Getting Asleep and Staying Asleep

Support group member Amanda reported, “Leo was up and down all night long again last night. He was sure he was late for an appointment. I tried to tell him it was 3am, and besides he didn’t have an appointment today, but he still worried. He was up again in an hour, brushing his teeth. ‘We’re late,’ he told me again. I have to admit that by the fourth time we were up, I was getting testy. ‘Go back to bed,’ I told him a bit too sharply. That worked, finally. He got back in bed and pretty soon he was asleep again. I know how important getting a good night’s sleep is for him—for both of us really. I hate it when I lose my cool. I know it’s not his fault. Surely, there’s another way?”

This is a cry for help that we hear over and over. Sleeping pills aren’t the answer. They are among those that can cause irreparable damage for our LBD loved ones. Here are some safer suggestions:

During the day:

• Exercise: Most LBD caregivers know that “exercise is better than most dementia drugs” for maintaining cognitive function. It is also better than most sleeping pills for fostering a good night’s sleep. However, make sure the exercise occurs 2 hours or more prior to bedtime.
• Keep active: Anyone sleeps better if they have been active during the day. Even if movement is limited, stimulate with other activities, talking, hobbies, and such.
• Keep the peace: Anything that upsets your loved one during the day may come back to haunt you both at night. Do everything you can to maintain peace and lower stress. (See our August 31, 2012 blog on stress reduction for a start.)
• Eliminate time worries: Don’t tell your loved one about future plans. As dementia progresses, the concept of time is lost. Everything is in the here and now. And so when your loved one remembers that you said he has an appointment for day after tomorrow at 4pm, he feels he has to be there NOW.
• Bright lights: These help to maintain circadian rhythms. First, encourage exposure to as much natural daylight as possible. Take walks outside and get in some good exercise too! If that doesn’t seem to help, consider setting up a bright-light box, the kind used with seasonal affective disorder (SAD). Have it turn on automatically a few minutes before morning wakeup time and let it stay on for about a half hour. Follow up with exposure to natural light during the rest of the day.

Preparing for Bedtime:

• Atmosphere: Make the bedroom calm, comfortable and dark. Have a soothing color scheme, darkened windows, a comfortable bed, good ventilation and a minimal number of blinking lights from clocks, radios and such.
• Keeping time: If your loved one still has a concept of time, a large clock that’s easy to see from bed may help to decrease excessive getting up. 
• The last few hours of the day: This should be the calmest time of the day. No stress, no excitement. If bathing is stressful, do it earlier in the day. Ask family and friends to refrain from calling at this time. If TV is part of your normal routine, find the most calming shows you can to watch. You can also find  many web pages that offer soothing content. Three are: a) Soothtube offers Youtube shows with a variety of content and soothing voices, b) Serenity Channel offers beautiful pictures and soothing music and c) PaulFromStokeUK offers beautiful music and photos scientifically designed for relaxation. He also has DVDs for sale.
• Routine: Set up a routine that includes a set bedtime, low stress, enjoyable activities, the usual bedtime preparation, soft music, etc. What you include depends on the individual and what they enjoy. Once the routine is set, try not to vary it.

Medications:

• Melatonin: This is a natural hormone that triggers wake and sleep cycles. It has been used for years as a fairly safe sleep aid, even with LBD except that it may increase depression—already a problem for our loved ones. However the depression will go away when the drug wears off and so it might be worth a try. Using bright light therapy may decrease the depressive side effects.
• Medication time change: Ask the doctor if your loved one’s medication times can be adjusted so that those that encourage wakefulness, such as Exelon and Aricept are given in the mornings and those that calm such as Seroquel are given in the evenings.

Website: http://lbdtools.com