Dear Doctors: Why does someone with Alzheimer’s disease have trouble sleeping? Is there a good sleeping medication for a person who has late-stage Alzheimer’s disease?
Dear Reader: It is common for people diagnosed with Alzheimer’s disease to develop disrupted sleep patterns. In the earlier stages of the illness, patients often begin to sleep more than usual. This includes sleeping longer at night and multiple naps during the day. As the disease progresses, insomnia, fragmented sleep and a marked shift in sleep cycles can occur.
It is not yet clear why this happens. However, research suggests that the complex neurological changes that are taking place begin to affect, or perhaps damage, the sleep centers of the brain. Conditions such as depression, sleep apnea and restless leg syndrome can also interfere with sleep.
People acting as caretakers for a patient with Alzheimer’s with poor or disordered sleep patterns are urged to first try behavioral and lifestyle changes. One thing that has proven to be important for all types of dementia, including Alzheimer’s disease, is helping the person follow a regular and predictable schedule. This includes the timing and pacing of meals, personal care, medications, activities and waking up and going to sleep. It can be particularly beneficial in the early and middle stages of Alzheimer’s disease, and it establishes habits that can be helpful as the disease progresses.
Our bodies are keyed to the cycle of light and dark. Exposing the person to sunlight upon waking and lowering the lighting in the evening and near bedtime can help to harness the body’s natural circadian cycles. Daily exercise is also important. So is avoiding caffeine, alcohol and tobacco products.
Medications, including some prescribed to Alzheimer’s patients, can interfere with sleep. Check with your doctor or pharmacist, and if this proves to be the case, see if the dosages can safely be administered earlier in the day.
When lifestyle changes don’t help, it’s important to talk to the patient’s doctor. They will evaluate the patient’s current condition and review their medical history. If insomnia is affecting the patient’s overall health or resulting in disruptive behavior, a sleep medication may be suggested. The preferred approach is to begin at the lowest possible dose, with a gradual increase until regular sleep is achieved. When this occurs, the use of the medication is paused until it is needed again. This is all done under medical guidance.
The medication prescribed will depend on each person’s physical and mental health, and on the type of sleep disruption they are experiencing. Options include tricyclic antidepressants, which affect brain chemistry; benzodiazepines, which slow the pace of communication between the brain and the body; antipsychotics; and medications that are specific to insomnia. This includes a drug known as Belsomra, which the FDA has approved for patients with Alzheimer’s who have difficulty with falling and staying asleep.
Each of these medications have potential side effects, which in some cases may outweigh the benefits. It’s also important to remember that the use of sleep medications can increase the risk of falls and can worsen confusion in people who are cognitively impaired.
(Send your questions to [email protected], or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)
