June 15, 2005
Education about good sleep habits, moderate exercise, and exposure to sunlight helped ease sleep problems in people with Alzheimer's disease, a new study reports. The findings suggest that a few simple lifestyle measures could help to ease poor sleep and related problems in those with Alzheimer's and ease the burden of caring for those with the illness.
Insomnia and daytime drowsiness is a common problem in many older adults, particularly those with Alzheimer's disease. Studies indicate that up to 44 percent of those with Alzheimer's suffer from sleep problems, which can contribute to physical deterioration and mood problems like depression. For family members who care for those with the disease, being awakened at night by loved ones who exhibit behaviors such as wandering, getting out of bed repeatedly, and talking in bed can be trying and make care even more difficult.
Sleep medicines are often prescribed, but they may have limited benefits. Doctors have therefore looked to behavioral and lifestyle strategies to boost the benefits of medications. Studies of Alzheimer's sufferers who live in nursing homes have shown that light physical exercise and good sleep habits, such as keeping patients out of bed during the day and providing care for incontinence during the night, made for a better night's sleep. Other measures, such as structured social and physical activities during the day or the use of bright light machines that simulate sunlight exposure have also helped to ease insomnia and troubled sleep for those in nursing homes.
In the current study, researchers from the University of Washington in Seattle tested these techniques in 36 people with Alzheimer's disease who were being cared for at home by a spouse or other family members. Skilled sleep educators trained all the people involved in the study on good sleep hygiene. Half of the caregivers also received specific instructions on a program called Nighttime Insomnia Treatment and Education for Alzheimer's Disease, or NITE-AD, specially tailored for those with dementia.
The NITE-AD program teaches caregivers about good sleep practices and behavior management skills. The program also enlists caregivers to see that those with Alzheimer's get more physical activity in the form of daily walks as well as increased exposure to light during the day. Specific measures to promote sound sleep with the NITE-AD program includes such steps as:
1. Caregivers are told to write down the times when those with Alzheimer's went to bed and arose each day. They are then instructed not to deviate more than 30 minutes from the customary times.
2. Triggers that might awaken patients at night are identified, such as snoring by a bed partner, rowdy pets, or traffic noise. Strategies are then developed to eliminate such triggers.
3. Caregivers are instructed not to let those with Alzheimer's nap after 1 o'clock in the afternoon and to limit naps to 30 minutes or less. They are also encouraged to engage patients in favored activities during the day to help keep them awake.
4. People with Alzheimer's are instructed to take daily walks, ideally for 30 minutes and preferably outdoors (weather permitting). Frail patients can take shorter walks or slowly build up to longer walks. Caregivers are given instructions on walking safety, including accompanying patients on walks.
5. Daily light exposure is increased by one hour a day via a device called a "light box" that emits fluorescent light that simulates natural sunshine. (The SunRay light box used in the current study came from the SunBox company in Gaithersburg, MD.) Light exposure is generally set for around 3 hours before a patient's bedtime. During light box sessions, those with Alzheimer's are free to eat, talk, play games, or watch TV.
6. During sleep times, light levels are reduced. For instance, dimmer bathroom bulbs are used, or heavy shades are put in place to block outside lights.
During the study, caregivers kept daily logs and helped those with Alzheimer's adhere to the new routine as closely as possible. Regular follow-up tests were done at the start of the study, then again after two months and six months. Caregivers and those with Alzheimer's were asked in detail about sleep patterns and behavior. Patients also wore a wrist monitor to measure levels of sleep and wakefulness.
Those who received the NITE-AD woke up fewer times during the nightan average of 5.3 fewer times. They also spent more of the night asleep, sleeping an extra 36 minutes, on average. In addition, those with Alzheimer's who had the NITE-AD program had less daytime drowsiness, and they tended to show fewer signs of depression. Benefits became even more apparent after six months.
The study highlights the ways in which good sleep hygiene may promote sound sleep in those with Alzheimer's disease. Caregivers can discuss ways to treat sleep problems in Alzheimer's with their doctor and other health professionals and should not start this program before talking to their doctor. For more tips on caring for the person with Alzheimer's disease, www.ALZinfo.org.
Susan M. McCurry, PhD; Laura E. Gibbons, PhD; Rebecca G. Logsdon, PhD; Michael V. Vitiello, PhD; Linda Teri, PhD: "Nighttime Insomnia Treatment and Education for Alzheimer's Disease: A Randomized, Controlled Trial." Journal of the American Geriatrics Society, 53 (5): May 2005, Pages 793-802.