Alzheimer’s Disease (AD) causes progressive, irreversible memory loss and affects the way people think, reason and behave.
As Alzheimer’s Disease progresses, it can lead to sleep problems that disrupt the routine of the person and their caregivers. A person with AD may have a variety of sleep problems, including short or fragmented sleep, changes in sleep cycles, and sleep disturbances.
Daily rhythm
Researchers believe that Alzheimer’s disease causes cellular changes in the brain by disrupting the sleep-wake cycle, which is a type of circadian rhythm. Changes in the brain’s production of melatonin, the sleep hormone, also contribute to sleep disturbances.
The suprachiasmatic nucleus (SCN) is an area of the brain that serves as the body’s internal clock. The SCN responds to ambient light signals that help the brain determine when a person should sleep and when they should be awake and alert. Scientists believe that individuals with Alzheimer’s disease may have damaged cells in the SCN. Such damage affects the activity of this area of the brain, leading to difficulty with the typical alternation of sleep-wake cycles.
Brain proteins and their relationship to Alzheimer’s disease
In people with Alzheimer’s disease, sleep changes may be associated with the accumulation of beta-amyloid protein in the brain. This protein is formed by brain cells and can accumulate between neurons. In Alzheimer’s disease, beta-amyloid forms amyloid plaques that disrupt the connections between brain cells.
Some studies show that during sleep, the brain clears excess beta-amyloid from the brain. Sleep deprivation can lead to increased levels of this protein in the brain, which is especially dangerous for areas such as the hippocampus and thalamus, which are affected in Alzheimer’s disease.
Another important protein that affects the progression of AD is tau. This protein is responsible for transmitting signals between neurons. In people with AD, tau forms clumps, indicating damage to nerve cells. Even one sleepless night can significantly increase tau protein levels in the cerebrospinal fluid.
While scientists confirm that quality sleep helps clear excess of these proteins from the brain, it is not entirely clear whether sleep disturbance causes or is a consequence of Alzheimer’s disease.
Do people with Alzheimer’s sleep more?
People with AD and other forms of dementia often sleep more at night than healthy people and it is not uncommon for them to need sleep during the day. As Alzheimer’s disease progresses, it causes more and more damage to the brain and the person becomes weaker. The person may feel exhausted after everyday tasks such as socializing or trying to make sense of the world around them. Sick people may sleep more during the day as Alzheimer’s symptoms worsen. In addition, medications that doctors prescribe to treat AD may contribute to sleepiness. These medications may include neuroleptics, antidepressants, antihistamines, and sleeping pills.
Other effects of Alzheimer’s disease on sleep
Alzheimer’s disease can cause a person’s sleep quality to decrease, which in turn can worsen other symptoms of Alzheimer’s disease. For example, lack of sleep can increase delirium, restlessness, and wandering in the dark, making sleep more difficult. People with Alzheimer’s may have difficulty letting their caregivers know that something is wrong. For example, they may not be able to tell a loved one that they are experiencing pain. In this case, the pain may impair their sleep.
Sufficient deep sleep with a normal rapid eye movement phase is necessary for memory retention, and memory loss is a leading symptom of AD. The duration of the deep sleep and REM phases of sleep is gradually shortened in people with Alzheimer’s disease. Other potential consequences of Alzheimer’s disease’s effect on sleep include decreased physical activity and spending less time in natural sunlight.
Sleep rules
Caregivers of people with AD can take certain steps to help their wards manage their sleep. These include:
- Identification of any other medical conditions. Caregivers can observe the patient to see if they have any disorders that lead to wakefulness. For example, sleep apnea causes short pauses in breathing, and restless leg syndrome involves uncontrolled movement or twitching of the legs.
- Revision of prescribed medications. Side effects of some prescription medications used for Alzheimer’s disease may contribute to insomnia. A doctor can advise on the best time of day to take such medications to lessen the unwanted effects.
- Awareness of the flow of time throughout the day. A patient with AD may benefit from having a watch with a 24-hour time display in sight to distinguish day from night.
- Conversations with the patient in case of nighttime awakenings. If the person gets up during the night, the caregiver may talk to the person to find out the reason for waking up. In such cases, it is better to ensure that the patient is relaxed and prepared to go back to sleep by using dim lighting and soft music that he or she likes.
- Using a device that signals the ward to wake up. Such wireless signaling devices will send a signal to the guardian in case the patient gets out of bed during the night. Once the guardian receives the warning signal, he or she will help the ward get back into bed sooner.
- Establishing a daily regimen. Following a sleep and wake schedule daily and establishing a daily routine, such as taking a relaxing bath or having a hot milky drink before bed, can help the person recognize the time of day and develop a reflex to fall asleep at the same time.
Psychological aspects of sleep in Alzheimer’s disease
Sleep in people with Alzheimer’s disease is not only physiologically impaired, but can also affect their psychological well-being. Sleep disturbances often cause anxiety and depression, making daily communication and interaction with the patient more difficult. Insomnia and night wakings can exacerbate cognitive impairment and increase the risk of patients developing aggression and irritability. This may be due to disruption of routines, inability to maintain stable relationships with others, and decreased ability to self-soothe. In such cases, it is important for caregivers to be patient and create a calm, relaxing atmosphere for the patient, using relaxation techniques and supportive conversation.
Conclusion
Alzheimer’s disease and sleep disorders are closely related, with significant impact on the quality of life of patients and their caregivers. Changes in the brain caused by the disease disrupt circadian rhythms and lead to problems with the sleep-wake cycle, which in turn exacerbates cognitive and emotional disorders. Proteins such as beta-amyloid and tau play an important role in disease progression, and quality sleep becomes an important factor in their removal from the brain. However, it is unclear whether sleep disturbance is a cause of the disease or a consequence.
Proper sleep management, including establishing a clear regimen, monitoring health and utilizing supportive techniques, can help improve the quality of life for people with Alzheimer’s disease. It is important for caregivers to be patient and attentive in creating a calm atmosphere for their wards. Thus, effective treatment of AD requires a comprehensive approach that includes both medical and psychological aspects aimed at improving the patient’s sleep and overall well-being.
