Geriatrician Questions Alzheimer's Disease

Sleep problems and Alzheimer's

My mother has Alzheimer's (mild to moderate). I am her main caregiver. She is not sleeping well. How can I best help her?

16 Answers

Insomnia common with Alzheimers and can make the situation worse. Usually the insomnia is early morning awakening rather than delayed falling asleep. Sleeping pills can make the confusion worse and then the insomnia worse. Often allowing a day time nap helps. In addition, Melatonin for sleep when she wakes up in the middle of the night may help. It lasts about 4 hours. Would start there.
Make sure she's not napping too much during the day.
Good question. I am glad you asked. We should make her environment comfortable and recognizable to her (even though she has dementia). Place objects that she is familiar with around her. Let's not look for medications right away...​
Sleep disorders are often caused by Alzheimer's disease. The details of how your mother is having sleep issues, along with her other medical problems, and how the diagnosis of Alzheimer's was reached, have to be considered to advise you how to help her sleep better. =20

Sleep disorder is common in patients with Alzheimer's disease. Sometimes, a small change in the medication can help. Sometimes we may have to add a different medication to help with the sleep
Sleep in patients with Alzheimer's can be challenging. First step is to develop good sleep hygiene. Regulate the light using dark curtains and day lamps. Keeping familiar items at the bedside can be helpful. First I would try things like melatonin. 3-10mg of synthetic can be helpful. If medicines are needed, trazadone and low doses of seroquel are good choice. Avoid sedatives and medications like ambien if able.
You can try Melatonin, this is over-the-counter, if that doesn't work, you need to see your primary physician for probably starting trazodone or mirtazapine??
My answer does not substitute for a proper medical evaluation. Without
addressing the specifics of your mother's medical problems or rendering a
medical opinion, the most straightforward way to proceed is seek help from
a sleep specialist. People with Alzheimer's do suffer from sleep
disturbances and this would need to be evaluated by a healthcare
professional. This work up would likely include a sleep study. She would
likely benefit from a sleep center based sleep study as opposed to a home
sleep study, based on her Alzheimer's diagnosis.

This must be so hard on both of you. Things that don't require her doctor would be trying to keep her more active during the day (so she's more tired at night). Sometimes that requires hiring outside help like home PT or getting her to an adult day care setting so she's engaged if you need to work. Otherwise for medications you would need to consult her doctor as the meds for sleep all have risks. The only safe OTC option would be melatonin 3 to 5mg in evening. DO NOT give her benadryl!
avoid napping during the day , avoid coffee or any tea that has cafein ,go to bed after 10:00 pm incrise her activities during the day
Contact Dr. Marcel Hungs, Neurological Associates of St. Paul @ 651-221-9051
Sleeping hygiene is the first step, keep awake during the day, avoid caffeine, sleep in a dark room, no noise, going to the bed from 10-6 am, etc. If she can walk and so, exercises also can help, if those tips don't work, you can try melatonin, trazodone, but again need to do full work up to r/out depression mainly.
Sleep disturbances are common for people with cognitive impairment and they are challenging. Physical activity is important in general and may help with sleep. I would also try melatonin at bedtime. Soothing music may be helpful. When simple things fail, we come to discussions of prescription medications. No medication is completely without side effects or risks, so discussions need to inform family members of these. Family involvement is very important in these decisions. Trazadone is often my first choice when medications are needed. Medications have to be tried cautiously and changes made if adverse effects occur.
Do not use over the counter sleep agents. They tend to make memory and confusion worse. Talk to your doctor if Seroquel may be appropriate for her at this stage of AD
I’m sorry to hear about your mother. It is often the case that people with Alzheimer’s have insomnia. Many physicians tend to prescribe sleep medications under the category of what we call benzodiazepines. These may include Ativan, Valium and many more. The problem with these medications is that they can exacerbate Alzheimer’s, especially with the elderly.

Psychology, sleep hygiene is key. Another suggestion would be a medication called trazadone. I would suggest you inquire about the options with the physician overseeing your mother's care and stay away from any medications in the benzodiazepine family. You can find out what these medications are by doing a simple google search.

Some other advice I would give is to take care of yourself as well. All to often we see burnout from caregivers.

I hope this helps.
Your mom needs to be outside exposed to normal daylight daily, minimum 30-60 min, addition of Melatonin and Sleepy-time tea also helps. Few other natural remedies can be given by knowledgeable functional/holistic physician. If this is not enough, your doctor can prescribe sleeping medications, some of them are not addictive and effective, like Trazodone and several more.