Day 20!

Today, I would like to chat a bit about sleepless for adults with dementia; particularly Alzheimer's disease. Again, if you haven't read the previous days, dementia is a term for cognitive impact. Many conditions and diseases cause dementia, such as Alzheimer's disease (75% of cases), Parkinson's, TBIs, diabetes, alcoholism/drugs, vascular events, and others.

Many patients discuss "sundowners" or sleeplessness with their loved ones.

Sundowning is a term defined to include difficulty sleeping late in the afternoon or evening and often, symptoms as agitation, restlessness, enhanced confusion, or even anxiety, may occur. Why does this happen?

Not to equate adults with dementia to infants, however just as an infant, when late in the day they get fidgety, cry, don't want to fall asleep, there are several reasons that may impact not being able to communicate needs.

Understanding dementia/Alzheimer's needs is subtle and caregivers actively listening and engaging will begin to ascertain what may be needed. Yes, sometimes nothing seems to help and that is dependent on the stage, or phase, of dementia.

Check if basic needs as:

Hunger

Pain

Thirst

Not enough activity and movement during the day

Too much chaos in the home (noise, tv, music, loud talking/fighting/screaming)

Overstimulation

Medication or drug interaction

Sugar or caffeine late in the day

So, what can you do?

Of course, see if their basic needs are met and if there is any area causing pain. Also, check if dentures are not pinching, as this is a common occurrence. Also, Alzheimer's impacts salivation and can increase caries or even gum infection.

Ensure your loved ones is moving their body during the day (of course, mobile).

Begin avoiding caffeine or sugar (especially those Ensure drinks; loaded with additives and sugar) and avoid eating late at night. Chamomile tea is a calming option. Check the "calming" teas as many have herbs that may stimulate some. I tried a Calming Mix and there was Ashwagandha and licorce which made my heart race.

Check if any part of their body is experiencing pain or discomfort. Falls or falling into the wall or areas, are common with dementia and leave bruises. I like gentle massage for relaxation. Yes, that is adding yet another activity for caregivers, however a little massage and help for a better sleep. If in hospice, please let them know you want all the therapies. Most hospices provide therapies as massage.

When in bed, use a weighted blanket, ensure the lights are low and there is nothing that is too stimulating as scents (not wall air fresheners!!!!!!!!!!). Sometimes I have tried the sleep sounds with the ocean or forest. It involves trying many different options.

Even if you find an option that works, as Alzheimer's progresses, things change quickly.

Also, check medications and drug interactions and side effects. Those "Dementia" drugs to slow progress, actually do not, and instead cause sleeplessness, anxiety, hallucination, etc.

I also have soft stuffed animals to cuddle with for my patients. I like a seal with a cute face. DM me if you would like the link.

Each person is unique and often, meeting with a gerontologist for home assessment is needed.

I hope this is a bit of support!

Dr. Holzner

Learn more about Sundowning....