Month: July 2022

People with dementia usually spend a lot of time sleeping both during the day and night, especially in the late stages of the disease. The sleep pattern typically changes as a person ages. However, these changes are more complex in people with Alzheimer’s disease or other forms of dementia.

As the disease advances, brain damage becomes widespread. The person also becomes weaker over time and, as a result, may feel exhausted after performing the simple routine tasks such as eating, communicating, or trying to comprehend their surroundings can exhaust them. As the symptoms worsen, they may need to sleep more during the day. Some drugs, including antidepressants, antipsychotics, antihistamines, and sleeping pills, may also cause sleepiness.

Why does Alzheimer’s disease or dementia affect sleep?

Although sleep disorders are common for people with dementia, how the disease affects sleep is still not clearly understood. Sleep disturbances may foreshadow the cognitive decline that occurs in dementia patients. Commonly occurring sleep problems include:

• sleeping during the day and being awake and agitated at night
• waking up more frequently and staying awake longer at night
• experiencing disorientation in the dark if the person wakes up to use the toilet
• unable to distinguish between day and night
• waking up in earlier hours and mistakenly believing that it is daytime.

Experts believe that Alzheimer’s disease and other types of dementia cause cellular changes in the brain that can disturb the sleep-wake cycle. In some people, the damage to their internal biological clocks (that judge the time) may lead to sleepiness at the wrong time of the day. Furthermore, malfunctioning of some other parts of the brain (that control whether we stay awake or not) due to damage may also result in sleep disturbances.

A person with dementia may occasionally entirely reverse their sleep pattern, staying awake all night and sleeping all day.

What to do if the person with dementia is sleeping a lot?

Dementia progression is likely the cause if your late-stage dementia patient has gradually started to sleep a lot. However, if it has suddenly started, or the person does not feel well in other ways, it may be due to some other reason.

In the latter case, you should consult a doctor to rule out any infection or condition that could be causing sleep disturbances in the patient. It would also be helpful to ask the doctor or the pharmacist about the side effects of the medication that your patient might be using.

If the person does not seem distressed or uncomfortable, there is no reason to be worried about sleeping more during the day. However, lying down and sleeping most of the time may cause health problems. Therefore, it is essential to check on your patient to ensure they do not develop any physical health issues.

Sleep disturbances in people with Lewy body dementia and Parkinson’s disease dementia

The type of dementia may affect the sleep pattern of dementia patients. People with Lewy body dementia (LBD) or Parkinson’s disease dementia often experience sleepiness during the day but feel very agitated and disturbed at night. They may hallucinate, feel confused, and have nightmares. Furthermore, they usually exhibit symptoms like insomnia, sleep apnea (breathing problems), and restless legs.

People with these types of dementia also manifest rapid eye movement (REM) sleep disorder at the earliest stages of the disease and onwards. This disorder causes them to mistakenly act out their dreams by shouting or moving in bed and can injure themselves or their sleeping partners. As a result, the person feels like they have not slept at
all, making them exhausted and sleepy during the day.

It might be difficult to stay awake throughout the day following a bad night’s sleep. However, if feasible, try to limit daytime sleep to tiny bursts or ‘catnaps.’ Otherwise, a person’s biological clock might become quite confused, making sleeping soundly at night even more difficult.

Brain proteins and sleep changes in Alzheimer’s disease

Recent research has shown a link between beta-amyloid protein, the hallmark of Alzheimer’s disease, and sleep changes. The brain removes excess beta-amyloid protein when a person sleeps. Sleep deprivation can cause an increase in beta-amyloid, as indicated in the mice model. In another study (performed on human subjects), the researchers found an increase in beta-amyloid levels increased up to 5% following a sleep deprivation of about 31 hours.

Scientists have also found a link between tau protein and sleep disturbances. According to a study, sleep deprivation of as little as one night can increase tau levels up to 50% in cerebrospinal fluid.

The link between beta-amyloid, tau, and Alzheimer’s disease is complicated, but researchers agree that getting quality sleep assists the brain in removing extra proteins. They are still uncertain if sleep disturbance causes Alzheimer’s, aggravates symptoms, and accelerates disease development or if it is a consequence of a disease.

References

1. National Institutes of Health, 2018. Sleep deprivation increases Alzheimer’s protein. NIH Research Matters, April, 24. https://www.nih.gov/news-events/nih-research-matters/sleep-deprivation-increases-alzheimers-protein

2. Shokri-Kojori, E., Wang, G.J., Wiers, C.E., Demiral, S.B., Guo, M., Kim, S.W., Lindgren, E., Ramirez, V., Zehra, A., Freeman, C. and Miller, G., 2018. β-Amyloid accumulation in the human brain after one night of sleep deprivation. Proceedings of the National Academy of Sciences, 115(17), pp.4483-4488. https://www.pnas.org/doi/10.1073/pnas.1721694115

3. Holth, J.K., Fritschi, S.K., Wang, C., Pedersen, N.P., Cirrito, J.R., Mahan, T.E., Finn, M.B., Manis, M., Geerling, J.C., Fuller, P.M. and Lucey, B.P., 2019. The sleep-wake cycle regulates brain interstitial fluid tau in mice and CSF tau in humans. Science, 363(6429), pp.880-884. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6410369/

Staying in a hospital can be an unpleasant experience for anyone, but it may specifically be hazardous for people with Alzheimer’s disease and other forms of dementia. Situations such as changed routine, unfamiliar people poking, an entirely different environment, etc., can make the stay a challenging experience for them.

