Dementia - Alzheimer’s Patients and Sleep Disturbances

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Sally Smith: Welcome to Age to Age. I'm Sally Smith. Let's talk. Today we are fortunate to have Rhonda Weichsel with us. She is an occupational therapist who deals mostly with patients with dementia and Alzheimer's and their families. She also is the MUSC coordinator of the Alzheimer's research and clinical programs, through the Department of Psychiatry and Behavioral Sciences, so she knows a lot about our subject today.

One of the things we've been talking about with Rhonda, having to do with caretaking and issues that loved ones have that have dementia. And I'm interested to read that many people with dementia are restless at night, that there's sort of a sundowning effect, where, at the end of the day, instead of them getting quieter and laid back, everybody gets more agitated. And I'm just very curious about that. What is this restlessness at night?

Rhonda Weichsel: Basically, individuals can become more restless at night because they're not getting enough sleep at night because they're napping during the day. They're getting up at 11 o'clock in the morning because they've been snoozing until lunch time, and they get up at lunch time, and they have not had enough exercise throughout the day, so they're much more restless in the evening.

Sundowning is a real problem. They do get agitated between four and seven in the evening because they're tired. Their bodies are starting to show signs of fatigue and they're starting to get agitated. That's correct.

Sally Smith: So, really, in a lot of ways it's like dealing with a baby that doesn't sleep through the night. You start saying, "Well, are we getting enough exercise late in the day?" "Do I need to give up on those naps?" Because they need to nap at night, not during the day. Is that the basics that you bring to bear, the strategies?

Rhonda Weichsel: That's right. Actually, that's a great analogy. Children often get sick five o'clock in the afternoon, their fever's going to spike. Sundowning is very similar to that. It's that time of day when everything goes wrong that can go wrong. And people get agitated, both the caregiver and the individual.

What happens is, many times, if the patient hasn't had a lot of sunlight - sunlight tends to arouse people during the day. So if you can get them outside, get them some exercise, give them chores to do, make them physically involved, that does tend to help them out. Also, there are certain medications that the regular medical doctor can prescribe to help them feel more fatigue at night.

Sally Smith: Is the structure of the's sounding like you're saying you need to make a structured day that they will, maybe, function better knowing that these things always happen. And also, then, you set it up in such a way that your goals are met, and that they nap when they should nap and they get sun when they should get sun.

Rhonda Weichsel: Routine, routine, routine is the best answer here. You're looking for the same time getting out of bed, the same time for lunch, the same time for exercise, the same time, if you can, to schedule the doctor's appointments, and the same time for dinner and bathing

Also, you want to focus on individuals that are hard to rouse in the morning. Different techniques that you can use are using the job that they had when they were in their prime. For instance, they are a machinist, they worked for a company where they make equipment, and you need to tell them, "OK dad. It's time to go to work. Don't forget that you have a lot of business to do today, and it's time for you to go to work. We're going to have breakfast before you're ready. Don't be late." And so that can arouse them and get them out of bed.

So, appeal to the prime of their life. If they were a homemaker, and they had young children, you could say to a mother, an older woman, "Don't forget the grandchildren are coming this morning. You really need to take care of them. I need you to get out of bed. They're coming any minute now." Appeal to the things that help them get out of bed.

Sally Smith: I love your approach of just go with the dream. I mean, just go with the fact they're still on their way to work, they've still got the babies. I mean, why not? It'd make them so happy, instead of all this, "Well, you know, that isn't true in your life anymore. You need to get up. Come on." I like that approach very much.

Well, if you were a caregiver of someone who did have sleep disturbances and night wanderings, obviously, you would be a little uptight wondering what was going on while you were asleep at night, wondering if you might miss some escape, or miss some wandering that could be detrimental. I believe you mentioned something at one time, something like a baby monitor can be good. How would these things help a caregiver relax and be able to get a night's sleep?

