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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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!

10. 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

11. 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)

12. 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

13. Are there Internet Resources?

14. 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.