Dealing with Sleep Problems and Dementia

Dealing with Sleep Problems and Dementia

Sleep problems are common in patients diagnosed with Alzheimer’s disease and other dementias.

Lack of sleep can worsen the behavior and mindset of all people, not just those with dementia. Without adequate sleep, we all become more prone to emotional instability as well as physical illnesses. It is important to know what common causes to look for in your loved one. Being prepared and providing useful information to your doctor is incredibly helpful when assessing the root of the problem.
 
Here’s what to know about what can cause sleep problems, how they should be evaluated, proven approaches that help, and some information about commonly used medications.

Common Causes of Sleep Changes

It’s hard to manage a problem if you don’t understand the cause of it. Several factors can cause people with dementia to have sleep problems. Here are a few to keep in mind:

  1. Sleep changes with aging. Healthy aging adults do experience changes with their sleep as they age. Sleep becomes lighter and more fragmented, with less time spent in deep REM sleep. One study also estimated that starting in mid-life, total sleep time decreases by 28 minutes per decade. These changes are considered a normal part of aging. However, lighter sleep means it’s easier for aging adults to be awakened or disturbed by things such as arthritis pain at night or sleep-related disorders. Aging is also associated with a shift in the circadian rhythm, the body’s inner system for aligning itself with a 24-hour day. Many seniors find themselves tired earlier in the evening and tend to wake up earlier in the morning.
  2. Chronic medical conditions and medications often affect sleep. Studies have found that older adults often experience “secondary” sleep difficulties. Secondary sleep difficulties are sleep problems that may be the result from other underlying health issues. For example, many people diagnosed with Alzheimer’s have additional chronic health problems that may be associated with sleep difficulties. Treating underlying causes can drastically improve sleep. Common causes of secondary sleep problems include the following:
    • Heart and lung conditions, such as heart failure or chronic obstructive pulmonary disease.
    • Stomach-related conditions, such as gastroesophageal reflux disease.
    • Chronic pain from arthritis or another cause.
    • Urinary conditions that make people prone to urinating at night, such as an enlarged prostate or an overactive bladder.
    • Mood disorders, such as anxiety or depression.
    • Medication side effects and substances such as alcohol (which is known to disrupt sleep).
  3. Many sleep-related disorders become more frequent with aging. Common sleep-related disorders include sleep apnea and similar conditions known as sleep-related breathing disorders. These may affect 40-50% of seniors. Restless leg syndrome is another sleep disorder that is thought to be clinically significant in 2.5% of people.
  4. Alzheimer’s and other neurodegenerative diseases change sleep. The brain deterioration associated with various forms of dementia affects the brain’s ability to sleep. In most cases, this causes less time spent in deep sleep and more time spent awake at night. Problems with circadian rhythm system are also increasingly common among dementia patients. There is another disorder called REM sleep behavior disorder, which can cause violent movements during sleep and can even emerge before thinking problems become substantial. Lewy-body dementia and Parkinson’s are often associated with the REM sleep behavior disorder.

Most seniors develop lighter sleep as they age. In addition, many older adults have health problems that prompt nighttime awakenings. Sleep-related disorders, such as sleep apnea, are also common in aging. Seniors with Alzheimer’s and other dementias are likely to be affected by any of these factors that change sleep in older adults. It has also been shown that dementia brings on extra changes that make nighttime awakenings more frequent.

It’s not surprising that sleep problems are so common in people with dementia. Fortunately, there are many things than can be done to improve these circumstances for our loved ones.

How To Diagnose the Sleep Problems of Dementia

Like many problems that affect older adults, sleep problems in a person with dementia are almost always “multifactorial.” In other words, there are usually several underlying issues creating the problem.

Multifactorial problems can be identified, especially if a family and the doctors are diligently keeping an eye on as many contributing factors as possible. Working with the doctors will help them understand what kinds of sleep-related symptoms and problems a loved one is experiencing. The American Geriatrics Society recommends asking your loved one the following questions when evaluating their sleep problems:

