By: Jennifer Beach, LSW, MA, C-SWCM
Mary noticed her father Bill had been extremely tired lately… more than usual. Mary understands the daily challenges her dad faces as he continues to care for his wife, Theresa. Theresa was diagnosed with dementia about two years ago. Bill is the main caregiver with the support of his two adult daughters who live nearby.
Mary asked her father if there was something more going on with him or if he was getting overwhelmed with the daily care and routine. Bill explained that Theresa has been up at night lately and sleeping during the day. Her (and now his) sleeping patterns seemed to have somehow flipped and it is taking a toll on him, physically and mentally. He doesn’t have the patience he normally does with Mary.
Changes in sleeping patterns are not uncommon as we age, complicated by diseases and conditions such as dementia. Children and adolescents need more sleep than adults; older adults need about the same amount of sleep as younger adults, seven or more hours a night.
Many older adults often get less sleep than they need for a variety of reasons, including:
- Trouble falling asleep
- Sleeping less deeply and waking up more often throughout the night
- Napping more often during the daytime
- Getting sleepier earlier in the evening and waking earlier in the morning
- Secreting less melatonin, the hormone that promotes sleep
- Becoming sensitive to changes in the environment, such as noise and temperature
- Having medical and psychiatric problems and conditions
- Experiencing pain
- Having insomnia
- Snoring and sleep apnea
- Having movement disorders, such as restless legs syndrome
Additionally, many people with Alzheimer’s or other types of dementia wake up more often and stay awake longer during the night. Brain wave studies show decreases in both dreaming and non-dreaming sleep stages. It becomes more challenging to others because those who cannot sleep may move about, be unable to lie still, or yell or call out, disrupting the sleep of their caregivers.
When an individual is not sleeping at night, they often begin daytime napping and develop other shifts in the sleep-wake cycle. Individuals may feel very tired during the day and then be unable to sleep at night. They may experience or become restless or agitated in the late afternoon or early evening.
Experts estimate that, in the late stages of Alzheimer’s, individuals spend about 40 percent of their time in bed at night awake and a significant part of their daytime sleeping. In extreme cases, people may have a complete reversal of the usual daytime wakefulness and nighttime sleep pattern.
Some ways to work on maintaining a normal sleep cycle:
- Try to maintain consistent, regular times for meals (breakfast, lunch, and dinner are natural markers in our days)
- Create a morning routine to include getting dressed for the day
- Seek morning sunlight exposure
- Encourage regular daily exercise, but no later than four hours before bedtime
- Avoid alcohol, caffeine and nicotine
- Treat any pain
- If the person is taking a cholinesterase inhibitor (tacrine, donepezil, rivastigmine or galantamine), avoid giving the medicine before bed
- Make sure the bedroom temperature is comfortable
- Use the bedroom only for sleep; stay out of the bedroom during the day
- Create an evening routine, including getting out of daytime clothing and going into the bedroom for sleep. Try listening to music or calming programs before bed. Avoid the news before bed.
- Provide nightlights and security objects
- If the person awakens, discourage staying in bed while awake; use the bed only for sleep
- Discourage watching television during periods of wakefulness at night. Try soft music; using headphones can be even more effective. A warm beverage (milk, decaf tea) can be tried and then return to bed.
In some cases, non-drug approaches fail to work or the sleep changes are accompanied by disruptive nighttime behaviors. For those individuals who do require medication, experts recommend that treatment “begin low and go slow.” This is something to discuss with the doctor.
Bill was able to implement some of the above suggestions, including creating a consistent nighttime routine. Theresa began listening to the same three songs after dinner, then getting into her nightgown, and having a cup of warm milk. This daily routine did seem to help to slowly get her back into a more “normal” sleep pattern.
Original Post: https://www.northeastohioboomer.com/blogs/when-sleeping-patterns-change/