Introduction
In the US, Alzheimer’s disease (AD) has been established to be the most prevalent type of dementia. Present estimates show that approximately five million Americans have AD. The majority of affected people are above 65 years of age with the commonality level increasing as age advances. This signifies that in the aging baby boomer generation, about 60% of people above 85 years old in the year 2050, which translates to around 15 million individuals, will be living with AD (Ooms and Ju 15).
Medicines used in the treatment of negative behavioral practices of AD and in slowing the continued progression of the disease are usually linked to side effects that result in sleep disorders. Therefore, most people with AD usually have difficulties with sleeping or might encounter variations in their sleep plan. The multimorbidity, co-occurrence of AD and sleep disorder, has been approximated to affect more than 90% of the primary care population from 65 years and above earlier living with Alzheimer’s alone. There is a need for effective treatment of AD-sleep disorder multimorbidity to prevent polypharmacy and improve the health condition of patients.
The Occurrence of Multimorbidity
Most people living with AD experience problems in their sleep cycles. Scientists and researchers do not fully comprehend why multimorbidity arises. Similar to variations in behavior and memory, sleep variations somehow emanate from the effects of AD on the brain. Although most of the older adults who do not have Alzheimer’s also experience some sleep-associated problems, the disorder arises more frequently and tends towards being more severe in the ones living with AD (Brzecka et al. 8).
There is proof that sleep disorders are more prevalent in later phases of AD, but research studies have established some occurrences in the early stages. Acetylcholinesterase inhibitors, for instance, donepezil, have been determined to slow cognitive decline in some people with Alzheimer’s but may lead to nighttime stimulation over and above being linked to incidences of dream disturbances. Uncharacteristic antipsychotic drugs such as risperidone and olanzapine raise daytime somnolence and fatigue. The utilization of such medicines should be personalized anchored in the status of patients, behavioral manifestations of severity, and sensitiveness to side effects.
AD is linked to increased delays in circadian rhythms, contrary to the characteristic advancements in the cycle with age. Such delays have the probability of contributing to sundowning, that is, confusion and anxiety in the evening, in addition to problems sleeping in the nighttime. Attributable to wandering and the ensuing possibility of injury, the occurrence of insomnia at night affects mortality and morbidity directly, which forms a strong basis for institutionalization (Okuda et al. 1493). Excessive sleepiness during the day might lead to poor cognitive function, unintended naps that negatively influence safety when driving, and reduced capacity to take part in social tasks and therapies.
One of the commonest sleep disorders for people living with AD is difficulty sleeping. In this condition, patients with AD wake up more frequently and remain awake for a long time at night. In such situations, brain waves establish reductions in both non-dreaming and dreaming sleep cycles. Older adults who have difficulty sleeping might wander, find it uncomfortable to lie still for a long time, call out, or shout thus interrupting the normal sleep of their carers.
Another sleep disorder for AD patients is daytime napping, as well as other alterations in the sleep-wake rhythm (Gehrman et al. 62). Patients with the problem may feel extremely drowsy in the daytime but find it impossible to sleep at night. They might feel anxious or restless toward the late afternoon. Health professionals estimate that in the late phases of AD, patients take almost one hour in bed awake at night and a considerable proportion of the daytime sleeping. In severe cases, patients may have a full turnaround of the usual daytime wakefulness- night sleep rhythm.
Contributory Medical Aspects
Older adults living with AD and who have sleep disorders should seek a comprehensive medical examination to discover any treatable condition that might be worsening the problem. Some of the conditions that may worsen sleep problems encompass depression, sleep apnea, and restless legs syndrome. Depression is a widespread medical issue that may become severe and negatively influence the manner in which a person thinks or behaves.
It results in sentiments of sadness and a lack of concern in activities that a person once liked. Sleep apnea causes abnormal respiration rhythms where a person may have many brief moments of stopped breathing at night, which negatively influence sleep quality (Milán-Tomás and Shapiro 164). In restless legs syndrome, people develop unpleasant prickling sensations in their legs that result in an irresistible desire to move them. Attributable to considerable negative effects of circadian and sleep problems in AD patients, there is a growing interest in the identification of effective treatment, with the optimism of decreasing carers’ trouble, improving quality of life for patients, preventing institutionalization, and slowing cognitive degeneration.
