By Lauren Mahakian Contributing writer. Originally published in Palos Verdes Penisnsula News on 7/22/2021
I’m sure most of us remember in our younger years how we would go to bed far too late and wake the next morning way too early. “I’ll make up for that by getting to bed early tonight,” we would tell ourselves.
I wonder how much sleep we now owe ourselves.
The quality of our sleep naturally declines as we age. We’ll have a restful sleep one night followed by a few nights that are much less so. We rarely make up for lost sleep, as we would tell ourselves years ago.
Our lives don’t wait for us to rest either, so we savor caffeinated beverages and tough it out. Except for the occasional nap, we basically learn to live with less sleep. Later, we realize we now have a hard time going to sleep or staying asleep.
In well over a decade of working with dementia patients, I know sleep issues are common and it’s one of the reasons families seek my help. I’ve seen countless cases of sleeping during the day and then being awake or restless all night. Those who do sleep might wake more often and stay awake longer during the night.
Many people with dementia become disoriented in the dark when they need to use the toilet. Disorientation can also lead to confusion, with some waking before morning and thinking it’s already daytime or time to go to work (even though they stopped working many years ago). Others no longer notice the difference between night and day.
Sometimes a person with dementia completely reverses their normal sleep pattern, staying up all night and then sleeping all day.
Sundowning is a common issue that’s related to sleep issues. It produces anxiety, agitation, and even aggressive behavior. Sundowning usually occurs late in the day or evening when the body’s clock says it’s time to rest. A person needs rest but can’t get it because of the uncontrolled emotional responses to the condition.
My experiences and observations in the field are certainly not unique. The Mayo Clinic reports that sleep disturbances affect up to 25% of people with mild or moderate dementia but affects 50% of people with severe dementia.
Because dementia affects the brain, and the brain controls most of what we do, it’s not always clear how dementia affects sleep. For some people, it could be the portions of the brain that judge the time of day may be damaged. In others, the brain control functions for staying awake or sleeping might be damaged.
In most cases, we will never know. We don’t even yet know whether dementia leads to poor sleep or if it’s the other way around. Studies are ongoing to discover whether poor sleep contributes to dementia or whether it’s an early symptom.
Of course, caring for a loved one with dementia is stressful. Caregivers and their families can, however, work to reduce this stress and lower anxiety levels by addressing sleep issues for those in their care.
As always, never deal with complicated health issues alone. If you’re concerned about any sleep disorder, consult a physician. Be sure to mention any underlying conditions you may suspect. These include depression, restless legs syndrome and sleep apnea. Some medications can cause insomnia, so raise any concerns related to prescriptions or supplements as well. As caregivers, we are closer to patients than their physicians, who need all the information they can get to help provide the best care.
Managing routines and habits seems to be highly effective. Maintain routines around meals and at waking and sleeping times. Put on soothing music or read, which helps establish a peaceful mood before bedtime. A comfortable temperature can also help with sleep.
During the day, try to avoid caffeine, nicotine and alcohol. Limit daytime sleep and discourage afternoon napping, which only makes matters worse. Encourage physical activity, such as walks. These can all help promote a better night’s sleep.
If your loved one does wake at night, discourage them from watching television. Even though many people fall asleep with the TV on, it does not promote sound sleep.
Most importantly, remember there are professionals who can help. Find a support group in your area. Share your concerns and challenges with others who are on a similar journey.
You might even end up sleeping better at night.
Lauren Mahakian is a certified care manager. Check out her free podcast, Unlocking the Doors of Dementia™ with Lauren and Free Support Groups on Zoom.