In this last blog on sleep, we finally get around to suggestions for better sleep. The bad news is that sleeping pills aren’t the answer. They are on the list to avoid for people living with dementia (PlwD*, and especially for people living with LBD (PlwLBD*). Here are some safer suggestions, an updated version of a 2012 blog:
During the day:
Exercise: Most dementia 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
Eliminate time worries: Don’t tell your loved one about future plans until the last moment. As dementia progresses, the concept of time is lost. Everything is in the here and now. That means thatn if 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 isn't possible, consider setting up a bright-light box, the kind used with seasonal affective disorder (SAD). Program it to turn on automatically a few minutes before morning wakeup time and stay on for about a half hour. Follow up with exposure to natural light during the rest of the day. Be prepared with sunglasses. Many people living with dementia have sensitive eyes and may need to protect their eyes even when it doesn't seem very bright.
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. Go to youtube.com and put "restful music" in the search box for a long list of suggestions.
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.
Most sleep aids. This was mentioned at the first of the blog but bears repeating. Most sleep medications are strong sedatives and are not considered safe for anyone with dementia.
Melatonin: This natural hormone is usually safe with LBD and has been used as a sleep aid. Because it triggers wake and sleep cycles, it should always be taken at least an hour before bedtime and should not be taken in the middle of the night so as to maintain proper cycles. A possible side effect is depression—a common LBD symptom already. However, the results are temporary, making melatonin worth a try. To decrease the likelihood of this side effect, try using the hormone in combination with bright lights mentioned earlier.
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.
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.
We love and welcome comments but we will not publish any that advertise a product or a commercial website. This is especially true for testimonials about miraculous Parkinson's cures and marijuana.
AD: Alzheimer's disease
BPSD: Behavioral and psychological symptoms of dementia
DLB: Dementia with Lewy bodies, where cognitive/behavioral issues occur first
LBD: Lewy body dementia, an umbrella term for both DLB and PDD
MCI: Mild cognitive impairment
MCI-LB: the form of MCI that precedes LBD
PD: Parkinson's disease
PDD: Parkinson's disease with dementia, where mobility issues occur first
PlwD: person/people living with dementia
PlwPD, LBD, PDD, AD, etc.: person/people living with PD, LBD, etc.
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