As we age, we might start to sleep a little less than we used to when we were younger. However, we still need the same quality of well-rested and deep sleep so our bodies and minds can recover and re energise for the next day.
While the hours spent sleeping vary amongst people with dementia, their frequency and severity of sleep disturbances are significantly higher than older adults without dementia. For more information on identifying sleep problems, have a look at the article Understanding sleeping problems in dementia.
In this article, we look at the possible reasons WHY a person with dementia may struggle to get a good night’s sleep. If you can understand why someone is struggling to sleep, then you can make changes to try and help them sleep better.
Dementia causes changes to the brain that can affect the sleep-wake cycle, disturbing normal sleeping patterns. The sleep-wake cycle is a 24-hour cycle that our body goes through every day. It makes sure that we are awake and active during the day and feel sleepy at night. When this cycle is changed, it results in many unusual and disruptive sleeping patterns. This includes being awake at night, problems falling asleep and maintaining sleep, day-time drowsiness and frequently napping during the day. These sorts of changes are seen in many types of dementia.
The sleeping environment (i.e. the bedroom) might not be suitable for the person with dementia.
There is a link between physical activity and sleep. If the person with dementia is not active, and taking frequent naps during the day, this negatively impacts their sleep-wake cycle and therefore the quality and duration of sleep. Their body is also probably not tired enough, and so it’ll take them longer to fall asleep.
Most people with dementia are older adults and are probably at risk for various age-related comorbid conditions. These can further worsen sleep issues and increase the risk for development for sleep problems. These comorbidities can also cause pain and discomfort that will interfere with sleep. This disturbed sleep, in turn, reduces pain threshold causing a vicious cycle. Some examples include:
Dehydration often interferes with physical and mental functioning, worsening dementia symptoms. It can lead to the person to become constipated which causes them discomfort and will in turn disturb their sleep quality. A person who is dehydrated can also experience cramping in the limps, headaches or just generally feel unwell. As a result they may become irritable and have difficulty falling asleep.
Many people who experience sundowning will struggle to sleep at night. Sundowning can be identified by increased confusion, wandering and agitation that tends to happen later afternoon into early evening and usually occurs in Alzheimer’s during the moderate to late stages of the condition. You can find out more about sundowning by reading Understanding sundowning in dementia. One of the causes of sundowning is thought to be related to changes in the sleep-wake cycle and secretion of melatonin (a hormone that promotes sleep).
It might be helpful to start a journal or use an app to document the patterns and disturbances that the person you are caring for is facing to identify and relate to the above list of reasons. Once you think you know the reason(s) for the sleeping problems, head over to the article Sleeping better with dementia for potential solutions.
Make sure that when you start to observe sleeping difficulties, you share this information with your doctor as they can help identify and come up with a treatment plan for better quality sleep.