By Pamela Atwood, MA, Director of Dementia Care Services
Most caregivers of persons with dementia (PWD) have stories of their family member being up at night, confused and thinking it is time to be awake. Research indicates at least 40% of people with later stage dementia have shifts in the sleep-wake cycle. Nocturnal activity (e.g. wandering, rummaging, and hoarding) is frequently an issue that leads to placement in a skilled nursing facility. According to the Alzheimer’s Association changes may include increased frequency and duration of awakening, decreased dream and non-dream stages of sleep, and daytime napping. While these symptoms can occur in older adults without dementia, they tend to be more severe in people with dementia.
The first step to take is to get a medical assessment. Interruption in sleep can be caused by apnea, depression, nightmares or even restless leg syndrome or involuntary limb movement. Medical issues need to be ruled out before any non-drug or drug interventions are tried. Some helpful tips offered by the Alzheimer’s Association include:
• Keep a consistent routine for going to bed and getting up in the morning.
• Use nightlights.
• Discourage staying awake in bed, and discourage TV watching when awakened at night.
• Avoid alcohol, caffeine (including things with caffeine, such as chocolate) and nicotine.
• Avoid excessive evening fluid intake.
• Treat pain symptoms.
• Seek morning sunlight exposure.
• Engage in regular daily exercise.
Activity routines can be planned by physical therapists, including the outpatient clinics offered by Hebrew Rehabilitation Group (523-3860). Regular daytime activity is abundant in our adult day centers. Home care staff can also assist with activity routines if appropriate. For more information on sleep issues, check the Alzheimer’s Association’s fact sheet “Sleep Changes in Alzheimer’s Disease,” at www.alz.org or call the national number at 1-800-272-3900.