Alzheimer’s and Sleep: A Guide to Better Sleep

According to the Alzheimer’s Association, nearly 5.8 million Americans are living with Alzheimer’s disease (AD), and it’s the 6th leading cause of death in the United States. Alzheimer’s disease impacts all facets of your day-to-day, including your sleep— and those with Alzheimer’s, or those caring for a person with AD, know a lack of sleep only exacerbates the symptoms of this disease.

In this article, we discuss what Alzheimer’s disease is, its relationship with sleep, and how you can help a loved one with Alzheimer’s get better rest.

What is Alzheimer’s Disease?

The National Institute on Aging defines Alzheimer’s disease as “an irreversible, progressive brain disorder that slowly destroys memory and thinking skills and, eventually, the ability to carry out the simplest tasks.”

More often than not, symptoms of Alzheimer’s don’t begin to appear until you’re in your 60’s; however, early-onset Alzheimer’s can afflict those as young as 30 years old. The first and most recognizable symptom of Alzheimer’s is memory loss, but amyloid plaques can begin to grow 10 to 15 years before your cognitive functioning is impacted. As the disease progresses, symptoms can include language troubles, visual and spatial issues, disorientation, impaired reasoning, and unpredictable behavior.

Alzheimer’s disease is characterized by two things: the presence of amyloid plaques and tau tangles in the brain, and a loss of connections between neurons in the brain.

According to the National Institute of Health, beta-amyloid is a metabolic waste product found in the fluid between brain cells. During sleep, your brain’s cleaning and restorative processes wipe this beta-amyloid waste away to keep your mind sharp— as a build-up of this amyloid waste product is linked to poor memory and brain function.

In people with Alzheimer’s, beta-amyloid clumps together and forms amyloid plaques, and these amyloid plaques inhibit your cognitive abilities. For this reason, researchers of AD believe chronic sleep deprivation puts you at risk of developing the common disease, and they expect cases of Alzheimer’s to rise to 14 million by 2050.

Amyloid plaques typically affect the hippocampus first, before moving onto other regions of the brain. The hippocampus is responsible for processing and storing new information as well as maintaining memories. When the hippocampus is damaged, you retain and remember less. As Alzheimer’s damage spreads, it causes neurons to die and brain tissue to shrink, resulting in irreversible deterioration.

Tau tangles are associated with a lack of deep sleep, as recent studies have shown those who consistently get less than the recommended amount of NREM sleep have higher levels of the brain protein tau. Tau plaques hinder the consolidation of new memories, contributing to the symptoms of Alzheimer’s. Plus, Stage 3 of NREM, otherwise known as the deep sleep stage, is when slow delta brain waves occur; these slow delta waves process and store new information. Therefore, a lack of deep sleep and an increase in tau tangles work in tandem to limit your cognitive abilities and memory.

Alzheimer’s can be managed, and catching AD early allows you to take the proper measures to delay the growth of amyloid plaques and keep your brain sharp. However, there is no known cure for AD, and researchers have not yet found a way to stop the growth of these harmful plaques altogether.

7 Stages of Alzheimer’s

Alzheimer’s impacts everybody in different ways; some individuals’ cognitive functioning can deteriorate rather quickly, while others can take years to show signs of significant mental decline.

We mentioned earlier that AD is the 6th leading cause of death in the United States. While that’s true amongst the entire population, Alzheimer’s is actually the third leading cause of death amongst older demographics. The disease can take as little as a few months to as long as a decade to become fatal.

Below, we list the seven stages of Alzheimer’s to help you have a better understanding of how the disease progresses.

Stage 1: No Impairment

During the first stage of AD, there are no noticeable symptoms. At this time, amyloid and tau protein plaques continue to accumulate and deteriorate the connection between neurons.

Stage 2: Very Mild Decline

At this point, memory loss is not apparent to outsiders, but those with AD may notice themselves easily distracted or continually misplacing things around the house. If given a memory test, those with Stage 2 of AD would likely have similar results as somebody without AD.

