For the last month and more, we've been talking about sleep, how important it is and the many ways it gets disrupted. Today, we finish up and next week we talk about ways to help your loved one get to sleep and stay asleep--which is probably what you've been wanting all along! After all, it doesn't help a lot to know why a person isn't sleeping if you can't do anything about it. Well, actually, it does help to know why a person isn't sleeping because the answer to how to get them to sleep rests on the why. That's why we've spent so much time talking about it. But first, let's talk about it for one more blog.
Depression, fatigue and anxiety are all common with dementia. (3/22/13) They all can lead to lack of sleep and they all can feed each other.
Depression can be situational and temporary or a chronic dementia symptom--or both. Situational depression becomes chronic when Lewy bodies attack dopamine, a chemical involved with both mobility and mood. It can also become long-lasting, as with care partners who continually feel overwhelmed. Depression can cause either insomnia or excessive sleep. In either case, one's Circadian clock will be disrupted, (Sleep Part 2) the brain will have difficulty with clean up (Sleep Part 3) and dementia is likely to become worse.
There are some fairly safe antidepressants available. In addition, consider exercise to add oxygen and openness about the dementia to decrease negative feelings. Yes, talking about sad things takes away the sting a lot more than burying them does! (4/1/16)
Fatigue is the extreme lack of sleep. (9/25/14) It can follow depression or cause it. The best treatment for fatigue is a good, calm bedtime routine and a bedroom conducive to sleep. (to be discussed in a future blog).
Anxiety is a negative emotion very common with dementia, where a person is continually being presented with unwanted changes and limitations. Negative emotions are motivators and thus sleep-disrupting almost by definition. (4/7/17) Lack of sleep can also cause anxiety as one's defenses lower. There are anti-anxiety drugs but for many, they can cause more problems than they fix. If you use them at all, insist on the smallest dose possible, monitor carefully and quit at any sign of discomfort.
The best answer to anxiety is a two step process where you first validate it. "Yes, feeling so down isn't fun." or "This whole thing is scary, isn't it?" This allows the PlwD to feel heard and their negative feelings decrease, allowing your next step to work. That's when you say and do things that cause the PlwD to feel positive. Bribes work well here, by the way! (Blogs coming up with more about anxiety and dealing with it.)
Depression, fatigue and anxiety can cause each other or all three, and so treatment probably needs to be for all three together. This is especially true for the non-drug remedies. Besides, anyone can use more positive reinforcement, everyone needs a good sleep routine and exercise and openness is also good for everyone. Doing all of it together should improve not only one's sleep but one's general quality of life.
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.
* Acronyms:
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
Showing posts with label fatigue. Show all posts
Showing posts with label fatigue. Show all posts
Friday, February 16, 2018
Friday, March 22, 2013
Depression, Apathy and Fatigue
These three are all symptoms that people with Lewy body (PwLB) disorders often experience. How do you know which is which? They can all make your loved one (or you!) feel so tired that they can hardly move and all they want to do is sleep.
Depression causes changes in mood, thinking, physical well-being and behavior. It generates such feelings as sadness, misery, unhappiness, anger, loss and frustration. Besides decreasing quality of life, it adds stress and decreases one’s ability to deal with illness. A person who is depressed has the motivation to improve but not necessarily the ability to do so. They will complain about being too tired and wish they had the energy to do more.
Situational depression is usually short term, caused by a distressing event. When a PwLBD’s depression doesn’t leave, or appears to get worse, it is probably not situational but is instead a neurological symptom of the disorder. Depression makes it more difficult to do tasks, make decisions or interact with others, all abilities that can also be decreased by dementia. Like LBD, it cannot be cured but can be treated. There are some Lewy-safe antidepressants which may improve cognitive functioning.
Apathy is the loss of motivation, without associated feelings of depression. It damages one’s self-starter—that extra push we need to overcome the inertia of inactivity. As it increases, it also decreases the ability to keep going. With apathy, nothing is easy. Everything takes effort, often more effort than a person can muster up. They may appear to have given up, accepting things as they are, voicing few complaints or wishes for change.
Fatigue is an extreme loss of energy. The loss may come from working hard. This doesn’t necessarily mean hard physical labor. If there are language difficulties, then talking can be exhausting. With motor problems, walking can wear your loved one out very quickly. Dealing with stress or illness can be tiring. Depression and apathy both deplete energy and leave a person feeling fatigued.
Negative feelings such as sadness or loss along with the presence of motivation suggest depression.
Ex: “I wish I didn’t feel so down all the time.” Or “I wish I had more energy.”
Negative feelings without motivation suggest both depression and apathy.
Ex: “I feel so down. I can't do anything. Just go away and leave me alone.”
The lack of both negative feelings and motivation suggests apathy alone.
Ex: “I don't care that I can't do that any more. Leave me alone; I just want to sleep.”
For the PwParkinson's, apathy without depression is a sign that dementia may soon appear. Consider a test for MCI.
Depression causes changes in mood, thinking, physical well-being and behavior. It generates such feelings as sadness, misery, unhappiness, anger, loss and frustration. Besides decreasing quality of life, it adds stress and decreases one’s ability to deal with illness. A person who is depressed has the motivation to improve but not necessarily the ability to do so. They will complain about being too tired and wish they had the energy to do more.
Situational depression is usually short term, caused by a distressing event. When a PwLBD’s depression doesn’t leave, or appears to get worse, it is probably not situational but is instead a neurological symptom of the disorder. Depression makes it more difficult to do tasks, make decisions or interact with others, all abilities that can also be decreased by dementia. Like LBD, it cannot be cured but can be treated. There are some Lewy-safe antidepressants which may improve cognitive functioning.
Apathy is the loss of motivation, without associated feelings of depression. It damages one’s self-starter—that extra push we need to overcome the inertia of inactivity. As it increases, it also decreases the ability to keep going. With apathy, nothing is easy. Everything takes effort, often more effort than a person can muster up. They may appear to have given up, accepting things as they are, voicing few complaints or wishes for change.
Fatigue is an extreme loss of energy. The loss may come from working hard. This doesn’t necessarily mean hard physical labor. If there are language difficulties, then talking can be exhausting. With motor problems, walking can wear your loved one out very quickly. Dealing with stress or illness can be tiring. Depression and apathy both deplete energy and leave a person feeling fatigued.
Negative feelings such as sadness or loss along with the presence of motivation suggest depression.
Ex: “I wish I didn’t feel so down all the time.” Or “I wish I had more energy.”
Negative feelings without motivation suggest both depression and apathy.
Ex: “I feel so down. I can't do anything. Just go away and leave me alone.”
The lack of both negative feelings and motivation suggests apathy alone.
Ex: “I don't care that I can't do that any more. Leave me alone; I just want to sleep.”
For the PwParkinson's, apathy without depression is a sign that dementia may soon appear. Consider a test for MCI.
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