  1. What time does your parent normally go to bed at night? What time do they normally wake up in the morning?
  2. Does your parent often have trouble falling asleep at night?
  3. About how many times does your parent wake up at night?
  4. If your parent wakes up at night, do they usually have trouble falling back asleep?
  5. Does your parent’s bed partner say, or are they aware, that your parent frequently snores, gasps for air, or stops breathing?
  6. Does your parent’s bed partner say, or are they aware, that your parent kicks or thrashes about while asleep?
  7. Is your parent aware that they ever walk, eat, punch, kick, or scream during sleep?
  8. Is your parent sleepy or tired during much of the day?
  9. Does your parent usually take one or more naps during the day?
  10. Does your parent usually doze off without planning to during the day?
  11. How much sleep does your parent need to feel alert and function well?
  12. Is your parent currently taking any type of medication or other preparation to them sleep?
  13. Does your parent have the urge to move their legs, or do they experience uncomfortable sensations in their legs during rest or at night?
  14. Does your parent have to get up often to urinate during the night?
  15. If your parent naps during the day, how often is the nap, and what is the duration?
  16. How much physical activity or exercise does your parent get on a daily basis?
  17. Is your parent exposed to natural outdoor light on most days?
  18. What medications does your parent take, and at what time of day or night are they taken?
  19. Does your parent suffer any uncomfortable side effects from their medications?
  20. How much caffeine (e.g. coffee, tea, cola) and alcohol does your parent consume each day/night?
  21. Does your parent often feel sad or anxious?
  22. Has your parent suffered any personal losses recently?

Family members may initially feel uncertain about how to answer these questions. So it is probably a good idea to prepare ahead of time so you can get the best help from your doctors on how to handle dementia and sleeping. It is advised that families keep a record of these questions for at least a week. Some families also may be able to use a sleep tracker to gather useful information.

Based on the information above, and after conducting an in-person examination to check for other medical issues, a doctor should be able to place the sleep difficulties in one or more of the following categories:

  1. Difficulty falling or staying asleep
  2. Excessive daytime sleepiness
  3. Abnormal breathing patterns during sleep
  4. Abnormal movements or behaviors during sleep

It may be necessary to have a sleep breathing study done to test for sleep apnea. Based on the category of the sleep problem and the underlying causes that have been identified, the doctor should then be able to propose a plan for improving sleep difficulties.

Medications and Sleep Problems in Dementia

You may be wondering whether medications can help manage sleep problems in dementia. It is important to first check current medications and make sure they are not negatively affecting a person’s sleep. For example, taking sedating medications during the day may cause an individual to sleep too much, resulting in more time spent awake at night. Additionally, a diuretic offered too late in the day might be causing excessive nighttime urination.

You may simply want to know, “Isn’t there a medication that can be taken in the evening to help my loved one sleep better at night?” Sleeping pills, sedatives, and tranquilizers are often prescribed to help keep people with dementia calmer at night. Antipsychotics prescribed may include, Olanzapine, Risperidal, and Quetiapine. Benzodiazepines include Lorazepam and Temazepam. There are prescription sleeping medications such as Zolpidem. Your doctor may even suggest trying over-the-counter sleep aids, which usually contain some form of sedating antihistamine.

Unfortunately, all these medications might cause some concerning side effects in people with dementia. Specifically, these medications may worsen cognition and increase the risk of falling. The antipsychotics have also been associated in some cases with a risk of early death. In addition, numerous scientific review articles state that in clinical trials, these drugs do not conclusively improve sleep. As such, experts in geriatrics recommend that these medications should generally be avoided and only used as a last resort once behavioral approaches (e.g., setting a routine, more walking, etc.) have been tried.

However, the medications listed below serve as a less-risky alternative:

Melatonin – Melatonin is a hormone involved in the sleep-wake cycle. A recent Scottish study found that two milligrams of melatonin per night improved the sleep of people with Alzheimer’s. However, in the U.S., melatonin is a poorly regulated supplement. U.S. studies have found that commercially sold supplements are often of questionable quality and purity, thusly, melatonin may work less reliably in the United States than in Europe.

Trazodone – Trazodone is an older, less-effective antidepressant that is mildly sedating. It has long been used by geriatricians as a “sleeping pill” of choice, as it seems to be less risky than the alternatives.

Although medications are often used to manage sleep problems in dementia, most of them are associated with high risks for serious side effects. It is advised to avoid sedatives until you’ve exhausted all other options. Non-drug approaches, such as plenty of outdoor light, regular exercise, a stable routine, optimizing chronic conditions, and checking for pain, often help. Plus, these approaches usually improve the person’s overall quality of life.

Dementia can cause sleep changes in your loved one. If you notice these changes, it is best to seek medical advice. A doctor may help to determine the cause of the problem as well as provide potential solutions.

