Sleep problems in elderly with dementia can be treated

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By Micha Shalev

Sleep disorders are commonly under diagnosed and a significant source of concern for the geriatric population.

Age alone does not cause sleep problems. Disturbed sleep, waking up tired every day and other symptoms of insomnia are not a normal part of aging. Instead, poor sleep habits, untreated sleep disorders, medications or medical problems can contribute to sleeplessness.

In addition to affecting quality of life — including excessive daytime sedation, physical, psychological and cognitive problems affecting overall health — sleep disorders have been implicated with an increased mortality rate among elderly dementia sufferers.

Unfortunately, the number of medications used increases with age, which in itself can lead to more morbidity, mortality, side effects such as falls, cognitive impairment, financial stressors and even sleep disturbances.

Treating insomnia in the elderly with dementia can improve overall health, but care must be taken when medications are used with this population.Education about age-related changes in sleep can alter the sufferer’s expectations. An example is when an elder realizes that an occasional sleepless night does not indicate a health problem.

Elder loved ones should be encouraged to improve sleep hygiene and use behavioral interventions. For example, to improve sleep hygiene, seniors are reminded not to consume stimulants — such as caffeine — for several hours before bedtime.

Behavioral interventions include sleep restriction therapy: Limiting the time spent in bed and minimizing daytime napping. This therapy increases sleep efficiency; it may deprive an elder of some sleep, but usually only at first.

Individuals should awaken at the same time each morning. They should determine when to go to bed based on their usual total nightly sleep time. This can be estimated by using a sleep diary. The time spent in bed is gradually increased as sleep efficiency increases.

Bright light therapy may help residents with an advanced or a delayed sleep phase. In sunny climates, outdoor bright light exposure may work just as well. A clinician should review all drugs that the insomniac is taking to check whether any may induce photosensitivity. This should determine whether there are any other disorders that may be exacerbated by this therapy.

Until recently, poor sleep in people with dementia was taken as an irreversible aspect of the disease. Today, however, studies are increasingly showing that sleep quality in people with dementia can indeed be improved and, consequently, symptoms of poor sleep, such as sundowning, insomnia and excessive daytime sleepiness, can be diminished.

Improved sleep means an improved quality of life for a person with dementia through increased alertness, decreased sleepiness and reduction in behavioral problems. These beneficial consequences have a positive impact on a caregiver’s quality of life and the quality of care the caregiver is able to give.

Normally, a caregiver’s own sleep quality begins to suffer as the caregiver deals with a wandering or belligerent person. A moment of inattentiveness on a tired caregiver’s part can potentially allow the person with dementia to get into dangerous situations.

Persistent poor sleep quality can cause the caregiver to suffer negative mood changes, such as depression, anger and hopelessness, which in turn can negatively impact the quality of care the person is able to give someone with dementia. Poor sleep quality and its impact on the caregiver may be the most common factor leading caretakers to institutionalize a person with dementia.

Micha Shalev, MHA, is the owner of Dodge Park Rest Home at 101 Randolph Road. Worcester. He can be reached at 508-853-8180 or by e-mail at m.shalev@dodgepark.com or view more information online at www.dodgepark.com. Archives of articles from previous issues can be read at www.fiftyplusadvocate.com.