Non-Drug Treatment of Sleep Disorder
In people with AD, the non-drug treatment approach for sleep disorder seeks to enhance circadian rhythm, improve the surrounding environment, generate an inviting sleeping setting at night, promote rest, and decrease napping time. Non-drug treatment approaches are recommended since some drugs have severe side effects, fail to improve sleep quality, and are linked to a high likelihood of falls and risks that overshadow their benefits, over and above resulting in polypharmacy.
Non-drug treatment practices include maintenance of standard time for meals, going to bed, and waking up (Ooms and Ju 17). There is a need to seek daybreak sunlight exposure, have regular daily exercise and not later than fours to bedtime, and avoid the use of alcohol, nicotine, and caffeine. Other non-drug treatment methods include ensuring comfortable bedroom temperature, discouraging remaining in bed when awake, and avoiding prolonged television watching time.
Medications for Sleep Disorder
In some instances, non-drug treatment methods fail to improve sleep quality or changes occur along with unsettling nighttime behavior. For AD patients who require the use of medicines for sleep disorder, health professionals recommended a low dosage and using drugs only for a short time. The form of medication offered by health providers is usually guided by the behavior that accompanies sleep variations.
The pharmacologic treatment acts as the basis for short-term therapy of sleep disorders in people living with AD (Liguori and Placidi 855). Some of the medications employed in the treatment of sleep disorders encompass tricyclic antidepressants, for example, nortriptyline; benzodiazepines, which include temazepam, oxazepam, and lorazepam; and sleeping pills such as zaleplon, chloral hydrate, and zolpidem. Though highly discouraged, antipsychotic drugs such as olanzapine, quetiapine, and risperidone are used in the treatment of sleep disorders.
Every time that new medications are prescribed to a patient, there is a need to inquire from the health professional concerning benefits of the medicine, its risks and side effects, and other possible alternatives available. Treatment objectives have a likelihood of changing in the process of treating AD. Being well-informed enables AD patients and their family members to create effective treatment plans (Ooms and Ju 14).
Risks associated with medications for the treatment of sleep disorders in older adults, who have a declining cognitive function, are substantial. They encompass a high possibility of fractures, falls, confusion, and deterioration in the capacity for self-care. In situations where medications for sleep disorder are highly preferable, they should be discontinued following the establishment of a regular sleep cycle. This assists in avoiding polypharmacy and improving patients’ health conditions.
Conclusion
AD is the most prevalent type of dementia in the US. The majority of AD patients are above 65 years of age. Medicines employed in the treatment of negative behavioral issues of AD and in slowing the development of the disease are associated with side effects that result in sleep disorders. Effective treatment of the AD-sleep disorder multimorbidity prevents polypharmacy and improves the medical condition of patients. Attributable to the extensive negative effects of sleep problems in AD patients, there is a rising interest in the realization of successful treatment to lessen carers’ problems, improve the quality of life for patients, avoid institutionalization, and slow cognitive deterioration.
Non-drug treatment for sleep disorder is effective and enhances the circadian cycle, improves the surrounding environment, creates an inviting sleeping ambiance at night, supports rest, and reduces napping time. Contrary to the non-drug treatment approach, drugs result in serious side effects, fail to ameliorate sleep quality, and are associated with a high probability of falls, in addition to resulting in polypharmacy.
Works Cited
Brzecka, Anna, et al. “Sleep Disorders Associated with Alzheimer’s Disease: A Perspective.” Frontiers in Neuroscience, vol. 12, no. 330, 2018, pp. 1-10.
Gehrman, Philip, et al. “Impact of Alzheimer Disease Patients’ Sleep Disturbances on Their Caregivers.” Geriatric Nursing, vol. 39, no. 1, 2018, pp. 60-65.
Liguori, Claudio, and Fabio Placidi. “Is it Time to Consider Obstructive Sleep Apnea Syndrome a Risk Factor for Alzheimer’s Disease?” American Journal of Respiratory and Critical Care Medicine, vol. 197, no. 7, 2018, pp. 855-856.
Milán-Tomás, Ángela, and Colin Shapiro. “Circadian Rhythms Disturbances in Alzheimer Disease.” Alzheimer Disease & Associated Disorders, vol. 32, no. 2, 2018, pp. 162-171.
Okuda, Shoki, et al. “Association between Sleep Disturbance in Alzheimer’s Disease Patients and Burden on and Health Status of Their Caregivers.” Journal of Neurology, vol. 266, no. 6, 2019, pp. 1490-1500.
Ooms, Sharon, and Yo-El Ju. “Treatment of Sleep Disorders in Dementia.” Current Treatment Options in Neurology, vol. 18, no. 9, 2016, pp. 1-21.