Before I met my life partner/care partner, Brian LeBlanc, he lived alone. He had recently been diagnosed with Alzheimer’s disease, and the sleep disturbances were already growing more frequent and severe.
He was scared.
It wasn’t just difficulty falling asleep and staying asleep. At times, vivid dreams and hallucinations before going to bed or upon waking would frighten him. Even healthy individuals who may have frequent night terrors can attest to the sheer aggravation of losing sleep to machinations of the unconscious mind.
Sleep Issues Commonly Associated with Alzheimer’s and Dementia
Sleep issues are among the most common Alzheimer’s and dementia behaviors, with up to 50 percent of those diagnosed experiencing sleep disturbances severe enough to affect quality of life. I believe, however, the total number of those affected would actually be much greater than what’s reported. The numerous types of sleep issues grow more severe in advancing stages of dementia, when our loved ones may no longer be able to express what’s ailing them.
While sleep issues aren’t so much a “behavior” as an “effect” of dementia, it’s important to note them because they often become behaviors as the stages progress. Here are some of the most commonly noted issues:
Sundowning is perhaps the most commonly attributed sleep issue associated with Alzheimer’s and other types of dementia. The part of the brain responsible for natural circadian rhythm (getting tired and preparing to sleep around sunset) may no longer work effectively, even in early dementia stages.
The body is tired. The brain is tired. They want to sleep. But they can’t. So what results? Increased confusion, agitation, anxiety and disorientation. Persons living with dementia who experience sundowning are essentially unable to settle into a comfortable evening routine. While healthy individuals may change into pajamas, relax in a comfy recliner, read a book, watch a little TV and prepare for bed, those with dementia may be too aggravated and wired to allow their bodies to wind down.
Negative behaviors — from becoming argumentative to physically aggressive — tend to increase in the evening hours with sundowning.
Excessive Day Sleeping
Coinciding with a distressed circadian rhythm, your loved one may spend more time sleeping during the day. When the internal clock is out of whack, sleep can come at the most unusual times (not that there’s anything wrong with a quick afternoon nap).
But common Alzheimer’s and dementia behaviors like day sleeping can become concerning when your loved one spends most of the day in bed. They may also nap frequently, dozing on and off throughout the day on a chair or couch.
Hallucinations, Vivid Dreams & Night Terrors
All the creepy creatures in the closet and under the bed come out at night. And, no, this isn’t just some child’s bedtime terror. It’s 100 percent real — at least in the minds of persons living with dementia. Individuals with dementia may experience some of the most vivid hallucinations and dreams that would keep anyone up nights.
Persons living with dementia are prone to visual and auditory misperceptions, especially at night when darkness, shadows and white noise stand out most dramatically. A shadow can easily look like a burglar or monster. A garbage truck down the street could sound like an invading army. Some more detailed hallucinations and terrors include seeing people from the past and even some of the individual’s greatest fears.
I briefly mentioned Brian’s experiences with sleep disturbances associated with Alzheimer’s and dementia. I shudder to think what he experienced before meeting me, because after coming together (and his additional vascular dementia diagnosis) his hallucinations have grown more intense.
Restlessness sets in, and your loved one just can’t stay in bed. Perhaps they have a condition unrelated to dementia — like restless leg syndrome or acid-reflux disease — that makes lying down very uncomfortable. Even in otherwise healthy people, getting up and walking around may be the only way to soothe the nerves.
Now, add dementia to the mix, when any combination of issues may cause your loved one to be uncomfortable and disoriented with time and space. Wandering could be a concern at any time of day, but especially nighttime when confusion and discomfort are most pronounced. You may notice your loved one simply walks around the house. Perhaps they make repetitive trips to the refrigerator or bathroom, or their evening sojourns may seem aimless. Your loved one may require additional monitoring or assistance in the evening hours to prevent falls or getting lost.
Interrupted Sleep Stages
Eventually your loved one with dementia will fall asleep. But the quality of their sleep may be spotty. That’s because the brain’s wiring that governs sleep stages may no longer function properly. Obviously, the goal is to advance through light and heavy sleep to achieve REM sleep (the dream stage) for a complete, restful and rejuvenating sleep.
Your loved one may skip stages or wake up at inopportune times, causing difficulty completing the full sleep cycle. Without each stage, they may wake tired and even more disoriented or upset the next day.
Sleep Issues are Common Symptoms of Alzheimer’s and Other Types of Dementia
You may feel helpless to help your loved one’s sleep disturbances associated with Alzheimer’s and other types of dementia. Discuss options with their neurologist, primary care physician and other members of the care-partner team. Prescription sleep medications may be effective — if they do not interact with various other meds your loved one may take. You may need assistance from other care partners to plan and monitor their evening hours.
#WeAreDementiaStrong. If you need help, Caregiver Support and Resources, LLC has over 25 years of experience with all aspects of life-care planning including dementia care. We’re happy to provide referrals and guide the process in a caring and compassionate way.