Making the Move of Your Elderly Parent to Senior Living Easier

Making the Move of Your Elderly Parent to Senior Living Easier

Be it ever so humble, there’s no place like home. For most of us, the feeling is less about how large or fancy a residence is than about it being a place where we feel safe and where we have created countless memories of those closest to us. In addition, we fill our homes with things we enjoy and belongings that remind us of loved ones and good times.

Now, put yourself in your parent’s shoes. They’ve likely lived in the same home for several years, but they’re getting older and their needs are changing. Mom or Dad is having trouble getting around, need more help with activities of daily living (ADLs) and their social life probably has significantly declined. You know that a move to senior living would be wise, but you’re also well-aware of the many obstacles that lie ahead on that path. Before jumping right in, you may benefit from some soul-searching and think carefully about how you plan to maintain compassion, boundaries, and self-awareness throughout this transition process.

Broaching the Subject of Senior Living

How do you approach this difficult decision? Leaving the house behind will be difficult on your parent, but you also care about their health and safety. Talk it over with your spouse and siblings and check with friends or coworkers who may have already gone through this with their own parents. Consult a caregiver support group, staff at the senior living community you have in mind and any other resources that may be able to offer some good advice.

It’s usually best to bring up the subject with your parent when things aren’t going so smoothly at home. Aim for a day when there is perhaps something like a plumbing or other home maintenance problem or when the bill is due for lawn maintenance. It’ll give you an opportunity to casually move into the conversation rather than bringing it up out of the blue. Express your understanding of their desire to remain where they are but point out the importance of planning for the future and the benefits that come with moving. Don’t seek a major commitment right away, as it may appear you have already made the decision for them. Help your mom or dad feel that this matter is entirely in their control, and you’re just there for support.

Encouraging Tours of Senior Living

If possible, it’s highly recommended to accompany your parent on tours of a number of senior living communities. When looking at various apartments, you can discuss where to put items your parent wants to keep in order to make the transition more seamless. While not an easy task, try to focus on the future more than the past.

In conversation, try to emphasize the creation of a comfortable new living space that will accommodate your parents’ needs. It’s highly likely that your parent will want to pay homage to the past, so sharing ideas of how to incorporate as many of his/her favorite pieces of furniture and décor as possible in the new apartment will be beneficial. You know your loved one best, so follow their cues. If your parent embraces change, talk about purchasing a cozy new sofa or recliner for their new home in senior living. If they’re more rooted in their routine and prefer to stay within their comfort zone, emphasize how you can mimic the layout of their current living room or bedroom in their new apartment. It’s all about balancing interest in the future with respect for the past.

The Act of Downsizing and Moving

A senior’s biggest dread (after moving out of their house) is usually the actual process of moving from point A to point B. Moving is daunting to people of all ages. The idea of sorting through, packing up, moving, and unpacking everything we’ve collected over the years is overwhelming. For many seniors, downsizing is synonymous with purging. Collectors, those who hang on to sentimental items, depression-era savers and even hoarders are often immediately turned off by the possibility of having to rid themselves of everything but a few possessions.

Figuring out what to do with mementos and symbols that represent a life well-lived is a burdensome task for all involved. What to keep? What to get rid of? And how do we carry out the process with tact? Sometimes adult children are too close to the situation and can be too frank or even impatient with their parents when it comes to processing furniture, clothing, and other personal belongings. This can cause the whole process to grind to a halt.

Be respectful of your parent’s possessions even if you don’t understand why they value the things they do. The purging process is highly symbolic and very poignant for many seniors. They are essentially choosing what aspects of their past they are able to bring with them and which ones they must let go. Fortunately, there are professional senior movers who specialize in helping seniors declutter, downsize, and relocate. They can help take some of the pressure and emotional pain out of this aspect of the move for both you and your mom or dad.

Handling a Parent’s Indecision

Moving out of a home one has lived in for decades is often akin to experiencing and mourning a loss. The spectrum of emotions that is involved in agonizing over all the details, providing loving reassurance and then accepting a massive change in carefully laid plans is vast and unpleasant. It can be unbearably frustrating to go through this process only to backtrack and wait for an epiphany or a change in health to spur things along again. Meanwhile, worry about mom or dad’s wellbeing at home sets in again.

It’s much easier said than done but try to exercise patience as your parent vacillates between their living options. Offer a realistic picture of how much simpler it will be to navigate this transition earlier rather than later. However, understand that if they are of sound mind, they alone are responsible for deciding how and where to live. You may have to step back and bite your tongue until something changes.

Shouldn’t My Aging Parents Move In With Me?

