1. The Relationship Between Sleep and Alzheimer’s Disease
Andrea C. Gambardella, MAIOP; Grace R. Denault, B.A; Lucille C. Gambardella, PhD, APN-BC,CNE
Academy of Sleep and Wellness, Middletown, DE
Introduction
Scope of the Problem
Conclusions
Sleep is an essential element for overall good health. Older adults who have poor sleep patterns are more likely to be depressed, have attention and memory problems, experience cognitive difficulties, have a great number of falls, and an overall poorer quality of life. All of this is further complicated if the older adult also has Alzheimer’s Disease. Brain changes in the Alzheimer client disrupts the sleep/wake cycle. Since AD affects an estimated 4.5 million Americans; the sleep concerns of this population and the management by their caregivers is a major community health concern.
Circadian rhythms are disrupted in AD
AD patients lose ability to stay asleep as the disease progresses
Sleep problems increase agitation in the AD population
“Sundowning” complicates sleep and care management (20%)
Evidence inconclusive on what occurs first: Alzheimer’s Disease or disorders of sleep in AD population
International studies indicate that AD clients can be assisted in returning to a more normal sleep pattern
New evidence indicates that AD does not destroy the biological clock
Community education on sleep and AD can diminish caregiver stress and improve the status of the AD client
Build up of plaque causing disruption in suprachiasmatic nucleus
Initiation of process
Projected effect on Circadian rhythms and maintenance of regular sleep patterns
Increases confusion
Restless insomnia
Sundowner syndrome
Daytime sleepiness
No biological sense of time
Purpose
The purpose of this community education initiative is to facilitate addressing these sleep issues as an integral part of the holistic health plan for AD clients. Sleep patterns do change as the disease progresses, so ongoing monitoring of needs and maintenance of meeting comfort and rest requirements is a challenge..
The pieces fit through evidence-based care
References:
American Academy of Sleep Medicine. Sleep and growing older. Sleep Education News. August 7, 2013.
Hoffman, Sandra. Sleep in the older adult: implications for nurses. Geriatric Nursing. 2013:24 (4)
Redeker, Nancy, & McEnay, Geoffrey (2015) Sleep disorders and sleep promotion in nursing practice. New York: Springer Publishing Company
Roh, JH, et.al. (2012) Discussion of the sleep-wake cycle and diurnal fluctuation of B-amyloid in mice with Alzheimer’s Disease. Science Translational Medicine, September 5, 2012.
Vitiello, Michael & Monjan, Andrew ((2017). Alzheimer’s Disease and Sleep. National Sleep Foundation
AD clients have difficulty falling asleep
AD clients wake up numerous times during the night creating safety problems for them and exhaustion for caregivers
AD clients are sleepy during the day resulting in a very poor sleep-wake cycle
Goals
Community Interventions
Contact Information
The goals for the community education outreach are to:
Raise awareness of the relationship between sleep and Alzheimer’s Disease
Provide information related to brain changes that create sleep problems in the Alzheimer’s client
Share community resources accessible to caregivers who provide safe, quality treatment options to this AD population
Community interventions focus on coping for the client and caregivers:
Create an ideal sleep environment
Keep as close as possible to a normal sleep/wake schedule
Get in bright light soon after waking
Utilize light to diminish sundowner effects
Encourage exercise to the extent possible
Andrea C. Gambardella, MAIOP, VP for Business Development
Delaware Sleep Disorder Centers, LLC, Wilmington, DE 19803
Grace R. Denault, BA, RPSGT, RST; Coordinator of Sleep Education
Academy of Sleep and Wellness, Middletown, DE 19709
Lucille C. Gambardella, PhD, APN-BC, Consultant
Academy of Sleep and Wellness Lewes, DE