treating sleep apnea. Scientists are focusing on people with MCI, and those with Alzheimer’s. Some scientists have seen a reversal in cognitive decline after treating sleep apnea with a CPAP [a procedure that involves patients wearing a face mask connected to a CPAP machine that helps them breathe]. I never discount the sleep issue; if your loved one has sleep apnea, get him or her treated, because cognitive decline is not necessarily part of aging; you need sleep to function. Scientists are also looking into restless leg syndrome [a condition that causes an urge to move the legs at night], which is sometimes diagnosed in Alzheimer’s patients.
Q: “My loved one roams around the house at night and has terrible sleep patterns. The rummaging and roaming are worrisome. What can I do to prevent these behaviors?”
A: A leading theory around neuropsychological behaviors such as rummaging, wandering and pacing at night is that Alzheimer’s patients have an unmet need. They’re distressed and need reassurance. Rather than telling them, “Go back to bed,” try asking, “What’s going on?” or “What are you looking for?”. That’s easy for me to say, but difficult for a caregiver in the middle of the night. If possible, ask several questions: Are they hungry or thirsty? Do they need to go to the restroom? Are they too hot or cold? Determine how to comfort them. For example, is there a meaningful activity they can do that would be comforting or reassuring for them? They may have liked gardening. You can set up a small garden inside or a different meaningful activity. If they enjoyed going to baseball games, gather a collection of baseball cards. These practices are also important during the day to soothe their anxiety.
This interview has been edited for length and clarity.