The pressure to help a parent make the best possible senior living decision is complicated further by the nagging feeling many adult children have that our own homes should be an option. This is a highly individual decision that must factor in the needs of all affected parties (you, your parent, your spouse/partner, your children, your pets, etc.) Regardless of whether multigenerational living is a viable option, guilt abounds over even suggesting that a loved one move into assisted living or a nursing home.

Society insinuates that senior living is where elders go when they do not have any family or their relatives have “abandoned” them. The truth is that living with an aging parent is downright impossible for some families. Of those who try it, few find it to be a pleasant and successful long-term solution. Living together may delay the move to senior living, but it seldom prevents it entirely.

When a parent is no longer safe or engaged in their own home, caregivers are faced with difficult decisions and there’s no way around them. Increasing needs are an open declaration that a parent is aging. They must accept it and so must the adult child. The move itself is physical proof, and it is often a serious blow to the entire family. All we can do is respect one another and strive to give our parents a safe and caring home, regardless of where it is located.

In Time, We All Adjust

Aging is not easy on seniors or the people who care about them, but what must be done eventually gets done. We bring up the possibility of a move. We address the amount of help we will be able to provide. We stress that we are still there for support but that changes must be made. We do research, take tours, assist with packing, and do our best to be strong and help our loved ones acclimate. We adjust and eventually our parents adjust too. Many seniors are happier after they have settled into senior living, but that doesn’t make the process any less difficult.

There’s just no way to avoid this transition when it becomes necessary. Moving from a person’s own home to a care facility of any kind is emotional. Acknowledge your parent’s pain as well as your own. If you or your elder are struggling too much, consider seeking third party assistance. Often a close friend, a religious leader or a paid counselor can offer support and fresh ideas to assist you both in looking to the future rather than solely dwelling on the past.

Do Your Parents Have a Plan for Long-Term Care?

Do Your Parents Have a Plan for Long-Term Care?

It’s not easy to bring up the fact that the parents who have cared for you all your life may someday not be able to care for themselves. But it’s a reality nonetheless. Americans are living longer every year, and many will age beyond their ability to live independently.

Sadly, many older adults have trouble facing the changes and losses in ability that come with aging. While some seniors know their memories aren’t as good as they once were or that they’re no longer able to keep up with important responsibilities, others may lack awareness that things are slipping through the cracks.

Still, it’s not an easy topic to bring up—and many people aren’t doing so. According to a recent survey, only 45 percent of adult children have discussed with their aging parents what they plan to do when they can no longer care for themselves. And only 30 percent have discussed how their parents will pay for care as they age.

Then there’s the related issue of where your parents will live. For many seniors, their first choice is to remain in their home and age in place, but for many this isn’t a realistic option. The home may have safety issues, be too far away from needed services, or be too expensive and difficult to maintain. Yet, many families simply fail to talk about if and when aging parents should move out of their homes.

Other studies show that one in three adults over the age of 75 has enough cognitive impairment to mishandle or fail to take care of important financial issues. One misstep in an area like this can cost your parents dearly; failing to make mortgage payments or pay property taxes could result in the loss of their home, for example, while failing to take medications could lead to a heart attack or other serious health problem.

Falls are perhaps the biggest risk of all for older adults living on their own. Many common medications can cause dizziness as a side effect, increasing the likelihood of falling, and the weakness common to aging also leads to falls. If your parent lives alone she may take inappropriate risks, like climbing on a chair to change a light bulb—or she might simply forget to turn on a light at night. And once an older adult takes a fall, it can trigger a cascade of health consequences from which she may not fully recover.

Once you introduce the subject of a long-term care plan, don’t forget to discuss the cost of care as well. Bringing the subject up earlier rather than later increases the chance that long-term care insurance will be within reach. And care planning will greatly influence how your parents save and spend the resources—including real estate—they have available.

Think of it this way: The longer you wait to discuss your parents’ long-term care plan, the greater the chance that they’ll wind up living with you. Of course, for some people this is an excellent solution, and one that everyone’s happy with. But it’s not a decision you want to make because you have no other option.

When is the Right Time to Consider Moving to a Senior Living Community?

When is the Right Time to Consider Moving to a Senior Living Community?

Determining when you may want to consider moving to a senior living community is a very complicated decision process. Many people wait for a crisis to occur before considering such a move. Others are far more proactive and move before something happens.

Planning requires that you look ‘realistically’ into the crystal ball.