Stage 3: Mild Decline

Stage 3 of AD is when memory loss becomes more apparent, and this is the time many family members begin to catch onto their loved one’s declining cognitive abilities. People with Stage 3 AD often misplace things and have trouble remembering aspects of their daily life.

You may notice in conversation with someone with Stage 3 AD that they’ll repeat themselves, bring the conversation back around to a topic already covered, have trouble finding the “right” word, and misremember the names of newer acquaintances or details of recent experiences.

Stage 4: Moderate Decline

Stage 4 of Alzheimer’s disease is when symptoms begin to impede your functioning severely. At this stage, it can be challenging to complete simple math equations and perform necessary day-to-day tasks, such as paying the bills or washing the dishes.

Those with Stage 4 AD may forget important details from their past or misremember entire events. Even more challenging? Stage 4 is when short-term memory begins to suffer, and some individuals with Stage 4 AD are unable to remember something that happened only hours prior.

Stage 5: Moderately Severe Decline

During Stage 5, those with AD will begin to need help completing simple tasks such as getting dressed, but they still maintain enough functionality to bathe and use the restroom on their own.  Many people experience significant confusion with Stage 5 of Alzheimer’s and may not be able to recall simple facts or details about their life. At this point, those with Alzheimer’s will still recognize family members and be able to remember stories from their childhood, but more recent memories may be harder to gather.

Stage 6: Severe Decline

Those with Stage 6 Alzheimer’s need constant supervision and care. Oftentimes professional care is needed, and those with Stage 6 AD will have in-home caregivers or be relocated to a nursing home to receive the proper care.

Individuals with Stage 6 AD often experience:

• Confusion about their surroundings or environment
• Major personality changes and shifts
• Loss of control over bodily functions
• The inability to recognize close family members and friends
• The inability to recall details about one’s past

During Stage 6, those with AD will need assistance performing simple tasks such as eating and going to the bathroom. The increased confusion and unawareness during this stage can lead to those with AD getting easily agitated and depressed. If a patient with Stage 6 AD is not confined to their bed, they may get up and wander, which puts both the patient and others at risk.

Stage 7: Very Severe Decline

Alzheimer’s is a terminal illness, and Stage 7 is the final stage of AD. During this stage, people with AD are nearing death— many lose the ability to respond to their surroundings, speak words, and even swallow. They need assistance with all aspects of living, and caregivers and family members take the best measures to ensure comfort during this difficult time.

Risk Factors for Alzheimer’s

There is no single cause of Alzheimer’s, and risk factors vary. Researchers believe Alzheimer’s stems from several factors, so it can be hard to pinpoint exactly why you may or may not have developed the disease. While age and genetics play a role, there are many lifestyle and environmental factors that can contribute, as well.

Age

There are two types of Alzheimer’s: Familial Alzheimer’s disease (FAD), sometimes referred to as early-onset Alzheimer’s, and Sporadic Alzheimer’s disease. As its name implies, FAD is a form of AD inherited within families, and it can be developed at any age. FAD is very rare and accounts for less than 5 percent of Alzheimer’s cases. The more common type of AD, Sporadic Alzheimer’s, is linked to older age.

Those 65 and older have an increased chance of developing the disease, and your risk doubles every five years after. According to the Alzheimer’s Association, 1 in 9 people over 65 and 1 in 3 individuals over 85 have AD.

Genetics

Recent research has uncovered two categories of genes related to the development of Alzheimer’s: risk genes and deterministic genes. Risk genes are genes that put you at risk of AD, and deterministic genes directly cause the disease. Deterministic genes cause less than 1 percent of Alzheimer’s cases.

If you’re related to somebody who has Alzheimer’s, you may have one or several of the risk genes associated with AD. The most significant risk gene associated with AD is APOE-e4— one of the three common forms of the APOE gene. APOE-e2 and APOE-e3 are the other APOE genes; APOE-e3 is the most common and plays a neutral role in the development of AD, while APOE-e2 is not as common and is associated with a lower risk of Alzheimer’s.

We inherit our APOE genes from our parents. If a person inherits one APOE-e4 gene, they are at some risk of developing AD; but inheriting two APOE-e4 genes doesn’t necessarily mean you’re bound to develop the disease, it just means your risk is higher.

