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Perchance to Dream: Addressing Sleeping issues in Dementia

By: Cate McCarty, PhD, ADC

Sleep has become the initial focus of most neurology consults because it has proven a key factor in brain health.  The need for Rapid Eye Movement (REM) sleep is vital to the brain’s health.  However, there are many obstacles to getting REM sleep. One of the obstacles is sleep disordered breathing.1 Research is showing that lack of oxygen during sleep may contribute to cognitive decline and dementia.  Which is why often your neurologist sends you for a sleep study as your first test when there have been cognitive changes.   If sleep apnea is determined, a Continuous Pressure Airway (CPAP) machine is often prescribed to improve sleep.2

But sleep disordered breathing is only one of the sleep problems for the individual with memory issues.  Too much sleep as well as switching night and day sleep patterns have been part of the dementia journey for some.  Research shows melatonin and bright light treatment are promising strategies.3

Sleep is equally prominent in caregiver health. Research shows that the daytime dementia behaviors like apathy, agitation, and depression are associated with caregiver report of poor sleep quality.3 These disturbances in sleep for caregivers often lead to daytime napping and excessive caffeine to stay awake, perpetuating the nighttime problem. Some caregivers stay up late or get up early simply to do tasks they are unable to do while their loved one is awake. Even non-residential caregivers may be losing sleep in excessive worry.4

So how do we address our sleep problems in dementia?  There are two prominent researched solutions.

Tailored lighting has been shown to reduce symptoms of depression, increase sleep efficiency and duration for both care recipients and caregivers.5 The tailored lighting is low level bluish white light used during the daytime.

Participating in pleasurable activities frequently is associated with sleep quality and efficiency for dementia caregivers.6 Called the Pleasant Events Schedule, this instrument looks at the individual caregiver’s participation frequency of pleasurable events such as meditation, gardening, reading, etc.  Those having a higher level of pleasurable events with greater frequency experienced better sleep quality and efficiency.

 All fitting under the category of self-care, if tailored lighting helps your loved one, it will help you.  If frequent pleasant events help your sleep, the same is true for your loved one.  For more strategies, contact your local Arden Courts.

 

By-line:  Cate McCarty, PhD, ADC has been collaborating with Arden Courts in a variety of roles since the late 90’s.  Her background in nursing, activities and admissions has given her a passionate commitment to quality of life for the individual and family with dementia. Cate is now personally caring for her spouse who has an FTD diagnosis.

Footnotes

1Duffy, S.L,, Lagopoulos, J., Terpening, ZLewis, S.J., Grunstein, R., et al., (2016).,   Association of Anterior Cingulate Glutathione with Sleep Apnea in Older Adults At-Risk for Dementia, Sleep,39(4): 899-906.

2www.sleepresolutions.com/blog/what-is-a-cpap-machine-how-does-cpap-work

3 Kales, H. C., Gitlin, L.N., Lyketsos, C. G. (2015)., Assessment and management of behavioral and psychological symptoms of dementia, Boston Medical Journal, Mar 2, 350-369.                                                                                 

4Simpson, C., & Carter, P. (2013)., Dementia behavioural and psychiatric symptoms, Journal of Clinical Nursing, 22 (21-22):3042-3052.

5Figueiro, M.G., Hunter, C.M., Higgins, P., Hornick, T., Jones, G.E., Plitnick, B., Brons, J., Rea, M.S., (2015), Tailored lighting intervention for persons with dementia and caregivers living at home, Sleep Health, 1(4): 322-330.

6McCurry, S.M., Logsdon, R.G., Teri, L., & Vitello, M.V., (2007).  Sleep Disturbances in caregivers of persons with dementia: Contributing factors and treatment implications, Sleep Medical Review, 11(2): 143-153.

7Moore, R.C., Harmell, A.L., Chattillion, E., Ancoli-Israel, S., Grant, I,. Mausbach, B.T, (2011).,  PEAR model and sleep outcomes in dementia caregivers: influence of activity restriction and pleasant events on sleep disturbances, International Psychogeriatrics, 23(9): 1482-1483

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