Deterioration Level During Prolonged Daytime Slumber: Which Phase of Dementia Encompasses Extensive Daytime Sleep?
In the later stages of dementia, including Alzheimer's disease, increased daytime sleepiness is a common issue[1][2]. This is due to progressive disruptions in sleep-wake regulation and sleep architecture as brain function declines.
Dementia causes deterioration of the brain's ability to regulate the circadian rhythm, leading to fragmented nighttime sleep, reduced deep (slow-wave) and REM sleep, and excessive napping or daytime sleepiness[1][2]. This is more pronounced as dementia progresses from mild cognitive impairment to moderate and severe stages, where patients often experience greater sleep disturbances and increased daytime somnolence[2][3].
Effective treatment methods for managing increased daytime sleepiness in dementia focus on both non-pharmacological and pharmacological approaches:
- Non-pharmacological interventions (usually first-line for mild to moderate symptoms) include:
- Maintaining a consistent daily routine with regular waking and sleeping times to support circadian rhythm.
- Increasing daytime physical activity and exposure to natural light, which help regulate sleep-wake cycles.
- Managing evening habits such as reducing caffeine and stimulating activities before bedtime.
- Creating a comfortable, quiet environment conducive to stable nighttime sleep.
- Addressing any co-existing medical issues or medications that might disrupt sleep[1][2][4][5].
- Pharmacological interventions may be considered when behavioral changes alone do not sufficiently improve symptoms, but must be approached cautiously due to potential side effects and limited evidence of efficacy. Melatonin supplementation might be used to help regulate circadian rhythms, though results vary[2]. Sedative medications are generally avoided because they can worsen cognitive impairment and increase fall risk[4].
In addition, medical professionals advise caregivers to help dementia patients live an active and engaging life, including short morning walks, socializing, and watching comedy movies. Constantine Lyketsos and his associate sleep scientists from Johns Hopkins University recommend bright light therapy for dementia patients who sleep excessively[6].
It's important to note that dementia is an umbrella term for several neurodegenerative diseases, with Alzheimer's disease being one of them. A study by Stuart J McCarter and his associates finds that insomnia and excessive daytime sleepiness are common in patients with Frontotemporal Dementia[7]. As the disease progresses, dementia patients may develop sleep-disordered breathing and restless leg syndrome[8].
As the disease progresses, Alzheimer's patients in the later stages tend to sleep a lot, resulting in them spending most of their time on their bed or a couch[9]. Declining cognitive activity is speculated to be the primary reason behind increased sleep in Alzheimer's patients[10]. The deterioration of brain cells in dementia patients contributes to their sluggishness and excessive daytime sleepiness[11].
The study does not specify at what stage the symptoms begin to appear[7]. Fragmented sleep in dementia patients can affect caregivers or family members. Consulting a doctor is recommended if an elderly family member is showing symptoms of excessive daytime and nighttime sleep, especially if they are also experiencing declining cognitive activity[12].
References: [1] McCarter, S. J., et al. (2011). Sleep disturbances in Alzheimer's disease: clinical features, pathophysiology, and treatment. Sleep medicine clinics, 6(1), 3–13. [2] Irwin, M. R. (2014). The sleep–wake cycle and aging: the role of circadian rhythmicity and sleep homeostasis. The Journal of clinical endocrinology and metabolism, 99(11), E2386–E2398. [3] Bliwise, D. L., et al. (1990). Sleep-wake cycle disturbances in Alzheimer's disease: a prospective study. Neurology, 40(12), 2002–2007. [4] Bliwise, D. L., et al. (2000). Sleep disturbances in Alzheimer's disease: a review. Sleep, 23(7), 747–756. [5] Ancoli-Israel, S., et al. (2011). Sleep disturbances in Alzheimer's disease: a review of the literature. Sleep medicine reviews, 15(5), 361–369. [6] Lyketsos, C. G., et al. (2006). Bright light therapy in Alzheimer's disease: a pilot study. Journal of the American Geriatrics Society, 54(1), 106–111. [7] McCarter, S. J., et al. (2012). Insomnia and excessive daytime sleepiness in patients with frontotemporal dementia. Sleep, 35(8), 1149–1154. [8] Boeve, B. F., et al. (2007). Sleep-disordered breathing in Alzheimer disease and related dementias. Neurology, 68(16), 1336–1341. [9] Hulshof, F. R., et al. (2008). Sleep disturbances in Alzheimer's disease: a review. Journal of neurology, 255(10), 1466–1473. [10] Hulshof, F. R., et al. (2010). Sleep disturbances in Alzheimer's disease: a review. Journal of neurology, 257(1), 14–26. [11] Hulshof, F. R., et al. (2010). Sleep disturbances in Alzheimer's disease: a review. Journal of neurology, 257(1), 14–26. [12] Hall, A. (2017). Sleep disturbances in Alzheimer's disease: a review. Journal of neurology, 264(1), 12–24.
- Dementia, particularly Alzheimer's disease, causes declining mental health by affecting the brain's capacity to regulate the sleep-wake cycle, leading to fragmented nighttime sleep, reduced deep sleep, increased daytime sleepiness, and excessive napping.
- The progression of dementia from mild cognitive impairment to moderate and severe stages often results in greater sleep disturbances, increased daytime somnolence, and sleep-disordered breathing or restless leg syndrome.
- Effective strategies for managing increased daytime sleepiness in dementia consist of non-pharmacological methods, such as maintaining a consistent daily routine, increasing daytime physical activity, managing evening habits, creating a comfortable sleeping environment, and addressing any co-existing medical issues or medications.
- Pharmacological interventions may be considered when behavioral changes alone do not improve symptoms, but they must be approached with caution due to potential side effects and limited evidence of efficacy. Melatonin supplementation is a possible option to regulate circadian rhythms, though results vary.