If you have a family history of Alzheimer’s, we suggest talking with a doctor or genetic counselor about your risk of developing AD. A physician or genetic counselor can recommend memory screenings and offer the best advice for delaying the (possible) development of Alzheimer’s.

Poor Heart Health

Heart disease, diabetes, stroke, high blood pressure, and high cholesterol all contribute to your chances of developing Alzheimer’s. Your heart is responsible for pumping blood to the rest of your body, and poor heart health impacts the health of your other organs, including your brain. Research studies have found amyloid plaques and tau tangles are more likely to develop and result in AD symptoms if the blood vessels in the brain are damaged.

Obesity and Sedentary Lifestyle

When researching the link between heart health and Alzheimer’s, researchers found that merely obesity and a lack of exercise can increase your chances of developing the disease, too. A BMI over 30 nearly triples your risk of Alzheimer’s, while squeezing in two workouts a week decreases your risk.

Regular exercise does more than just lower your chances of Alzheimer’s, it contributes to an overall healthy lifestyle. Keeping your body active helps you sleep better at night and feel better during your day-to-day.

Head Trauma and Lack of Mental Activity

Severe head injuries and concussions can increase your chance of developing AD since they take a toll on your brain’s health and functioning. Of course, the severity and time of injury matter, as well. A concussion in your adolescence should not impact your brain health decades down the line; however, getting a concussion in your 50s or 60s can contribute to the development of AD.

A lack of mental activity can not only impair your cognitive functioning in general, but it can lead to the development of amyloid and tau protein plaques. Keeping your mind sharp strengthens the connections between neurons and prevents deterioration. Using your brain in a new way every day is an easy way to improve your mind’s health and avoid dementias like AD. Memory loss is somewhat typical in older populations, but regularly using your brain can help prevent that altogether.

If you don’t feel like you’re exercising your mind enough, try taking up an instrument, playing a board game, completing a puzzle, reading, or finding a hobby that interests you. Both mental and physical activity is pertinent in keeping your cognitive functioning on par.

Poor Diet

A diet rich in fruits and vegetables positively influences both your mental and physical health. Replacing a bag of chips with an apple is not only better for your heart, but the vitamins and minerals you receive from fruit contribute to a healthy brain. A balanced diet helps you sleep better at night, which decreases your chances of AD, as well.

If you tend to avoid leafy greens and nutritious fruits, we recommend talking with your doctor about ways to incorporate more healthy foods such as fish, legumes, and vegetables into your day-to-day.

Sleep Troubles

In recent years, researchers have been studying the connection between Alzheimer’s and sleep. While it’s already been established that Alzheimer’s can cause sleep troubles, studies are now finding that consistently getting poor sleep throughout your life can lead to Alzheimer’s, too.

During sleep, our brain cleans and restores itself for a day ahead; part of that process is clearing out beta-amyloid waste and tau proteins. If we don’t get enough deep sleep, our brains cannot fully refresh themselves, resulting in a build-up of these plaques. Since Alzheimer’s is characterized by the presence of amyloid and tau protein plaques, it’s become evident to researchers that getting enough sleep is critical in avoiding or delaying Alzheimer’s.

What is the Relationship Between Sleep and Alzheimer’s?

The relationship between Alzheimer’s and sleep is complex; research concludes poor sleep can lead to Alzheimer’s, and AD symptoms can make getting adequate sleep tough. Many individuals with Alzheimer’s report frequent sleep troubles such as the inability to fall asleep and regularly waking throughout the night.

“Several major scientific and medical organizations have recognized that getting 7-8 hours of sleep is recommended for most adults,” says Dr. Michael Grandner, Director of the Sleep and Health Research Program at the University of Arizona. “Getting enough sleep is important to protect brain health, maintain healthy cognitive function, and manage risk for cardiovascular disease—a major risk factor for the development of Alzheimer’s disease.”

Recent studies have found that getting less than six hours of sleep on a nightly basis throughout your life puts you at a higher risk of developing Alzheimer’s than those who clock 7 to 8 hours of shut-eye. Plus, sleep deprivation puts you at risk of diabetes, depression, and heart disease— all of which are risk factors for AD.

