Sleep Disorders and Dementia

Getting a good night’s sleep is critical for good brain health, yet many older adults experience trouble sleeping. Our brains have a core circadian clock that keeps us on a 24-hour cycle, telling us when to wake and when to sleep, but this seems to change as we age.

A recent study at the Pittsburgh School of Medicine looked at the effects of normal aging on the molecular rhythms in the frontal cortex of the brain. This area of the brain is responsible for executive functioning — making good decisions and exercising sound judgement.

Scientists identified 235 core genes that make up the molecular clock in our brains. Drilling down into these core genes, scientists found that younger people have the daily circadian rhythm in all the classical “clock” genes while older people’s “clock” genes tend to lose this rhythm. Interestingly, other genes seem to be gaining in rhythmicity — so it seems the aging brain is compensating.

While this area of brain changes and sleep patterns is a field for more research, what we do know is that there is an association between disrupted sleep and Alzheimer’s pathology. It is a bit of a chicken and egg scenario — where disrupted sleep leads to brain changes which lead to disrupted sleep patterns — and the cycle continues. Breaking the disrupted sleep pattern is an important step to take in helping slow down the development of negative brain changes.

Sleep disorders and dementia seem to go hand in hand. It is estimated that between 40 — 60% of people with dementia also have a sleep disorder. Sleep disorders interfere with cognitive functioning, increase the risk of falls and increase the risk of depression and aggressive behaviour. Getting treatment for this underlying disorder may have a significant positive effect on cognitive functioning, as well as improving quality of life.

Individuals providing care also require a good night’s sleep. It is difficult to remain patient and focused when you are suffering from fatigue. It is also much easier to become sad and feel overwhelmed when you are suffering from a bad night (or many bad nights) of poor sleep.

In this post, I’m going to cover four main areas that you should consider in trying to address sleep problems.

1. Daytime Activity

Increased daytime activity and light physical exercise will improve sleep patterns in healthy people and will also have a similar positive impact in people with dementia. Enjoyable daytime activities increase the production of hormones and chemicals that improve mood and decrease anxiety. So make sure you have enough physical and mental activity to bring you (or your loved one) to the end of the day pleasantly tired.

One of the most disturbing times of day for individuals with dementia is late afternoon and early evening when symptoms of sundowning may occur. Increasing daytime activity can help reduce this agitation at the end of the day.

Providing appropriate intellectual activity for individuals with dementia can be difficult. The Fit Minds ® Programs contain many enjoyable exercises, games and activities that can be used to increase daytime activity. Physical activity is also important. Getting the body moving can improve circulation and digestion, reduce joint stiffness and pain, and improve sleep quality.

A daily activity routine helps prevent or reduce daytime napping. This will help the individual be more ready to sleep at the end of the day. When planning activities, spread them out throughout the day to avoid becoming overtired. You should also avoid activity close to bedtime, which can be overstimulating.

Motivation to be active can be lacking, particularly after meals. Upbeat music can have a positive effect and encourage the individual to participate in activities.

2. Sleep Hygiene

Good sleep hygiene or habits are essential for a good night sleep. Some ideas for creating an environment conducive to getting a good night’s sleep are:

1. Have a fixed time to go to sleep and a fixed time to wake-up that are the same every day. This will create a habit and expectation in your brain that it is time to go to sleep.
2. Create a bedtime ritual — play a certain piece of music, use a specific hand lotion, have a bedtime snack that is the same each night. All these cues help the body recognize that it is time to go to sleep;
3. Avoid caffeine, alcohol and very spicy foods 4 to 6 hours before bedtime. Caffeine can impact the body’s melatonin production, which is an important chemical required for sleep.
4. Use passive body heating to signal to the brain it is time to go to sleep. Raise your body temperature through a warm bath, shower or a hot water bottle on the lap or torso. Once the heat source is removed, your body temperature will drop, signalling the brain that it is time to go to sleep.  

3. The Sleep Environment

The bedroom environment can also impact the quality of sleep. Ensure the bedroom is well set-up for sleep. Some tips to improve the bedroom’s sleep-inducing qualities are:

1. Have the overnight temperature a bit cool;
2. Keep the room well ventilated; and,
3. Run a fan that creates neutral ‘white’ noise that can help block out disturbing sounds.

4. Bright Light Therapy

The body’s sleep/wake cycle is strongly influenced by the melatonin hormone, which is created by the exposure of the eye to bright light. Bright light therapy has shown good results in improving the sleep/wake cycle for individuals suffering from sleep problems and regularizing sleep patterns.

The best source of bright light is natural daylight — so getting outside every day is essential for a good night’s sleep. If that is not possible, there are other options such as the use of blue spectrum lights that can be purchased at home health stores. You may also find that where you live has an impact on the amount of daylight that is reasonable or practical for you to get exposure to. In the middle of winter in many parts of Canada and the northern United States it is almost impossible to get enough exposure to natural daylight.

The best time to be exposed to bright light lamps is in the morning. This will increase daytime alertness. Bright light lamps should not be used after 4pm. Check with your pharmacist for the best way to use a bright light lamp in your particular circumstances.

Taking the time to create a framework for good sleeping patterns can go a long way to improving the quality of life for both the individual you are caring for and for yourself. Sleeping well helps our body and brain repair and recover from the stresses and strains of the day.