Time Change Can Prompt Sleep and Behavioral Issues for People with Alzheimer’s Disease

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For people on a regular routine, the end of Daylight Saving Time is a noticeable change. Sunset arrives one hour earlier, so it is darker in the evening.

Nighttime can already be a troubling time for those with Alzheimer’s disease or dementia. Reduced lighting can cause disorientation. Sundowning, also known as late-day confusion, occurs in some Alzheimer’s patients, meaning that their confusion or agitation could be worse in the late afternoon or evening hours. Some known factors that cause sundowning are end-of-day exhaustion (both mental and physical) and an upset in the “internal body clock,” causing a biological mix-up between day and night.

So, caregivers may need a plan to help their loved one get accustomed to darkness arriving earlier. Alzheimer’s experts say nighttime restlessness typically peaks in the middle stages of Alzheimer’s, and then diminishes as the disease progresses. Scientists don’t completely understand why sleep disturbances occur with Alzheimer’s disease, which is a fatal brain disease that cannot be prevented, cured or slowed. As with changes in memory and behavior, sleep changes somehow result from the impact of Alzheimer’s on the brain.

Some studies indicate as many as 20 percent of persons with Alzheimer’s will experience increased confusion, anxiety and agitation beginning late in the day. Rebecca Hall, Director of Care and Support for the Alzheimer’s Association Miami Valley Chapter, said, “Fewer hours of daylight may affect the routine of someone living with dementia. Because reduced lighting and increased shadows may cause people with Alzheimer’s to misinterpret what they see, and become confused and afraid, we recommend making sure to keep the home well-lit in the evening, maintaining a regular schedule, and including daytime activities that keep the person living with dementia as active as possible.”

Research indicates that up to 45 percent of people with dementia may have sleep problems. Many people with Alzheimer’s wake up more often and stay awake longer during the night. Those who cannot sleep may wander, be unable to lie still, or yell or call out, disrupting the sleep of their caregivers. Experts estimate that in late stages of Alzheimer’s, individuals spend about 40 percent of their time in bed at night awake and a significant part of their daytime sleeping. For sleep issues due primarily to Alzheimer’s disease, most experts encourage the use of non-drug measures, rather than medication.

Below are some tips if a person is awake and upset at nighttime:
• Approach him or her in a calm manner.
• Find out if there is something he or she needs.
• Gently remind him or her of the time.
• Avoid arguing.
• Offer reassurance that everything is all right.
• Don’t use physical restraint. If the person needs to pace, allow this to continue under your supervision.

For more information, call the Alzheimer’s Association’s 24/7 Helpline at 800.272.3900.

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