Research shows that brain health is promoted by maintaining good sleep practices.

Our thanks to Dr Rosie Gibson from Massey University for her help with this month's topic. 
 

Sleep and wellbeing
  • We spend around a third of our lives asleep!
  • Sleep is a key pillar of health and well-being.  
  • Research has identified many important functions of sleep for our physical and mental health. For example, sleep is important for digestion and metabolism of food, emotional processing, and for learning.
  • Different dimensions of sleep play a role in maintaining wellbeing.  These include: 
  • Sleep duration (the total amount of sleep obtained per 24 hours)
  • Timing (the placement of sleep within the day)Alertness/sleepiness (our ability to maintain attentive wakefulness); and
  • Satisfaction/Quality (our subjective assessment of our sleep as “good” or “poor”). 
  • We move through different stages or depths of sleep which work together to support our wellbeing.  For example, deep “slow wave” sleep is important for growth and restoration, while “rapid eye movement” sleep is important for consolidating our memories.
  • During sleep brain a rhythmic “washing” of the brain occurs which helps remove unnecessary toxins as well as consolidating useful neural connections.  
Sleep problems and age

  • 20-30% of older New Zealanders report a sleep problem.

  • Experiencing brief periods of problematic sleep is normal but if sleep is chronically disrupted this can impact our health, including raising our risk of cognitive impairment.  For example, long lasting insomnia is associated with anxiety, depression, and impaired attention and memory.  Sleep disordered breathing has been associated with cognitive impairment.    

  • As we get older, sleep typically becomes lighter and more fragmented.  Some of us also experience early morning awakenings, increased need to use the toilet overnight, and increased daytime sleepiness.  To some extent, this is all normal and may not be associated with significant costs to our health.

  • Clinical sleep disorders also become more common with ageing.  These include insomnia (trouble getting to or staying asleep), obstructive sleep apnoea (characterised by loud snoring, pauses in breathing and daytime sleepiness), and restless legs syndrome (an urge to move due to discomfort in the legs when we try to go to sleep).

  • These more problematic sleep changes with ageing have been related to several factors:

    • Physiological deterioration of our internal “body clock” changes our sleep/wake timing and interferes with smooth transitions between sleep stages.
    • Other health conditions, for example, cardiovascular disease, obesity and diabetes have strong links with sleep disordered breathing, and pain and anxiety can lead to insomnia. 
    • Lifestyle changes, for example, changed routines and responsibilities due to retirement, grandparenting, providing care for our partner, or moving into residential care.
    • Access to cues for our “body clock” can be altered, including access to natural light, physical activity, and social engagement.
       
Sleep problems amongst people living with dementia
  • Sleep disturbances are more commonly experienced by people with dementia than in healthy ageing.
  • Damaged functioning of the internal “body clock” system has been identified in the early stages of dementia, particularly when it is due to Alzheimer’s disease. This means people with dementia may be more susceptible to being awake at night and falling asleep in the day.
  • People with dementia are more likely to experience agitation or confusion in the early evening as well as waking up feeling confused or seemingly automatic behaviours in the night.
  • Some of the medications used to enhance memory and brain power can have negative side effects on sleep, for example increased wakefulness at night and nightmares
  • Sometimes the ability to maintain regular routines and manage usual environmental cues for sleeping and waking is affected by dementia, exacerbating sleep disturbances and impairing the ability to be wide awake when appropriate.
  • Sometimes dementia causes changes in movements while people sleep, especially “REM Sleep Behaviour Disorder” in dementia illnesses associated with Parkinson’s symptoms.  This can lead to injury or disturbing other sleepers.
  • Those of us who support someone with dementia at home often experience sleep disturbances too.  This is because we have our own factors potential affecting sleep as we age, new caregiving responsibilities and concerns which can be physically and mentally tiring, increased awakenings at night if the person we support care is waking, and less opportunity to rest in the day if there is a lack of respite.
     
Maintaining good sleep practices
  • Strengthen the internal body clock by keeping a regular routine across the week and across each day,  spend some of the daytime in bright light, and exercise regularly. 
  • Avoid eating or drinking too much before bed to reduce likelihood of indigestion or toileting disrupting sleep .
  • Avoid alcohol too close bed as this can disrupt the quality of sleep, even if it seems to help with falling asleep at the start of the night.
  • Have a relaxing pre-sleep routine to help the mind and body to relax.
  • Keep the bedroom a “safe sleep zone”, for example: 
    • appropriate lighting for sleep and safety 
    • block out disturbing noise, but consider gentle music or something relaxing
    • avoid watching TV or using brightly lit devices in bed 
    • make the bed nice and comfortable 
    • keep the temperature suitable for sleep
    • reserve the bed for sleep, relaxing lie-ins, and sexual intimacy, not for work or other activities
  • Consider how the routines and sleep of anyone you share your bed or bedroom with may impact on your sleep, and vice versa.
  • Make a plan for what you will do if you cannot fall asleep.  Rather than watch the clock or lie in bed frustrated, try getting out of bed, spend a little time in another room doing a relaxing activity, then go back to bed. 
  • Consult your doctor if you have a long-lasting sleep problem, feel excessively sleepy in the day, or think you have heavy snoring or trouble with your breathing while sleeping.  A doctor can advise and refer you to your local sleep clinic if necessary.
  • Some people use medication to resolve insomnia.  Although these may be useful for a short period, their success rate is very varied and side effects can outweigh the benefits.  Please consult your doctor before using. 
Supporting good sleep for people living with dementia

In addition to the tips above, for people living with dementia:

  • Helping to create a peaceful setting for sleep might involve reading aloud, soothing music, or a back rub.
  • Rituals and routines can be especially helpful.
  • A little snack and a warm uncaffinated drink can be useful to avoid waking up hungry and to help settle (but not overeating).
  • If the person living with dementia wakes up gently remind them that it is nighttime. Check for unmet needs such as being too cold or needing to go to the bathroom. It may be useful to restart the bedtime rituals to help them settle.
  • Remember that underlying conditions such as pain, low mood, or a urinary tract infection can impact on the sleep of someone living with dementia. A change in sleep may not always be due to "the dementia".
  • It may be helpful to adapt aspects of the environment for some people, for example removing shadows and mirrors that may be disturbing or providing a floor level nightlight. 
  • Think about providing cues that it is nighttime, such as not having daytime clothes in sight, having a dementia friendly clock that shows whether it is day or night, or some facilities even have their staff in pyjamas for the overnight shift!
  • It's not necessary to cut out napping altogether but it is often useful to have naps at the same time for a relatively short period of time. 
  • Consider scheduling activities that take more energy earlier in the day.
  • The Australian Sleep Health Foundation has many resources on sleep and dementia:
    www.sleephealthfoundation.org.au/fact-sheets/dementia-resources.html