Alzheimer’s disease causes disruptions and changes in overall sleeping patterns. Researchers are still unsure as to why Alzheimer’s impacts your sleep schedule, but it’s thought the changes in brain functioning impair your natural circadian rhythm and make it harder for your body to know when it’s time for sleep and time to wake. These sleep changes aren’t as prevalent during the early stages of Alzheimer’s, but as the disease progresses, sleep troubles worsen. This vicious cycle of sleeplessness can cause AD to progress more quickly and makes symptoms harder to deal with, it’s crucial to nip sleep troubles in the bud sooner than later.

Common Alzheimer’s Sleep Changes

Apart from the obvious— the inability to fall asleep or stay asleep— individuals with Alzheimer’s also experience other shifts in their natural sleep-wake cycle. Commonly, those with AD feel drowsy and prefer to nap during the day; while we always encourage you to rest when you need rest, consistently squeezing in a daytime nap can make it harder for those with Alzheimer’s to get good sleep at night. It’s not uncommon for patients in the later stages of Alzheimer’s to report staying awake all night and sleeping during the day.

One of the early warning signs of Alzheimer’s is excessive daytime sleepiness; if you catch yourself yawning and feeling groggy most days, we suggest talking with your doctor about your risk of developing AD.

Those with AD spend nearly 40% of their time at night lying in bed, unable to fall asleep.  When those with Alzheimer’s cannot fall asleep, they’re prone to wander and yell out in frustration— which can disrupt the sleep of other family members or caregivers.

Another phenomenon that almost 20% of people with Alzheimer’s are prone to is called “sundowning.” The term “sundowning” refers to the increasing frustration, agitation, and confusion those with Alzheimer’s experience in the late afternoon and early evening— when the sun goes down.

There are a few factors that contribute to the frequency and severity of sundowning; those who feel more tired by evening time, as well as those with a shifted circadian rhythm, are more likely to experience these negative emotions at sunset. The lack of light and increase in shadows can cause confusion and fear when the sun sets, too.

How to Help those with Alzheimer’s Get Better Sleep

Though sleep troubles are widespread among those with Alzheimer’s, there are things you can do to help a loved one manage those troubles and get better sleep. Fortunately, these tips and tricks for better sleep are easy for almost anybody to follow and revolve primarily around improving sleep hygiene.

“These sleep hygiene recommendations can help prevent some sleep problems, and even eliminate more minor sleep problems,” notes Dr. Grandner. “Many people find that supporting their natural rhythms and removing barriers to healthy sleep can help them optimize their own sleep patterns and feel better during the day.”

• Stick to a consistent bedtime routine and go to sleep at the same time each day. It’s thought that sleep troubles associated with AD stem from a damaged circadian rhythm— reinforcing your natural sleep-wake cycle can prevent restless nights.
• Get sunlight first thing in the morning. Those with AD often feel drowsy and inclined to nap in the middle of the day; early morning exposure to sunlight further reinforces your circadian rhythm and hinders the production of melatonin, easing daytime sleepiness.

• Plan activities that require more energy for the morning and early afternoon. Getting up and active first thing in the morning strengthens your brain’s association that sunlight means it’s time to wake up and take on the day. Waking up and lounging around can lead to drowsiness and makes it easier for those with AD to nod off for a quick nap.
• Limit naps. Even if your loved one is cranky and throwing a fit, allowing them to sleep during the day only worsens their sleeping problems. Phase-out daytime naps by shortening them day after day until your loved one is used to waking up in the morning and sleeping again at night.
• Incorporate daily exercise into your routine. Even if it’s just a walk around the neighborhood, it’s beneficial to get the body moving and heart pumping. Plus, going outside and getting some fresh air can be relaxing and prevent feelings of anger and confusion those with AD often experience.
• Be mindful of caffeine consumption. Caffeine is in more than just coffee and can hide in snacks like chocolate, for instance. While caffeine doesn’t need to be eliminated entirely, we recommend cutting it out at least 6 to 8 hours before sleep as to not impede a good night’s rest.
• Create a relaxing environment for sleep. Creating a peaceful sleeping environment can help someone with Alzheimer’s relax and wind down before heading to sleep. Keep the lights low, invest in a comfortable mattress, reduce noise levels, set the thermostat to a comfortable temperature, and set up night lights in the bedroom and hallways. As we mentioned earlier, those with AD can experience sundowning, which can be summarized as agitation or confusion in the evening hours. Maintaining a serene environment can counteract sundowning and make drifting off to sleep easier.

