Expert: Mary Gordon - 2/23/2011

Question
QUESTION: My dad has middle stage Alzheimer which was diagnosed roughly 6 years ago. Over the past few months he has had agitation, sleeping now roughly 16 hours a week, etc. It seems like in the last week, everytime he eats a meal (not a large meal), he can hardly walk back to his house and must take a long nap immediately? Couldn't find anything about this strange new development. Any ideas?

ANSWER: Hi Mariane, I'm not sure what you mean by him sleeping 16 hours a week. Do you mean that much a day? I'm also not sure what you mean by walking back to his house - does he take his meals somewhere other than where he lives.

I'm not sure how to answer your question since I'm not sure what the issue is other than excessive napping after means. If I haven't answered what you need answered, come back and clarify for me.  

It's very common for people with dementia to develop both agitation and sleep disorders. The brain damage systems to get their internal rhythms get all messed up, and they can sleep too much during the day, and then drive everyone crazy at night, getting up repeatedly.

Sleep disturbances associated with Alzheimer’s disease include  walking up and staying away at night many times. Dementia also seems to result in a decrease in the dreaming and non-dreaming stages of sleep, and seems to cause daytime sleepiness. Similar changes occur in older people without dementia, but it's more common and 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 sleep of everyone around them, including caregivers if they are at home, 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.

Other conditions can make things worse. Restless leg syndrome can cause periodic limb movement - endless twitching of the legs that disturbs sleep. 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, which is often associated with snoring. Depression in a person with dementia may make sleep problems worse.

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 wide awake and a lot of their daytime hours asleep. This increased daytime sleep tends to be very light and doesn't make up 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 (i.e. asleep all day, awake all nightl.

The best approach is nondrug, since the drugs don't seem to really improve the quantity and quality of sleep for them, and can have side effects, such as an increased risk of falls.

To create an inviting sleeping environment and promote rest for a person with Alzheimer’s:

Maintain regular times for going to bed and arising - a routine that discourages daytime napping is key, to encourage better sleep at night.
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 (i.e. no TV in the bedroom, no lazing in bed in the morning).
If the person awakens, discourage watching television (i.e. snoozing during the day in front of the TV) .
Just as a note: In the dementia ward my mother in law lived in actually banned TV entirely, since so many residents would zone out in front of the set, and snooze, rather than be up and active - and then, of course, they would not be tired at bedtime.
Establish regular meal times - again part of a set routine which can help.
Avoid alcohol, caffeine, and nicotine.
Avoid excessive evening fluid intake and empty the bladder before retiring (you don't want extra trips to the bathroom to wake the person up).
Avoid daytime naps if the person is having trouble sleeping at night if at all possible - and if you can't, at least try to limit them to short naps, early in the afternoon.
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 which might cause sleep problems.
Administer drugs that may have a stimulating effect no later than six to eight hours before bedtime.

Hope this helps. I'm not sure exactly what is going on. Please get back to me if there is anything you can clarify.

Mary


---------- FOLLOW-UP ----------

QUESTION: To further clarify-When I say he is sleeping 16 hours a day-basically he can not seem to stay up for more than 1.5 hours before needing another nap for 2 hours or so. the good news is he sleeps very good at night even with all the naps during the day. The latest issue is that right after he eats, he practically falls asleep while still at the table. Seems like the brain shuts down with food? Any ideas?

Answer
Any time there is a sudden change in the person like this, your first suspicion should be that there may be an undetected health issue - that could be something as simple as a urinary tract infection. Quite often people with dementia will not complain of symptoms, and changes in their behavior is the only signal that they have an illness.

It's kind of like they are just holding on with their fingernails, and anything physical going on will really affect them. I remember once my mother in law got a cold - not a big deal - and it happened to be on the day there was a special Mother's Day tea.  You or I might feel a little foggy from a cold, but it had a HUGE impact on her. She was almost in a stupor, and kept nodding off. After she got better, she was much more alert and more like her old self.

I would take him to the doctor and see if he or she can determine what is going on.  

Hope this helps.

Mary