Sonia Ancoli-Israel, Ph.D.
The problem with Alzheimer's disease, as well as other forms of dementia, is that it has negative effects on the sleep/wake cycle. The greater the degree of dementia, the sleepier the patient is. With more severe forms of dementia, patients are often sleepier during the day, and their sleep at night tends to be fragmented and disrupted. Over a 24-hour period, for example, patients are rarely awake and rarely asleep for a full hour at a time. They are constantly waking up at night and falling asleep during the day. This pattern is fairly common in Alzheimer's patients.
Many Alzheimer's patients experience what is called "sundowning": agitated behavior that is thought to occur primarily after the sun goes down; for example, pacing, yelling out, or getting violent. This behavior is usually repetitive. Sundowning can include wandering around at night. Wandering and incontinence are the top two causes of institutionalization, because the family member has great difficultly taking care of a patient who displays one characteristic or the other.
It's important to realize that sundowning doesn't always occur after sundown; it can take place all day long and frequently peaks around 12:30 – 1:00 p.m. It is just easier for the family member to cope with a behavior like wandering during the day than at night, when it is more disruptive.
Unfortunately, there is no silver bullet. There are medications that are used to try to bring agitated behavior and sleep under control. Sometimes these medications make the patient better, sometimes worse. It is important to talk with the patient's physician about the advantages and disadvantages of medication in treating forms of dementia.
Fortunately, there are some things you can do at home to help improve the patient's behavior:
One of the characteristics of dementia is sleep disordered breathing. More than 80 percent of dementia patients have sleep apnea. If we can treat them successfully for sleep apnea, we might be able to improve their sleep at night and their alertness during the day. Speak to the patient's physician about this possibility.
Improving sleep at night and functioning during the day helps to postpone institutionalization, which would be better for the patient and the family and would save tens of millions of dollars.
--Sonia Ancoli-Israel, PhD, is Professor of Psychiatry at the University of California, San Diego. She is also Director of the Sleep Disorders Clinic at the Veterans Affairs San Diego Healthcare System. Dr. Ancoli-Israel is author of All I Want Is a Good Night's Sleep.
This article originally appeared in the Winter 2001 issue of sleepmatters.