I find that a very interesting question also , as my mother is sleeping a lot lately , I did a search on the net about it and found a bit about it on the AZ site I think it was from I! had to download open with adobot reader and save it I can’t find the link sorry so have cope paste it on hear
The nature of sleep changes in Alzheimer’s
Scientists do not completely understand why sleep disturbances occur in people with
dementia. Sleep disturbances associated with Alzheimer’s disease include increased
frequency and duration of awakenings, decrease in both dreaming and nondreaming
stages of sleep, and daytime napping. Similar changes occur in the sleep of older people
who do not have dementia, but these changes occur more frequently and tend to be more
severe in people with Alzheimer’s disease.
Some people with Alzheimer’s disease sleep too much while others have difficulty
getting enough sleep. When people with Alzheimer’s cannot sleep, they may wander
during the night, be unable to lie still, or yell or call out, disrupting the rest of their
caregivers. Some studies have shown that sleep disturbances are associated with
increased impairment of memory and ability to function in people with Alzheimer’s.
There is also evidence that sleep disturbances may be worse in more severely affected
patients. However, a few studies have reported that sleep disruption may also occur in
people with less severe impairment.
Coexisting conditions may intensify sleep problems for older adults with Alzheimer’s.
Two conditions in which involuntary movements interfere with sleep are periodic limb
movement and restless leg syndrome. Other common conditions that disrupt sleep include
nightmares and sleep apnea, an abnormal breathing pattern in which people briefly stop
breathing many times a night. Depression in a person with dementia may further worsen
sleep difficulties.
Shifts in the sleep-wake cycle of people with Alzheimer’s can be severe. Experts estimate
that in the later stages of the disease, affected individuals spend approximately 40 percent
of their time in bed awake and a significant proportion of their daytime hours asleep. This
increased daytime sleep consists almost exclusively of light sleep that compensates
poorly for the loss of deep, restful nighttime sleep. In extreme cases, people with
dementia may experience complete reversal of the usual daytime wakefulness/nighttime
sleep pattern.
Treatment of Alzheimer sleep problems
Although widely used medications can temporarily improve the sleep disturbances of
older adults, a number of studies have found that prescription drugs do not improve
overall ratings of sleep quality in older people, whether they are living in the their homes
or in residential care. Thus, the treatment benefits of using sleep medications in
individuals with dementia may not outweigh the potential risks. To improve sleep in
About sleep changes
in Alzheimer’s disease
This fact sheet is prepared in consultation with the Alzheimer’s Association Clinical Issues and Interventions Work Group.
The information provided does not represent an endorsement of any medication or nondrug sleep intervention by the
Alzheimer’s Association. Updated April 15, 2002.
Facts:
these individuals, the U.S. National Institutes of Health (NIH) has encouraged use of the
nondrug measures described below rather than medication therapy unless the sleep
disturbance is clearly related to a treatable medical condition. It is important that the
person experiencing sleep problems be professionally assessed for medical or psychiatric
causes for the sleep disturbance before applying any drug or nondrug interventions.
Nondrug treatments
A variety of nondrug treatments for insomnia have been shown to be effective in older
adults. These treatments, which aim at improving sleep routine and the sleeping
environment and reducing daytime sleep, are widely recommended for use in people with
Alzheimer’s disease. To create an inviting sleeping environment and promote rest for a
person with Alzheimer’s:
Maintain regular times for going to bed and arising.
Establish a comfortable, secure sleeping environment. Attend to temperature
and provide nightlights and/or security objects.
Discourage staying in bed while awake; use the bedroom only for sleep.
If the person awakens, discourage watching television.
Establish regular meal times.
Avoid alcohol, caffeine, and nicotine.
Avoid excessive evening fluid intake and empty the bladder before retiring.
Avoid daytime naps if the person is having trouble sleeping at night.
Treat any pain symptoms.
Seek morning sunlight exposure.
Engage in regular daily exercise, but no later than four hours before bedtime.
If the person is taking cholinesterase inhibitors (tacrine, donepezil,
rivastigmine, or galantamine), avoid nighttime dosing.
Administer drugs such as selegiline that may have a stimulating effect no later
than six to eight hours before bedtime.
Medications
Drug therapy should be considered only after a nondrug approach has failed and
reversible medical or environmental causes have been ruled out. For those people who do
require medication, it is imperative to “begin low and go slow.” The risks of sleepinducing
medications for older people who are cognitively impaired are considerable.
These include increased risk for falls and fractures, increased confusion, and decline in
the ability to care for oneself. If sleep medications are used, an attempt should be made to
discontinue them after a regular sleep pattern has been established.
The table below lists some of the many different types of medications that can
temporarily assist in sleep. The list includes drugs prescribed chiefly for sleep as well as
some whose primary use is in treating psychiatric illnesses or behavioral symptoms.
Although little is known about the safety and effectiveness of medications for treating
chronic sleep disturbances in Alzheimer’s, all of these medications are commonly
prescribed to treat insomnia and disruptive nighttime behaviors in Alzheimer’s disease.
All of the medications listed here are available by prescription only and must be used
under a physician’s supervision. The medication recommended by a physician often
reflects the type of behavioral symptoms accompanying the sleep problems.
Some medications commonly used in the treatment of
insomnia and nighttime behavioral disturbances in Alzheimer’s disease
Drug category Examples
(generic names)
Recommended dose
in milligrams/day
Potential adverse
effects
Tricyclic
antidepressants
Nortriptyline 10 –75 Dizziness, dry mouth,
constipation, trouble
urinating
Trazodone 25 – 75 Dizziness, especially
when standing or
rising
Benzodiazepines Lorazepam 0.5 – 2 Lethargy, confusion,
unsteadiness
Oxazepam 10 – 30 Dependence
Temazepam 15 – 30 Confusion,
unsteadiness
Nonbenzodiazepines Zolpidem 5 - 10 Sedation, confusion
Zaleplon 5 – 10 Sedation, amnesia
Chloral hydrate 500 – 1,000 Sedation, nausea
“Classical”
antipsychotics
Haloperidol 0.5 – 1.5 Parkinson-like
symptoms
“Atypical”
antipsychotics
Risperidone 1 – 6 Dizziness, especially
when standing or
rising; nausea
Olanzapine 5 – 10 Sedation
Quetapine 12.5 – 100 Sedation; dizziness,
especially when
standing or rising
Where can I get information about other Alzheimer-related issues?
To obtain information about other important issues related to Alzheimer’s disease, please
call our Contact Center at (800) 272-3900 or visit the Alzheimer’s Association Web site
at
www.alz.org.
