Curr Treat Options Neurol. 2003 May;5(3):261-272. doi: 10.1007/s11940-003-0017-9.
Sleep Dysfunction in Alzheimer's Disease and Other Dementias.
Current treatment options in neurology
Susan M. McCurry, Sonia Ancoli-Israel
Affiliations
Affiliations
- Department of Psychiatry, University of California San Diego School of Medicine, Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, USA. [email protected]
PMID: 12670415
DOI: 10.1007/s11940-003-0017-9
Abstract
Changes in sleep architecture and circadian rhythms, including increased sleep latency and nighttime awakenings, decreased slow-wave sleep, rapid eye movement sleep, and total sleep time, and increased daytime napping are widespread in people with dementia. In addition, cyclic agitation episodes ("sundowning"), nightmares or hallucinations, sleep attacks, and nocturnal behavioral outbursts are associated with specific dementia syndromes. Sleep hygiene recommendations, particularly those aimed at reducing daytime sleep and improving the sleep environment and routine, can offset the circadian disturbances of some dementia patients. However, they can be burdensome for caregivers to implement, and must be targeted to the specific patterns of sleep disturbances patients are experiencing. Pharmacologic treatments may be useful for symptomatic treatment of insomnia and nighttime behavioral disturbances in dementia patients, but there have been few controlled trials demonstrating their efficacy or long-term safety. Clonazepam is highly effective for treating the nighttime behaviors associated with rapid eye movement behavior disorder. For most dementia patients, however, the side effect risks of prolonged use of sedating medications must be weighed against the potential benefits. Dementia patients should be evaluated for common primary sleep disorders that may contribute to nighttime behavioral disturbances and impact treatment decisions. Continuous positive airway pressure, the gold standard for treating obstructive sleep apnea, can be tolerated by mild to moderately demented individuals with support from supervising caregivers. Increased daily light exposure and physical activity may help normalize circadian rest-activity rhythms in some dementia patients, although the frequency and dose needed to maintain treatment effects is currently not known.
References
- Biol Psychiatry. 1996 Aug 15;40(4):259-70 - PubMed
- Drugs Aging. 1995 Aug;7(2):79-87 - PubMed
- J Sleep Res. 2000 Dec;9(4):373-9 - PubMed
- Alzheimer Dis Assoc Disord. 1997 Sep;11(3):175-8 - PubMed
- J Gerontol A Biol Sci Med Sci. 1995 Nov;50(6):M303-6 - PubMed
- Sleep. 2000 Feb 1;23 Suppl 1:S23-30; discussion S36-8 - PubMed
- J Am Geriatr Soc. 1999 Jul;47(7):784-91 - PubMed
- Physiol Behav. 1988;42(2):141-4 - PubMed
- J Am Geriatr Soc. 2000 Jul;48(7):811-6 - PubMed
- Arch Gen Psychiatry. 2001 Apr;58(4):353-60 - PubMed
- Sleep. 1991 Apr;14(2):169-77 - PubMed
- CNS Drugs. 2001;15(4):267-75 - PubMed
- J Gerontol A Biol Sci Med Sci. 1999 Dec;54(12):M621-8 - PubMed
- Int J Geriatr Psychiatry. 2000 Nov;15(11):1028-33 - PubMed
- J Clin Psychiatry. 1998;59 Suppl 9:28-32 - PubMed
- J Am Geriatr Soc. 2003 Oct;51(10):1455-60 - PubMed
- Sleep Med Rev. 2000 Dec;4(6):603-628 - PubMed
- Cochrane Database Syst Rev. 2002;(2):CD002852 - PubMed
- J Gerontol Nurs. 2004 Jan;30(1):12-20 - PubMed
- Sleep. 1991 Dec;14(6):496-500 - PubMed
- BMJ. 1998 Sep 19;317(7161):802-8 - PubMed
- Curr Treat Options Neurol. 2001 Jan;3(1):19-36 - PubMed
- Chronobiol Int. 2000 May;17(3):313-54 - PubMed
- Int J Geriatr Psychiatry. 1998 Oct;13(10):682-90 - PubMed
- J Am Geriatr Soc. 2002 Feb;50(2):282-9 - PubMed
- Sleep. 1997 Jan;20(1):18-23 - PubMed
- Biol Psychiatry. 1997 May 1;41(9):955-63 - PubMed
- J Geriatr Psychiatry Neurol. 1999 Summer;12(2):53-9 - PubMed
- Psychiatry Res. 1993 Sep;48(3):277-92 - PubMed
- Chronobiol Int. 1999 Jul;16(4):505-18 - PubMed
- Sleep. 1997 Jan;20(1):24-7 - PubMed
- Z Gerontol Geriatr. 2001 Dec;34(6):491-7 - PubMed
- J Biol Rhythms. 1997 Apr;12(2):146-56 - PubMed
- Clin Geriatr Med. 2001 May;17(2):359-76 - PubMed
- J Neurol. 1997 Apr;244(4 Suppl 1):S37-45 - PubMed
- Sleep. 1999 Dec 15;22(8):1128-33 - PubMed
- Br J Gen Pract. 1997 Mar;47(416):166-9 - PubMed
- Curr Neurol Neurosci Rep. 2002 Mar;2(2):169-77 - PubMed
- Sleep. 1999 May 1;22 Suppl 2:S402-8 - PubMed
- Gerontologist. 1995 Apr;35(2):263-6 - PubMed
- Mov Disord. 2001 Jul;16(4):622-30 - PubMed
- Chronobiol Int. 2000 May;17(3):405-18 - PubMed
- Age Ageing. 1997 May;26(3):179-84 - PubMed
- Gerontologist. 1999 Dec;39(6):729-35 - PubMed
- J Rehabil Res Dev. 1998 Oct;35(4):411-9 - PubMed
- Neurophysiol Clin. 2001 Dec;31(6):356-75 - PubMed
- Psychiatry Res. 1997 Nov 14;73(1-2):83-90 - PubMed
- J Am Geriatr Soc. 1991 Mar;39(3):258-63 - PubMed
- J Clin Endocrinol Metab. 2001 Oct;86(10):4727-30 - PubMed
- J Gerontol A Biol Sci Med Sci. 2001 Jun;56(6):M356-60 - PubMed
- Sleep. 2000 Feb 1;23(1):87-95 - PubMed
- Brain. 2000 Feb;123 ( Pt 2):331-9 - PubMed
- Can J Psychol. 1991 Jun;45(2):221-39 - PubMed
- Chronobiol Int. 2000 May;17(3):233-43 - PubMed
- Behav Sleep Med. 2003;1(1):22-36 - PubMed
- Am J Psychiatry. 2001 May;158(5):704-11 - PubMed
- Clin Psychol Rev. 2000 Aug;20(6):783-805 - PubMed
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