According to studies, people with dementia have an increased risk of experiencing adverse outcomes¹ following hospitalization. Even a brief stay can exacerbate the dementia symptoms and augment the risk of complications, including falls, dehydration, malnourishment, delirium, and hospital-acquired infections.

Due to the mentioned reasons, caring for your loved one with Alzheimer’s or dementia in a hospital can be a daunting task. However, some tips can help you make their hospital stay a bit convenient.

Prepare Beforehand

Whether your patient has a scheduled treatment or unexpectedly ends up in the emergency department, it is critical to have a few essential items on hand. An already prepared and packed hospital kit can come in handy in emergencies. You should include the current insurance information and relevant health information, such as a comprehensive list of medications, a brief medical history, and a copy of the medical power of attorney document.

While planning for the stay, think of the things that can make your patient’s hospital stay easier. Take along items such as a cherished photograph album, a favorite book or puzzle, or a prepaid topped-up mobile phone with easy-to-locate contact numbers to keep them engaged.

Before your arrival, it will be helpful to call the hospital ward to know what services they can provide to dementia patients.

Provide Comfort And Reassurance To Your Dementia Patient

Hospitals may appear loud and unfamiliar to dementia patients, making them confused and agitated. They may not know where they are or why they are there. Therefore, it is essential to explain to them the place and why they are there in a calm manner. Try to be gentle and reassuring to make your patient feel at ease.

Since the noise at the hospital can scare the patient and add to their anxiety, check that their hearing aids are on and adjusted as per new surroundings. Ask the staff if there is a day room for the patient to take a break from the ward, especially at the peak times (such as visiting hours or ward rounds).

Another way to provide reassurance is to talk to them, read to them, and support them emotionally since familiar faces can bring comfort to dementia patients in such situations.

Share Information About Your Dementia Patient With Staff

It is helpful to discuss your loved one’s behavior and dementia symptoms they exhibit with the hospital staff because the staff might not know that the patient has dementia or may not have experience dealing with dementia patients. Sharing information about the person will help the staff to understand and respond to them more effectively.

You can give details of the person’s daily routine, the food they like or dislike, difficulties they have during mealtimes or while communicating, sleeping patterns, or any other information that can help staff build a good relationship with the patient. It is also necessary to let the staff know if your loved one needs reminders or assistance with activities such as eating, drinking, dressing, taking medication, or going to the toilet.

Support Your Loved One With Dementia To Eat And Drink

Hospital stays can considerably impact the mealtimes of dementia patients, who can become stressed, dehydrated, and malnourished. If ward mealtimes occur outside of visiting hours, you can ask the staff if you can stay after these timings. As hospital staff is often busy at mealtimes, they may be grateful for any assistance you can provide. So, it will be helpful to be there for mealtime or bring extra food if you can.

Since you may not always be around for assistance, it would be better to let the staff know about any difficulties your patient has at mealtimes.

You can make your patient’s mealtimes easier by having a drink or snack with them. If they do not seem to eat, do not presume that they are not hungry. Instead, try engaging them in different ways and making food seem more appealing.

Support Your Patient If They Are Walking About

A person with Alzheimer’s disease or other types of dementia might attempt to get up and roam around the ward. As the patient must be safe, this behavior can make the staff worried. However, walking can be a great activity to stay active in the hospital.

If the patient wants to walk around the ward, and it is safe and possible, ask the staff to assist them. Some dementia patients may become stiff if they do not move around, increasing the risk of falls. So, explain to the staff why it is important for your patient to walk around.

Sometimes, the person may feel angry, threatened, or agitated if they are prevented from walking around. In such cases, you can ask the staff to make any adjustments to help them. For instance, they can let them walk when they have visitors.

Stay By Your Loved One’s Side

When it comes to keeping a senior calm in the hospital, a familiar face may do wonders. Make every effort to spend as much time as possible with your loved one, especially in the evenings, during meals, and while medical tests and procedures like IV insertions and vital sign checks are carried out. If you are unable to visit the hospital regularly, attempt to arrange for other family members to do so.

Alzheimer’s Research Association is committed to helping caregivers of Alzheimer’s disease and dementia by providing the latest news and research on Alzheimer’s, useful tips, and grants. For more information, contact us!

References

1. Fogg, C., Griffiths, P., Meredith, P. and Bridges, J., 2018. Hospital outcomes of older people with cognitive impairment: an integrative review. International journal of geriatric psychiatry, 33(9), pp.1177-1197. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6099229/