Try to imagine your life in 5 to 10 years from now. Looking in the crystal ball, you need to think about a scenario when you may not drive anymore or if your health starts to change, how will you manage? Try to create a mental image of what the situation will be like for a year if you or your spouse passes away or requires care. It is important that you are realistic, so you thoroughly think through this process.

Who’s going to change the light bulbs?

It’s human nature for people to elect to “stick it out” in their own homes. This then creates a tremendous burden on their family and friends. There is a great deal of loneliness and isolation that occurs and a level of vulnerability of abuse from outsiders. Access to services is limited, plus simple chores like driving to the grocery store or picking up your prescription medication becomes a major challenge. Home maintenance and repairs become major issues and the potential for exploitation from unscrupulous vendors can be problematic.

It is always better to be five years too early than five minutes too late.

Many senior living communities have medical acceptance criteria to be considered for residency. This is a very important factor to consider. People who wait for a crisis to occur or have progressive medical conditions often find out that the community or communities they were considering have no openings when they suddenly need to move.

If you are a couple, you need to look after each other and protect one another in case one of you requires care. More importantly, you need to make sure the healthy spouse has their future care plan in place. Unfortunately, many people fail to consider this scenario and the healthy spouse ends up in a dire situation (medically, socially, and financially) after the non-healthy spouse passes away.

Senior living communities are not nursing homes.

At the root of the timing question is the misconception that senior living communities are nursing homes and by moving to a retirement community, you will be losing your independence. Senior living communities offer a wide spectrum of services and amenities, including dining, social activities, fitness & wellness programs so residents can keep active and healthy longer.

Am I ready to consider a move to a retirement community?

Many folks that ultimately move to a senior community will say that prior to their move they were not ready. If you talk with them after they move however, nearly 100% will say that it was the best decision they ever made and wished they would have made it sooner.

So…when is the right time?

There are different time frames to consider. When to you want to start your research, when do you see yourself narrowing down your choices and when do you want to move? By doing your research early, you may find that community you are considering has a waiting list or is planning to expand, or is under construction.

If you have a long-term plan to move, try to figure out what needs to occur between now and this date in the future to make you ready.

Select, don’t settle.

By selecting a senior living community before your health changes, you can choose the place that best fits your needs and lifestyle. The longer you wait, the less selection you will have. If you are considering a new community, you often can pick your desired location and floor plan.

Bottom line? Don’t wait for something to occur. Plan for your tomorrows today!

Benefits of a Winter Move to Senior Living

Benefits of a Winter Move to Senior Living

Planning a move is a daunting task for everyone, especially older adults. This life adjustment takes plenty of planning and assistance to make it less stressful for everyone involved.

We tend to associate moving with warmer months, but sometimes a big move happens during the wintertime. If the opportunity to move to senior living occurs during the big chill, don’t fret. There are actually some advantages for moving in the cold.

A Chance to Get the Family Involved

The winter months are filled with holidays and cheer, bringing families together for plenty of celebrations. This is the perfect opportunity to help your senior loved one pack up their belongings and move into a community like The Classic at Hillcrest Greens.

Wisconsin winters can be brutal and filled with cold air, snow and ice, which makes the added assistance from family all the more helpful. Extra hands also remove the burden from family members who may otherwise be tasked with taking care of a big move by themselves.

Plan Your Move Around the Weather Forecast

Not all predictions are accurate, but it’s still important to pay close attention to the weather forecast. If the local meteorologist calls for a major snowstorm, try to plan your senior loved one’s move on a different day.

Hire a Senior-Friendly Moving Service

Any move is easier with the help of professionals, especially during the wintertime. Caregivers benefit from reduced stress if they hire a professional service that specializes in moving seniors. Moving services vary from assisting with the transfer of large items to packing up older adults belongings and moving precious goods into their new homes.

Winter is a Good Time for Sellers

If a component of your loved one’s move is the sale of a home, the winter months are actually a great time to sell. Homes listed in the winter have nearly a 10 percent greater likelihood of selling. And…given that the current home sales market continues to favor sellers, your chance of getting the price you are seeking remains high.

Winter is Lonely

Winter tends to be a lonely time, especially if an older adult lives alone. Moving to a senior living community like The Classic gives seniors an opportunity to mingle with neighbors and participate in planned activities. The community atmosphere is a great opportunity for older adults to expand their social skills and make new friends.

While winter weather brings its own challenges, it is a time of year that also brings its advantages when it comes to moving your senior loved one into a senior living community.