Alzheimer's: Managing sleep problems

Sleep problems and Alzheimer's disease often go hand in hand. Understand what contributes to sleep problems in Alzheimer's — and what you can do to promote a good night's sleep.

Why sleep problems are so common

Many older adults have problems sleeping, but people who have Alzheimer's often have an even harder time. Alzheimer's may reverse a person's sleep-wake cycle, causing daytime drowsiness and nighttime restlessness. These sleep disturbances often increase as Alzheimer's progresses. Eventually, round-the-clock naps may replace deep, restorative nighttime sleep.

Sometimes other health problems affect sleep as well, such as:

• Obstructive sleep apnea, which happens when throat muscles relax during sleep and obstruct airflow through the nose and throat
• Restless legs syndrome, a condition that causes discomfort when sitting or lying down, which can make it difficult to fall asleep or stay asleep
• Depression

How to promote a good night's sleep

Sleep disturbances can take a toll on both you and your loved one. To promote better sleep:

• Think light. Exposing your loved one to a few hours of bright sunlight in the morning may improve his or her sleep at night. Light therapy with a specialized light box may be helpful, too.
• Avoid caffeine and alcohol. Caffeine in soda, tea, coffee or other products may contribute to sleeplessness, and alcohol can contribute to confusion and anxiety. If your loved one insists on having a drink, offer a soft drink in a familiar cocktail glass or serve nonalcoholic beer or wine.
• Manage medications. Find out what time of day your loved one should take his or her medications — morning for drugs that have a stimulating effect, and evening for drugs that make your loved one sleepy. Note that sleeping pills are generally discouraged for people who have Alzheimer's. These drugs can increase confusion and the risk of falls.
• Encourage physical activity. Plan your loved one's days to include walks and other physical activities, which can help promote better sleep at night. Taper your loved one's activities as the day winds down, however. Physical activity close to bedtime may leave your loved one too energized to fall asleep.
• Limit daytime sleep. If your loved one needs a nap, make sure it's short and not too late in the day. Have your loved one nap on the couch or in a recliner rather than in bed. If you think staying in bed too long in the morning contributes to nighttime wakefulness, wake your loved one earlier.
• Establish a bedtime routine. Do the same things in the same way every night, such as brushing teeth, using the toilet, listening to soft music and rubbing your loved one's back. If bathing or dressing for bed is difficult, do it earlier in the day. It's also important to create a comfortable place for sleeping. Make sure the temperature in your loved one's bedroom is comfortable. Turn on a night light. Place security objects, such as a favorite blanket, within easy reach.
• Treat underlying conditions. If you suspect that an underlying condition — such as sleep apnea, depression or pain — is interfering with your loved one's sleep, consult his or her doctor. Treatment may lead to more restful sleep for everyone.

What to do if your loved one wakes during the night

If your loved one wakes during the night and is upset, do your best to stay calm — even though you may be exhausted yourself. Don't argue or demand explanations, and remember that your loved one isn't deliberately trying to annoy you. Instead, ask what your loved one needs. Gently remind your loved one that it's night and time for sleep. If you find your loved one wandering in the house, gently guide him or her back to bed.

Remember that you need sleep, too

Your loved one's sleep is important, but so is yours. If you're not getting enough sleep, you won't have the patience and energy needed to take care of someone who has Alzheimer's. If possible, have family members or friends alternate nights with you — or talk with your loved one's doctor, a social worker or someone from a local Alzheimer's association to find out what help is available in your area.

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