By Betty Weiss

The inability of Alzheimer's patients to sleep at night can be very difficult to resolve.   They are frequently sleepier during the day than at night when their sleep patterns tend to be fragmented and disrupted.  Some nap off and on both day and night with every hour having periods of wakefulness and light sleep.  Such naps help replace the deep, restorative sleep we all need - but it's a major problem for the caregiver, causing serious sleep deprivation.  In addition to the disease's inherent sleep problems, there may be pain or discomfort the patient is unable to tell you about.  Be alert for urinary tract infections, sleep apnea, restless legs syndrome and depression.  The doctor may be able to treat any such conditions.

Sleep medications are not always effective and sometimes make the patient more agitated. Such medications in the elderly, especially with existing cognitive impairment, can be risky. They may result in more falls and fractures, increased confusion, and some decline in the ability to care for oneself.  So the caregiver has to be extra alert.  However, there are several sleep medications used in the treatment of insomnia and nighttime behavioral disturbances in Alzheimer's patients and it's worth a discussion with the doctor to try them. 

Emphasizing again, most important is that the caregiver does not become sleep deprived - that's the way prisoners are sometimes tortured - it's no joke - your health and caregiving ability will suffer.  When nothing else works, family members often take turns at night sleeping outside the patient's room while the other caregiver gets some critical rest, or a night attendant has to be hired.  Caregivers must get enough sleep, that's paramount. 

Obvious things to avoid are excessive fluid intake before bedtime; no exciting or frightening television, and no television if the patient awakens during the night, soft music if that helps; avoid alcohol, caffeine and nicotine; do not give drugs that have a stimulating effect within several hours before bedtime, talk to the pharmacist about the best dosage time for sleeping for all drugs; maintain regular bedtime and waking time; maintain regular meal times; try to get in some daily exercise, but again, not during the hours close to bedtime; reduce daytime naps if that works, but sometimes a nap is good so that the patient does not become too tired to sleep at night.  Try the old standbys of milk, extra pillows, maybe a nightlight--otherwise keep the room dark and the house quiet.  Draw curtains so that window reflections do not startle the patient, cover or remove mirrors, close closet doors, try to eliminate spooky shadows, and as with children, make a bathroom run.  Check room temperature and that bedding, pj's and gowns are comfortable and warm or cool enough. 

Do not be surprised if your loved one will not stay in bed alone.  They become frightened and feel abandoned when they cannot see their caregiver.  I would crawl into bed with my husband, have soft music on, hold his hand or hug him until he fell asleep, then I could get up and do something I wanted to do - and often enough, he'd be just a few steps behind me when I left!

Light, especially morning sunlight, has a lot to do with normal sleep cycles, waking with the dawn, retiring when it gets dark--get as much in your routine as you can.  Take your loved one outside whenever possible, and let the sunshine inside.  Some people are just night owls, but for most, things that disturb sleep patterns are jet lag, working nights, spending all day inside with no windows, winter or seasonal blues, daylight savings time changes, changes in body chemistry, and damage to brain cells in diseases like Alzheimer's.  Bright light, including certain artificial ones, can sometimes help improve sleep, mental functioning and make people more alert.  If you don't have a computer, get your grandchild to do some research on Alzheimer's and 'bright light therapy' or 'full spectrum light.'  Call the Alzheimer's Association and consult with your doctor, they should know a thing or two about it.  Let there be light!        

Betty Weiss is the author of the best selling Alzheimer's Surgery: An Intimate Portrait, and When The Doctor Says, "Alzheimer's:" Your Caregiver's Guide to Alzheimer's & Dementia. She does not give medical advice.                           
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