Disturbed sleep in Alzheimer’s not helped by medication

Medical Tribune June 2008 P1

David Brill

Sleep medications are not necessarily beneficial for Alzheimer’s disease (AD) patients, a study has shown.

Researchers from the University of Washington found that AD patients who used medications were six times more likely to experience poor sleep than those who did not.

Moreover patient medication use was associated with situations where their coresident family caregiver was also sleeping poorly, suggesting that the use of such therapies may not benefit either party.

Dr. Joshua Kua, deputy chief of the department of geriatric psychiatry at the Institute of Mental Health, Singapore, advised physicians who are dealing with AD patients to carefully assess all of the factors that might contribute to sleep disturbances before deciding on the appropriate treatment.

“Medication itself may not always be the solution or the panacea to sleep problems for a person with dementia or their caregiver. Try to think about a nonpharmacological approach first, rather than dishing out medication,” he said, adding that medication use can also worsen cognition levels and increase the risk of falls and fractures.

The researchers also found that patient depression is a significant predictor of poor sleep for both patients and caregivers. This is a factor that doctors need to be aware of when dealing with AD patients in future, according to Kua.

“Someone who is (suffering from dementia may not) be able to verbalize their feelings so the need to recognize depression – especially in advanced disease where language may be impaired – is very important. It’s something that we often miss, particularly in the primary care setting,” he said.

Sleep disturbances in dementia patients can place stress upon co-habiting caregivers, leading to tiredness and frustration. These feelings can increase the risk of the patient being institutionalized and in some cases may lead to elder abuse, according to Kua.

Dr. Lim Li Ling, medical director of the Singapore Neurology and Sleep Centre, added that a lack of sleep can lead to a further decline in cognitive function among dementia patients.

“Caregivers should know the importance of good quality and adequate sleep for both themselves and their charges,” she said.

Lim advised caregivers to develop regular sleep-wake schedules, avoid stimulants such as coffee or tea in the evenings, and to get regular exercise where possible. She added that patients should be given adequate daytime exposure to light in order to regulate their circadian clocks, and be kept occupied during the day in order to avoid excessive napping.

The study, published in the journal Sleep, comprised 44 patient-caregiver pairings whose sleep patterns were monitored over 1 week using wrist movement recorders. Other outcomes were assessed using a variety of tests, including the Cornell Scale for Depression in Dementia and the Dementia Management Strategies Scale.

Acknowledging the small size of the study, the researchers reported that larger scale investigations have already been initiated in order to better understand the factors that contribute to sleep disturbances in AD.

“Identifying common patterns and causes of sleep disturbances would … improve quality of life and overall physical and emotional wellbeing of both patients and caregivers,” added Lim.