It's a fact of life that as we get older, tasks and activities we used to perform without a second thought can become more of a slog.
For many of us, slowing down – both physically and mentally – is such a gradual process, that both ourselves and the people around us are unlikely to notice as we start to ease back, and take things more slowly.
However, the alarming rate at which fatigue can take hold of someone with dementia can be very distressing – especially if that person used to be bursting with energy, fit and healthy.
Perhaps someone you care for is sleeping far more than previously throughout the day, or once simple tasks, such as getting dressed seem to wipe them out completely.
Why are they so sleepy all the time?
One of the typical signs of later-stage dementia, in particular dementia with Lewy Bodies (LB), is that people seem to need far more sleep than they used to, and appear more fatigued when they're awake. The medical term for excessive sleeping is called hypersomnia, and is the opposite of insomnia – both of which people with dementia can experience.
Researchers believe this is because of neuronal changes in the systems that control our sleep-wake systems. But, when it comes to dementia fatigue, a whole host of factors beyond these can come into play. For instance:
Medication – It could be possible that certain drugs (or combinations of them) used to treat dementia, Parkinson's and depression, could result in a general lack of energy, or even interfere with sleep patterns. If so, it might be worth talking to your GP to see if there are alternative drugs available that could improve sleep quality at night.
B12 levels – Deficiencies in vitamin b12 can be a strong factor in why someone is experiencing weakness and fatigue. Without stable levels of this vitamin (often found in animal products), the body is unable to make red blood cells which carry oxygen around the body, leaving people in a permanent state of exhaustion. Older people are far more common to display deficiencies or be unable to absorb the vitamin through food sources alone.
Depression – We know that the effects of dementia over time can be devastating, playing havoc with daily life and vastly altering someone's ability to experience the world as they once did. So it's not difficult to see how symptoms of tiredness may be a sign that someone you love with dementia, may also be experiencing depression or a general sense of apathy.
More on depression
Excessive fatigue, lack of energy and trouble sleeping are all general symptoms of depression. Often, people can find it harder to sleep at night, and when they do, it may be more restless; while others can feel the opposite, with a heavy sense of exhaustion weighing on them at all times, leading them to nap more throughout the day.
It can be troubling to see your loved one going through these challenges, and sadly there's not an easy solution. If you think your loved one's depressed, it's crucial to seek support and guidance. However, patience, love and, if possible, distraction techniques can all be powerful ways of helping someone cope.
Problems sleeping with dementia
Over half of people living with dementia ( and 90% of people with Lewy Body dementia) experience issues with sleeping. Less sleep at night can seriously hamper their daily quality of life, and can exacerbate the symptoms we associate with dementia, such as feeling aggravated, moody, exhausted, less focused, tense and paranoid.
Broken or poor sleep patterns can often be traced back to a number of neurological issues, including :
- Obstructive Sleep Apnoea When breathing starts and stops when you're sleeping, causing you to wake.
- Periodic Limb Movements Uncontrollable spasms of the legs or arms, that can disrupt sleep.
- Growing confusion Waking with an alarming sense that it is daytime, or being in the wrong place, leading to distress or even night time wanderings.
- REM Sleep Behaviour disorder Random body movements in people living with Lewy Body dementia, Parkinson's and Alzheimer's, this sleep disorder affects the circadian rhythms our brains rely on for stable sleep patterns.
How to help someone with dementia get a better night's sleep
Daytime fatigue may be due to a restless night's sleep, and while it's not always possible to reverse dementia-related sleep issues, there are some steps you can take to that may make nights smoother:
Keep it dark – Any light present during the night can cause someone with dementia to become confused as to whether it's daytime or not – especially during seasons with longer daylight hours. It may be worth investing in a blackout blind to help keep nights darker.
Establish a routine – Building patterns of behaviour can help people with dementia recognise the cues that tell them night time is coming. Doing the same things every night in the same order, such as brushing teeth, followed by a back massage and a favourite song, can help lead to a better night's rest.
Banish blue-light before bed – While it's tempting to let loved ones drift off to their favourite television programme, blue-light emitted by screens can cause havoc with the melatonin levels (a hormone that aids sleep) in the brain, and our sleep cycles. If possible, try listening to calming music before bed instead.
A note on sundowning...
You may have heard the term 'Sundowning' in relation to dementia; this generally refers to agitation, odd behaviour and a growing sense of anxiety that occurs in the evening (hence sundowning), when someone with dementia is more tired. It can be worrying, but try to keep someone as comfortable and reassured as possible when daylight hours are fading.