Dementia and Sleep

Alzheimer's disease and senile dementia are characterized by frequent sleep disturbance, both for those diagnosed and their caregivers. In fact, many caregivers cite sleep disturbances, including night wandering and confusion, as the reason for institutionalizing the elderly. Once institutionalized, these elderly residents' sleep disturbances don't cease. Two-thirds of those in long-term care facilities suffer from sleeping problems. While tranquilizing drugs may be the drugs of choice at many institutions, these drugs can further confusion and increase the risk of falls. Monoaminergic drug therapies, such as modafinil, are under investigation and may improve behavior along with sleep disturbances in these patients. Other categories of medication - including neuroleptics, benzodiazepines, antidepressants, anticonvulsants, and beta blockers -have shown positive effects in some cases.

Sleep problems should be evaluated in all patients. Depression may be mistaken for dementia, as may the effects of certain medications, malnutrition and alcohol abuse. Many elderly patients suffer from undiagnosed apnea, drug interactions and excessive drug use or dependence. In fact, the elderly use both prescription and over-the-counter medications far in excess of their proportion of the population. Alcohol interacts with many of these drugs. It also may exacerbate dementias not caused by alcohol abuse.

Some experts advise elderly people to have no more than one alcoholic drink per day, even if they are taking no drugs and have no medical contraindications. That drink should not be taken before bedtime.