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How can we get my mom with dementia to sleep?

A fellow caregiver asked...

We are checking to see if there is something that can be given or done for our mother9Who is in her 70) that has Dementia to help her sleep. She is up every two minute at this startes at 8:00pm and will go sometime til 4:00am. she want to get dress, she throws a fit, gets mad and upset but will not stay in bed. My father is with her all the time and is not getting any sleep. We let her do the little things but they are now starting to be bigger. She act like she is fighting to go to sleep. Is there any thing that we can do?

Expert Answer

Kathryn Pears, who has a master's in public policy and management, has been involved in dementia care for 30 years. She was a caregiver for her father, who had early onset Alzheimer's disease, and cared for him at home until his death in 1991. She was director of Public Policy and Education for the Alzheimer's Association, Maine chapter, until June 2011, when she left to create Dementia Care Strategies, where she provides consulting and training services to family and professional caregivers about all aspects of caring for someone with Alzheimer's disease or a related dementia. In addition, she has led multiple legislative initiatives in Maine to improve care for individuals living with dementia, including passage of a Silver Alert program to track missing people with dementia as well as special care unit disclosure.

Your poor father must be totally exhausted. This is a very common problem in dementia and are related to the neurodegenerative process that is occurring in her brain. It is a very difficult situation for the caregiver who often winds up suffering from severe sleep deprivation.

Estimate are that in late stages of Alzheimer's, individuals spend about 40 percent of their time in bed at night awake and a significant part of their daytime sleeping. In extreme cases, people may have a complete reversal of the usual daytime wakefulness-nighttime sleep pattern. It sounds like your mother may fit into this category.

Here are some suggestions:

Increase her exposure to daytime light. Some studies have shown that increasing the amount of bright light the person is exposed to during the day can re-synchronize sleep/wake activity. Usually this is accomplished with a "light box" but it requires that someone be with her to ensure she remains in front of the box for the required amount of time (usually 1 hour).

You mention this pattern starts at 8 pm. Can you keep her up later at night. Try to discourage her napping during the day as this will compromise her ability to sleep at night.

Increasing her daytime activity through more physical exercise (walking, for instance) and social activity could help. Is there an adult day program in her area that she could attend? This would increase her daytime activity while also allowing your father to get some much needed rest. Also, be sure the temperature in her bedroom are neither too hot nor too cold.

Avoid products with caffeine in them such as coffee, tea, cola drinks, chocolate, etc.

Some medications cause nighttime stimulation. Aricept is one of them. Some atypical anti-psychotics, such as olanzapine and risperidone also disrupt sleep.

Chronic pain can also disrupt sleep. Is there any chance that your mother may be in some physical discomfort? Does she have arthritis, osteoporosis or other joint pain that may be bothering her. Check with her physician about starting her on a regular schedule of ibuprofen or Tylenol. Urinary tract infections are very common in people with dementia and often present without any obvious symptoms. A complete urinalysis would rule this out as a cause of her problems.

Sleep apnea has been in the news lately as an issue for people with dementia. That said, diagnosing and treating it in someone with dementia would be challenging.

As a last resort you may need to try medication. Antidepressants, benzodiazepines, nonbenzodiazepines, and antihistamines are commonly used, although limited evidence exists for their long-term safety and use with cognitively impaired older adults. Some people have tried melatonin and report success however research studies have not shown the same results. The prescription medication Ramelteon (Rozerem) has shown some success. It works similarly to melatonin, a natural substance in the brain that is needed for sleep.

Not only is your father sleep deprived but your mom is as well. This will increase her behavioral problems and it sounds like you are seeing this. Try the above suggestions relating to exercise, reviewing her current medications with her physician, and ruling out any physical discomfort that could be making it difficult for her to sleep. Due to the potential for side-effects medications for inducing sleep should be a last resort but may be needed if nothing else improves the situation.

Finally, if your parents are able to afford it, it might be possible to hire a home care worker to come into the house at night and stay with your mother so that your father can sleep. It's an expensive option but it's a possibility.

The impact of sleep deprivation on the caregiver cannot be underestimated. Your father's physical and emotional health are likely extremely compromised. Sleep disturbances are often the precipitating factor in a family deciding to seek a facility placement. If nothing else works this may be something you and your father will need to consider.

Best of luck to you and your family. I hope these suggestions help.