Alzheimer's: Managing sleep problems

Alzheimer's sleep problems affect both you and your loved one. Try these tips for getting both of you a good night's rest.

When people with Alzheimer's can't sleep, they may wander through the house — waking caregivers and possibly endangering themselves. These sleep disturbances, and the caregiver exhaustion that so often accompanies them, are among the most common reasons people with Alzheimer's are placed in nursing homes.

Sleep problems are common

Many older adults have problems sleeping, but people with Alzheimer's have an even harder time. Alzheimer's may reverse their sleep-wake cycle, causing daytime drowsiness and nighttime restlessness. And these sleep disturbances often increase as Alzheimer's disease progresses.

Eventually, people with Alzheimer's may nap off and on both day and night. Every hour may include periods of wakefulness and periods of light sleep. These naps replace the deep, restorative sleep most people enjoy at night.

Coexisting conditions

Some people with Alzheimer's have other health problems that affect their sleep. In many situations, these problems respond well to treatment.

Sleep apnea. This disorder happens when throat muscles relax during sleep and obstruct airflow through the nose and throat. People with sleep apnea typically snore loudly, and their breathing periodically stops during sleep. It is very common in people over the age of 65.
Restless legs syndrome. Occurring most often in middle-aged and older adults, this disorder consists of leg discomfort relieved only by moving the legs.
Depression. Many people with Alzheimer's also suffer from depression. Sleep problems are common in both diseases. Treating the depression may improve quality of life for both you and your loved one.

Risks of sleeping pills

Most medicines designed specifically to help people sleep can cause problems for people with Alzheimer's disease. These drugs often increase confusion. They also may contribute to falls, although other factors — such as lack of sleep in itself — could be responsible for making people with Alzheimer's less sure-footed.

Some drugs used to control the agitated and combative behaviors often associated with Alzheimer's disease also have sedative properties that help people sleep.

The role of light

Exposure to a few hours of bright light in the morning may improve your loved one's sleep. Sunlight will do the trick, as will a special type of extra-bright light bulb used to help treat seasonal affective disorder — a form of depression that occurs when daylight is limited. Seeing sunlight may help regulate your loved one's circadian rhythms, which are predictable changes in mental and physical functioning that normally occur over the course of a day. These rhythms affect your sleep cycle, appetite and mental focus.

Avoid stimulants

Foods, drinks and medicines often can affect sleep. Limit caffeine-containing foods and beverages — such as chocolate, sodas, tea and coffee — to mornings only. Consuming caffeine later in the day can cause sleeplessness.

Don't serve your loved one alcohol. It contributes to confusion and can increase anxiety. If he or she insists on having a drink, try serving a soft drink in a familiar cocktail glass or serve nonalcoholic beer or wine.

Check with your doctor or pharmacist to find the best time to give your loved one medication. Some drugs have a stimulating effect and shouldn't be taken in the evening.

Benefits of exercise

Plan days to include plenty of interesting activities — such as walks, car rides and exercise. Taper activities off as the day winds down, and finish any physical exercise at least four hours before bedtime.

If possible, follow the same sleep and wake schedule the person maintained during his or her working years. If you feel that your loved one has trouble sleeping at night because of staying in bed too long in the morning, wake him or her up earlier.

Limit daytime napping. If your loved one needs a nap, make sure it's short and not too late in the day. Have him or her take the nap on the couch or in a recliner rather than in bed. Reserve the bed for nighttime sleep.

Bedtime routines

Establish a bedtime routine of relaxing activities, such as listening to soft music or giving your loved one a back rub. Do the same things in the same way every night, including using the toilet before bed.

Avoid stressful activities near bedtime. If bathing or dressing for bed is difficult, do it earlier in the day. Create a comfortable, familiar place for sleeping. Make sure the bedroom is cool and quiet, and have extra blankets available.

If needed, make sure security objects, such as a favorite blanket or stuffed animal, are within easy reach. Use a night light in the room because darkness adds to confusion.

Keep calm

Try to stay calm if your loved one wakes during the night and is upset. It may not always be easy because you may be exhausted yourself. Remember that your loved one doesn't have control over his or her behavior and isn't deliberately trying to annoy you.

Don't argue or demand explanations. Instead, ask what he or she needs and be reassuring. Gently remind your loved one that it is night and time for sleep. If you find your loved one wandering in the house, gently guide him or her back to bed.

You need sleep, too

If you're caring for your loved one at home, it's important that you get enough sleep, too. If you're sleep deprived, you won't have the patience and energy needed to take care of someone with Alzheimer's. Have family members or friends alternate nights with you. If you don't have any help, talk with your loved one's doctor, a social worker or someone from a local Alzheimer's association to see what help is available in your area.