Sleep Problems: What to Do when Your Loved One Can’t Sleep A WellMed Charitable Foundation Caregiver Tele-conference Session

Objectives This session will help participants understand: That sleep problems are one of the biggest predictors of placing a loved one in a facility Why caregivers need to know about sleep problems both for themselves and for their loved one How caregivers can cope with sleep problems to get a good night’s rest

What is “normal” sleep? National Sleep Foundation: Recommends 7 to 9 hours of sleep each night for: Optimum performance Optimum health Optimum safety Sleep improves our memory, learning ability, and insight Sleep reinforces the pathways of brain cells and allows formation of new ones Sleep is necessary for those pathways to work up to the speed needed to perform these tasks

What happens with sleep deprivation? Sleep “debt” can be accumulated Is difficult to “pay back” Is linked to: Obesity High blood pressure Negative mood and behavior Decreased productivity Safety issues when driving Safety issues at home and at work

What are common sleep problems? Sleep problems or “insomnia” can present as Trouble falling asleep (more than 30 minutes) Trouble falling back asleep in the night Waking earlier than desired and unable to get back to sleep Waking after a full night’s sleep and not feeling rested There is a high correlation between depression, anxiety, and insomnia

What are sleep problems common to persons with dementia? Sundowner’s Syndrome (most common) Daytime napping at the expense of a good night’s rest Shift in sleep-wake cycles Changes in routine: Exercise Meal time and size Bed time distractions Medication side effects

What is Sundowner’s Syndrome? Recognized by: Increasing restlessness and agitation between afternoon and evening May include increased paranoia, verbal abuse, self-destructive tendencies Most often seen in early to middle-stage dementia Can exhibit as a total reversal of regular sleep-wake pattern Can also occur in persons without dementia after surgery or in the hospital setting

What are some of the causes of Sundowner’s Syndrome? Dementia Overstimulation Exhaustion Hormone imbalance Lack of exposure to sunlight (biological clock disturbance) Changing routines Depression resulting in trouble with daily activities, leading to increased agitation and anxiety

What do experts know about Sundowner’s? Very little, just like dementia An estimated 12 to 25% of persons with Alzheimer’s experience Sundowner’s Syndrome Term may be outdated as persons with dementia may exhibit same symptoms throughout the day May be closely related to environmental stimulation or changes Also, may be affected by caregiver’s feelings of fatigue or exhaustion May be made worse by restless leg syndrome or sleep apnea Bright lights at night can help or irritate!

Are there ways to ease the symptoms of Sundowner’s? Set a regular routine for the day: Load physical activity/stimulation into the morning hours Encourage regular exercise, but no later than 3 or 4 hours before bedtime Plan calmer things for afternoon and evening Establish regular bed time and meal times Avoid alcohol, caffeine, nicotine, or other stimulants Provide familiar bedtime setting, limiting noise, activity, visitors Consider security features to prevent wandering, disorientation, falls Consult your loved one’s MD regarding sleeping medication, including over the counter meds

And what can the caregiver do for him/herself? CA Caregiver Resource Centers report 41% of caregivers awakened at night by care receiver How to handle: Present a very calm manner Assess need or problem Remind of the time and what it means Avoid asking for an explanation Reassure that everything is normal and okay Offer assistance in going back to bed Get exercise daily and have a regular bedtime Get nighttime respite! (studies say you need at least 1 good night’s rest out of every 3 nights)

National Family Caregiver Support Program Are there resources for respite care or more information on dementia and sleep problems? National Family Caregiver Support Program Specialists who know caregiving and maybe some tips for a better night’s sleep Support groups with other caregivers Educational information and classes Condition-related agencies, e.g.: Alzheimers’ Disease Parkinson’s Disease Multiple Sclerosis Ask your physician for referral to a sleep specialist, if needed

Are there Internet Resources? http://www.nhlbi.nih.gov/health/public/sleep/healthy_sleep.pdf

Conclusion Q&A session: Ask caregivers to share their tips and ideas about getting a better night’s sleep Summary: Highlight key points from session including feedback from caregivers. Promote: Encourage caregivers to participate in next tele-session Thanks to all attendees and speakers.