Sleep is as necessary to good health as exercise--maybe even more! An elderly or infirm person, including anyone with dementia, needs about 7 to 9 hours of sleep a day to function properly. The symptoms from lack of adequate sleep include: confusion, less muscle strength, decreased function of vital organs, pain sensitivity, diabetes risks, and a weakened immune system. Add the damage already done by dementia, which increases all of the above symptoms in both likelihood and severity, and you can see how important sleep is for our loved ones. However, LBD,* and dementia in general, also interrupts sleep with a variety of issues and so sleep isn't always easy to obtain.
Sleep is the time when the body actively restores and strengthens its resources. During our deepest sleep, muscles are relaxed, allowing them to rest and be repaired. The blood supply to muscles is increased, bringing hormones and other chemicals to repair damage and normal wear and replacing the proteins needed to fuel movement. The tremors common to persons living with Parkinson's disease with dementia (PlwPDD)* put a lot of wear on their muscles each day and so this restorative period is quite important.
Unlike the muscles and other body functions that slow down and relax during sleep, the brain is very busy. Think of it as a busy office, shut down for the night. Besides being the time for restoring used up chemicals and proteins and preparing for a new day, this is when the brain does its heavy cleaning. This has become a very interesting area for researchers. First, it was nutrition like antioxidants that would rid the body damaging "free radicals." Then came drugs that that clear away sticky clumps of plaque in the brain and improve function. So far, all the research has been with Alzheimers, but we of course hope that it works with other dementias too. Then came new research on how important sleep is for the brain's janitor work. Even the drugs need sleep to work properly!
Sleep is a part of the Circadian Rhythm, an internal clock that times various functions including sleeping, waking and secreting of various chemicals at appropriate times for repair, cleaning, relaxing, waking, and so on. When this cycle is thrown off, the body doesn't get the restorative care it needs. As people age, they tend to wake more often for a variety of reasons, from bathroom visits to apnea and more. All can interfere with the function of their internal clock. The visual cortex is often an early Lewy body target (Think hallucinations!) and so a PlwLBD can experience these issue earlier and more intensely.
Apnea is one of the conditions that can greatly interfere with sleep. Apnea, a condition which sleepers stop breathing hundreds of times during the night, is linked to memory decline itself. Its resulting lack of oxygen tends to make already present dementia worse. This lack of oxygen is what wakes a person up, so that they can start breathing again. Apnea is treatable but a PlwD may not be able to tolerate or accept the treatment.
Depression often interferes with sleep. Depression is a very common symptoms with LBD, because of the loss of dopamine, which is a feel good chemical as well as one that facilitates movement. The problem here is that some Parkinson's drugs may decrease depression but cause insomnia.
REM sleep behavior disorder is a common symptom of LBD, often showing up years before any other symptoms. Its active dreams can disturb sleep, or more likely disturb a partner's sleep. Past blog entries have discussed this phenomenon.
And finally, how do we combat all of this? How do we help our loved ones...and ourselves...get the sleep we need. The easiest answer is to take a sleeping pill, but that is probably the lest safe for anyone. There are many environmental and mental things to try. Mainly it is a matter of setting up a soothing routine, following it with relaxing thoughts and waiting for nature to take charge.
Look for more about each of these issues in future blogs.
For more information about Lewy body disorders, read our books:
A Caregivers’ Guide to Lewy Body Dementia
Managing Cognitive Issues in Parkinson's and Lewy Body Dementia
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LBD: Lewy body dementia
PD: Parkinson's disease
PlwD: person living with dementia
DLB: dementia with Lewy bodies
PDD: Parkinson's disease with dementia
PlwD, PD, LBD, PDD, etc: person/people living with dementia
PlwPD, LBD, PDD, etc.: person/people living with PD, LBD, PDD, etc.
MCI: mild cognitive impairment
MCI-LB: the form of MCI that precedes LBD
BPSD: behavioral and psychological symptoms of dementia
Helen and James Whitworth are not doctors, lawyers or social workers. As informed caregivers, they share the information here for educational purposes only. It should never be used instead of a professional's advice.