Rhonda Weichsel: Well, first of all, let's go back to locking the doors. That's very important, that you not have your loved one leaving the home while you're asleep in your own bedroom. But the other thing that's very beneficial is to have a baby monitor. It can pick up so many noises - the door opening, the individual getting out of bed. But also they have monitors that actually show the person. You can install those very inexpensively in the bedroom or a particular room in the house, and you can see and hear what your loved one's doing at night, and it shows them very clearly.
Sally Smith: I understand that in some cases, you could even take this monitor with you, and call back and speak to a patient that was at home, so that they felt that you were nearby, even though you might have had to run to the grocery or something.

Rhonda Weichsel: That's right. Actually, my mother has that. It's a baby monitor where she doesn't have to press a button, but my dad can press a button and speak to her, but he can hear her at all times.

Sally Smith: That's just amazing about modern technology. Do bed rails help keep night wanderers from wandering, or do they get agitated over the bed rails?

Rhonda Weichsel: Bed rails just prevent someone from falling out of bed. If someone really wants to get out of bed, they're going to get out, if they're mobile. Certainly, you'd never ever want to restrain anyone in their bed. That's an absolute no. So you definitely want to have their beds safe, perhaps against the wall so that they don't roll out of bed while they're trying to get up or when they're attempting to wander. But you certainly want to keep their bed safe and keep them near a wall.
Sally Smith: In a last-ditch effort to keep a loved one at home, if this wandering was really chronic and tearing the family apart, and unable to be dealt with, are there certain sleep chairs or things that like that that are harder to get out of, that would be, I don't mean that it would be restrain, more like a recliner that didn't really sit back up very easily? Are there stop-gap measures between bed and the nursing home where they have to be contained?

Rhonda Weichsel: If they're wanting to get out of bed, then they should get out of bed. Because if they need to urinate through the night, you don't want to compromise that. You want to keep their independence as much as possible in the safety of their own home. But there are no chairs. There are no beds that would restrain them from getting out of bed, and I don't suggest that.

Sally Smith: I see. So that's not a direction to go. I remember when my mother was doing a lot of night wandering and we began to put some Tylenol PM in her nightly little warm milk that she liked that would help her sleep, and we'd just have the sigh of relief. Now, I know it was just nothing but one little Tylenol PM, but since reading more about this topic, I realized that I should have felt guilty, because they say sedatives is really not a good way to go, that it complicates other medicines that people are having, and it can actually backfire and keep people up at night. What are your thoughts on that?

Rhonda Weichsel: Well, certainly, you want to check with the physician, because the patient may, or the loved one may be on certain medications, that it is contraindicative. A sleeping pill, or any kind of Benadryl, that kind of thing, that does induce sleep, you want to check with the doctor to make sure that there's no problem with that.

However, warm milk, whatever puts the person to sleep - if that's a dark room - make the setting, make the environment sleepable. Turn the lights down, pull the shades, if that Benadryl is what works for your family member, that's fine. Certainly don't overdo it. Use that as a last resort. But many people do that.

Sally Smith: Do dreams play a role in the fact that Alzheimer's patients wake up? Is it a sort of thing where they have more nightmares than normal people, or do dreams really not play into it?

Rhonda Weichsel: Dreams, actually, are decreased, from my understanding. However, people do have delusions and hallucinations, and that does seem to be increased for people with Alzheimer's and memory problems. Oftentimes, that again is a result of medications that they're taking. Different medications can make you dream more vivid dreams, and perhaps make you act out on them. But typically, the dream and the dream state, the REM, is decreased.

Sally Smith: Thank you so much, Rhonda, for being with us today to talk about sleep disturbances and night wandering. It was a real privilege to have you. I'd also like to thank my producer Betsy Reeves, web administrator Sujit Kara. Thank you to all of our listeners too for joining us today. We welcome your suggestions and invite your comments on our website. This is Sally Smith, Age to Age, saying goodbye and wishing you courage and joy on your journey. We are all connected.

Announcer: If you have any questions about the services or programs offered at the Medical University of South Carolina or you'd like to schedule an appointment with one of our physicians, please call MUSC Health Connection at 1-843-792-1414.

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