Medication Treatments for Alzheimer’s

If natural remedies and lifestyle changes aren’t enough to combat sleep troubles, we recommend talking with your doctor about your medications and how they may be contributing to your sleep problems. A handful of medications prescribed for Alzheimer’s have a stimulating effect, so it’s important to take those at appropriate times as to not impede sleep; however, it’s always best to talk with your doctor before switching up your medication times.

If modifying your current medication doesn’t do the trick, your doctor may prescribe antidepressants, antipsychotics, or benzodiazepines (anti-anxiety medications) to ease feelings of stress and restlessness and promote feelings of calm and relaxation.

It’s important to note that sleeping pills are not recommended for those with AD. While yes, they are designed to help you fall asleep, recent studies have found they aren’t effective on those with Alzheimer’s and just caused them to be more disoriented and confused.

Frequently Asked Questions

In this section, we cover some of the more common questions about Alzheimer’s disease.

Do Alzheimer’s patients sleep a lot?

Alzheimer’s patients don’t tend to sleep more than the average individual; however, they’re perceived as sleeping more than others because they’re more prone to daytime sleepiness. A patient with Alzheimer’s may sleep all day, but that means they won’t sleep all night.

In some extreme cases of AD, a person’s sleep cycles can be flip-flopped entirely, where they sleep during the day and are awake at night. In others, someone with AD may sleep on and off all 24 hours of the day. Over these 24-hour periods, patients are rarely awake (or asleep) for more than an hour at a time, and instead, follow a consistent pattern of brief sleep with brief awakening.

It’s not until a person reaches later stages of Alzheimer’s where excessive sleepiness all day and all night is prevalent.

How does sleep affect Alzheimer’s?

As we discussed throughout this article, sleep and Alzheimer’s disease have a bidirectional relationship. Getting poor sleep throughout your life can lead to the build-up of amyloid and tau protein plaques, leading to Alzheimer’s, and Alzheimer’s disease can damage your circadian rhythm and make it harder to get good sleep.

If you have AD, it’s important to take the necessary steps to get adequate, deep sleep night after night; as deep sleep helps clear these plaques from your brain and eliminate symptoms of AD. Getting poor sleep with AD can only contribute to the development of amyloid and tau protein plaques.

Why do Alzheimer’s patients not sleep at night?

As you grow older, your body’s natural circadian rhythm shifts. It’s not uncommon to see older populations falling asleep earlier in the evening and waking up at sunrise. Having Alzheimer’s can shift your circadian rhythm even further, making it hard for your body to distinguish day from night. Even if the sun is shining, someone with AD may feel like it’s time to head off to bed.

It’s critical to reign in sleep troubles and reinforce good sleep hygiene early into your diagnosis so that these troubles don’t worsen and lead to more discomfort and problems.

Is excessive sleepiness a sign of Alzheimer’s?

Excessive sleepiness is one of the earliest warning signs of Alzheimer’s. A recent study of 123 adults, with an average age of 60, showed individuals who reported feeling more sleepy during the day had a threefold increased risk of developing amyloid plaques on their brain.

Considering most of us don’t get the necessary 7 to 9 hours of rest each night, we may not think too much of excessive sleepiness; but if you’re taking strides to improve your sleep and still feeling fatigued, talk to your doctor about your sleeping patterns.

Is insomnia a sign of Alzheimer’s?

Insomnia can result from a number of things, from poor diet to elevated stress levels. Recent research has shown that irregular sleep patterns may be an indicator of Alzheimer’s, but there are too many things that can lead to insomnia to say it’s a sure precursor of Alzheimer’s.

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