Alzheimer’s and Sleep: Cause and Effect

Alzheimer’s disease is often accompanied by changing sleep patterns. Studies further suggest that poor sleep may increase the risk of developing Alzheimer’s. Let’s examine the relevant variables.

By Sheryl Grassie

In 2019, reported Alzheimer’s cases reached 5.8 million in the United States. Of these cases, 5.6 million are with people over the age of 65, and 200,000 of these people are younger adults experiencing early onset. Alzheimer’s primarily affects older adults.

When a person develops Alzheimer’s, there are alterations occurring to their brain that affect memory, behavior, speech, the ability to function normally, and sleep. Changes in sleep do not necessarily occur in the early stages of the disease but are unusually very noticeable by later stages. Patterns of sleep may change in a number of ways but are hallmarked by less sleep at night and more sleep during the day. For some, sleep becomes truncated—they sleep in fits and starts, and  they probably don’t get sufficient time in deeper sleep states like NREM stage 3 (slow-wave sleep) and REM. Lack of sleep time in these deeper states may actually intensify Alzheimer’s symptoms.

Sleep Issues with Alzheimer’s

The predominant sleep issues people with Alzheimer’s experience include the following.

Trouble Sleeping at Night

Patients, or their caregivers, report a departure from regular sleep patterns. The Alzheimer’s patient may be up and down, restless, and unable to sleep for extended periods. Studies show that, by late-stage Alzheimer’s, most patients are awake at least 40% of nighttime hours.

Pronounced Napping

With or without trouble sleeping at night, people with Alzheimer’s can be very drowsy during the day and prone to numerous naps. They also often go through a restless or agitated period in the later afternoon or early evening that is typical of Alzheimer’s and called sundowning or late day confusion.

Reversal of Day and Night

For many with this form of dementia, sleep/awake schedules become reversed. Day and night are switched and patients sleep only during the day and are awake all night long with a complete turnaround from their normal circadian rhythm.

Sleeping All the Time

Anecdotally, family members and caregivers report that Alzheimer’s patients seem to be sleeping all the time, with the idea that they are getting a lot of sleep. This may or may not be the case. Many Alzheimer’s patients are in an out of sleep all day and night. The National Sleep Foundation states that over the course of a day, “patients are rarely awake and rarely asleep for a full hour at a time.”

Elderly couple sleeping

Treatment

The Alzheimer’s Association strongly encourages non-medical interventions for sleep disturbances. Research has shown that drugs don’t work with this population and may have serious side-effects. They recommend that good sleep hygiene be tried before any pharmaceuticals, and if a last resort medication is tried, start with small amounts and increase slowly. Good sleep hygiene may consist of any or all of the following:

  • Get Exposure to Daylight: Get sunlight early in the day and be outside for prolonged periods of time—as much as possible all year. The earlier in the day the better, but anytime is fine.
  • Avoid Napping: Do as much as possible to keep patients awake during the day and on a normal sleep/wake schedule.
  • Don’t Eat After Dinner: Don’t offer food after dinner or offer very light food no later than two hours before bed. Late evening eating can disrupt sleep.
  • Limit Blue Light: Screens like phones, iPads, or TVs emit a blue light that can interfere with sleep. Turn off screens at least two hours before bed.
  • Maintain a Consistent Sleep Schedule: Try to encourage going to bed and getting up at the same time every day.
  • Get Enough Exercise: Exercise helps with maintaining most bodily functions including circadian rhythm. Avoid exercising in the evenings.
  • Manage Any Pain: Pain can be keeping patients awake at night. Diagnose and treat any specific pain.
  • Avoid Alcohol and Caffeine: Both can interfere with sleep, especially if consumed in the evening.
  • Do Something Relaxing Before Bed: Take a bath or listen to music. Get a massage or do something that is very low key.
  • Reduce Artificial Light in the Evening: Sleep hormones kick in relative to diminishing light. Turn off as many lights as possible, and lower the ones that are on.
  • Sleep in a Dark, Quiet, Cool Room: Keep the room dark and the temperature low. Even nightlights can interfere with sleep. Use room darkening curtains if needed.
  • Provide a Security Object: A flashlight, a call button, or a bell will work if the person is living at home and sleeping by themselves.
  • Aromatherapy: Lavender has been shown to help with sleep. Use in a diffuser or essential oil on a pillow.

How Sleep Disturbances May Contribute to Alzheimer’s

More and more studies are finding links between Alzheimer’s and sleep. Researchers at Stanford University Medical Center have identified a gene connected to sleep apnea. If you have this gene, it predisposes you to the development of Alzheimer’s.

A further link between sleep and Alzheimer’s has to do with brain proteins. People who experience sleep disturbances, especially sleep deprivation, tend to have higher levels of two proteins in their brains: beta-amyloid (which is actually a protein fragment) and tau. With beta-amyloid, as little as one night of missed sleep can elevate levels. With tau, levels seem to be most affected by lack of slow-wave sleep (NREM stage 3), the phase of sleep where memories are consolidated. Higher levels of both beta-amyloid and tau proteins are hallmarks of Alzheimer’s. Consequently, a correlation is being drawn between lack of sleep and the possible development of Alzheimer’s.


Summary

Understanding the cause and effect relationship between Alzheimer’s and sleep is still an ongoing endeavor. There is no definitive answer as to what causes Alzheimer’s, but lack of sleep may be a factor. An increase in brain proteins that results from different sleep disturbances are linked to Alzheimer’s. Additionally, Alzheimer’s symptoms include sleep disorders that plague patients with abnormal sleep/wake cycles, especially in the advanced stages of the disease. Contact your doctor for any specific treatment you may need.


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