Treatments for sleep changes..... (Alzheimer’s )

    People with Alzheimer’s often have problems with sleeping or may experience changes in their sleep schedule. Scientists do not
completely understand why these sleep disturbances occur. As with
changes in memory and behavior, sleep changes somehow result
from the impact of Alzheimer’s on the brain. When managing sleep
changes, non-drug coping strategies should always be tried first.
Contributing medical factors
A person experiencing sleep disturbances should have a thorough
medical exam to identify any treatable illnesses that may be
contributing to the problem. Examples of conditions that can make
sleep problems worse include:
Depression
Restless legs syndrome, a disorder in which unpleasant “crawling”
or “tingling” sensations in the legs cause an overwhelming urge
to move them
Sleep apnea, an abnormal breathing pattern in which people
briefly stop breathing many times a night, resulting in poor sleep
quality
For sleep changes due primarily to Alzheimer’s disease, there are
non-drug and drug approaches to treatment. Most experts and the
National Institutes of Health (NIH) strongly encourage use of non-
drug measures rather than medication.
Studies have found that sleep medications generally do not improve
overall sleep quality for older adults. Use of sleep medications is
associated with a greater chance of falls and other risks that may
outweigh the benefits of treatment.

Common sleep changes
Contributing medical factors
Non-drug strategies
Medications

Common sleep changes

Many people with Alzheimer’s experience changes in their sleep
patterns. Scientists do not completely understand why this happens.
As with changes in memory and behavior, sleep changes somehow
result from the impact of Alzheimer’s on the brain.
Many older adults without dementia also notice changes in their
sleep, but these disturbances occur more frequently and tend to be more severe in Alzheimer’s. There is evidence that sleep changes are more common in later stages of the disease, but some studies have also found them in early stages.
Sleep changes in Alzheimer’s may include:
Difficulty sleeping. Many people with Alzheimer’s wake up more
often and stay awake longer during the night. Brain wave studies
show decreases in both dreaming and non-dreaming sleep stages.
Those who cannot sleep may wander, be unable to lie still, or yell or
call out, disrupting the sleep of their caregivers.
Daytime napping and other shifts in the sleep-wake cycle.
Individuals may feel very drowsy during the day and then be unable
to sleep at night. They may become restless or agitated in the late
afternoon or early evening, an experience often called “sundowning .”
Experts estimate 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.

Contributing medical factors
A person experiencing sleep disturbances should have a thorough
medical exam to identify any treatable illnesses that may be
contributing to the problem. Examples of conditions that can make
sleep problems worse include:
Depression
Restless legs syndrome, a disorder in which unpleasant “crawling”
or “tingling” sensations in the legs cause an overwhelming urge
to move them
Sleep apnea, an abnormal breathing pattern in which people
briefly stop breathing many times a night, resulting in poor sleep
quality
For sleep changes due primarily to Alzheimer’s disease, there are
non-drug and drug approaches to treatment. Most experts and the
National Institutes of Health (NIH) strongly encourage use of non-
drug measures rather than medication.
Studies have found that sleep medications generally do not improve
overall sleep quality for older adults. Use of sleep medications is
associated with a greater chance of falls and other risks that may
outweigh the benefits of treatment.

Non-drug treatments for sleep changes
Non-drug treatments aim to improve sleep routine and the sleeping
environment and reduce daytime napping. Non-drug coping strategies
should always be tried before medications, since some sleep
medications can cause serious side effects. To create an inviting
sleeping environment and promote rest for a person with Alzheimer’s:
Maintain regular times for meals and for going to bed and getting
up
Seek morning sunlight exposure
Encourage regular daily exercise, but no later than four hours
before bedtime
Avoid alcohol, caffeine and nicotine
Treat any pain
If the person is taking a cholinesterase inhibitor (tacrine,
donepezil, rivastigmine or galantamine), avoid giving the medicine
before bed
Make sure the bedroom temperature is comfortable
Provide nightlights and security objects
If the person awakens, discourage staying in bed while awake;
use the bed only for sleep
Discourage watching television during periods of wakefulness

Medications for sleep changes 
In some cases, non-drug approaches fail to work or the sleep
changes are accompanied by disruptive nighttime behaviors. For
those individuals who do require medication, experts recommend that
treatment “begin low and go slow.”
The risks of
sleep-inducing
medications for
older people who
are cognitively
impaired are
considerable.
They include
increased risk for
falls and
fractures,
confusion and a
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 type of medication prescribed by a doctor is often influenced by
behaviors that may accompany the sleep changes. The decision to
use an antipsychotic drug should be considered with extreme
caution. Research has shown that these drugs are associated with
an increased risk of stroke and death in older adults with dementia.
The FDA has ordered manufacturers to label such drugs with a “black
box” warning about their risks and a reminder that they are not
approved to treat dementia symptoms.