Abstract
Sleep and wake in Alzheimer’s disease (AD) are often fragmented as manifested by bouts of wakefulness at night and napping during the day. Management of sleep disturbances in AD is important because of their negative impact on both patients and caregivers. Pharmacological treatments, mainly sedative-hypnotics and antipsychotics, are often used but can be associated with significant adverse effects. Non-pharmacological treatments represent a beneficial alternative approach to the management of sleep disturbances in AD since they are associated with fewer adverse effects and their efficacy can be sustained after treatment has been completed. The aim of this article is to review non-pharmacological treatments, such as sleep hygiene, sleep restriction therapy (SRT), cognitive behavioral therapy (CBT), light therapy, and continuous positive airway pressure (CPAP), for the management of sleep/wake disturbances in AD.
Similar content being viewed by others
References
Dauvilliers, Y., Insomnia in patients with neurodegenerative conditions. Sleep Med, 2007. 8Suppl 4: p. S27–34.
Hope, T., et al., Predictors of institutionalization for people with dementia living at home with a carer. Int J Geriatr Psychiatry, 1998. 13(10): p. 682–690.
Ancoli-Israel, S., et al., Sleep in non-institutionalized Alzheimer’s disease patients. Aging (Milano), 1994. 6(6): p. 451–458.
Vitiello, M.V. and S. Borson, Sleep disturbances in patients with Alzheimer’s disease: epidemiology, pathophysiology and treatment. CNS Drugs, 2001. 15(10): p. 777–796.
Yesavage, J.A., et al., Development of diagnostic criteria for defining sleep disturbance in Alzheimer’s disease. J Geriatr Psychiatry Neurol, 2003. 16(3): p. 131–139.
Yesavage, J.A., et al., A follow-up study of actigraphic measures in home-residing Alzheimer’s disease patients. J Geriatr Psychiatry Neurol, 1998. 11(1): p. 7–10.
Ancoli-Israel, S., et al., Use of wrist activity for monitoring sleep/wake in demented nursing-home patients. Sleep, 1997. 20(1): p. 24–27.
Sadeh, A., et al., The role of actigraphy in the evaluation of sleep disorders. Sleep, 1995. 18(4): p. 288–302.
Cole, R.J., et al., Automatic sleep/wake identification from wrist activity. Sleep, 1992. 15(5): p. 461–469.
Wooltorton, E., Risperidone (Risperdal): increased rate of cerebrovascular events in dementia trials. Cmaj, 2002. 167(11): p. 1269–1270.
Conn, D.K. and R. Madan, Use of sleep-promoting medications in nursing home residents: risks versus benefits. Drugs Aging, 2006. 23(4): p. 271–287.
Sultzer, D.L., et al., Clinical symptom responses to atypical antipsychotic medications in Alzheimer’s disease: phase 1 outcomes from the CATIE-AD effectiveness trial. Am J Psychiatry, 2008. 165(7): p. 844–854.
Thapa, P.B., et al., Psychotropic drugs and risk of recurrent falls in ambulatory nursing home residents. Am J Epidemiol, 1995. 142(2): p. 202–211.
Ross, J.S. and J.R. Shua-Haim, Aricept-induced nightmares in Alzheimer’s disease: 2 case reports. J Am Geriatr Soc, 1998. 46(1): p. 119–120.
Burns, A., et al., The effects of donepezil in Alzheimer’s disease — results from a multinational trial. Dement Geriatr Cogn Disord, 1999. 10(3): p. 237–244.
Rogers, S.L., et al., Donepezil improves cognition and global function in Alzheimer disease: a 15-week, double-blind, placebo-controlled study. Donepezil Study Group. Arch Intern Med, 1998. 158(9): p. 1021–1031.
Stahl, S.M., et al., Examination of nighttime sleep-related problems during double-blind, placebo-controlled trials of galantamine in patients with Alzheimer’s disease. Curr Med Res Opin, 2004. 20(4): p. 517–524.
Markowitz, J.S., et al., Sleep-related outcomes in persons with mild to moderate Alzheimer disease in a placebo-controlled trial of galantamine. Sleep, 2003. 26(5): p. 602–606.
Ancoli-Israel, S., et al., Effects of galantamine versus donepezil on sleep in patients with mild to moderate Alzheimer disease and their caregivers: a double-blind, head-tohead, randomized pilot study. Alzheimer Dis Assoc Disord, 2005. 19(4): p. 240–245.
Dijk, D.J. and C. Cajochen, Melatonin and the circadian regulation of sleep initiation, consolidation, structure, and the sleep EEG. J Biol Rhythms, 1997. 12(6): p. 627–635.
Haimov, I., et al., Sleep disorders and melatonin rhythms in elderly people. Bmj, 1994. 309(6948): p. 167.
Kennaway, D.J., et al., Urinary 6-sulfatoxymelatonin excretion and aging: new results and a critical review of the literature. J Pineal Res, 1999. 27(4): p. 210–220.
Zeitzer, J.M., et al., Do plasma melatonin concentrations decline with age? Am J Med, 1999. 107(5): p. 432–436.
Wu, Y.H. and D.F. Swaab, Disturbance and strategies for reactivation of the circadian rhythm system in aging and Alzheimer’s disease. Sleep Med, 2007. 8(6): p. 623–636.
Singer, C., et al., A multicenter, placebo-controlled trial of melatonin for sleep disturbance in Alzheimer’s disease. Sleep, 2003. 26(7): p. 893–901.
Gehrman, P.R., et al., Melatonin fails to improve sleep or agitation in double-blind randomized placebo-controlled trial of institutionalized patients with Alzheimer disease. Am J Geriatr Psychiatry, 2009. 17(2): p. 166–169.
Gellis, L.A. and K.L. Lichstein, Sleep hygiene practices of good and poor sleepers in the United States: an internet-based study. Behav Ther, 2009. 40(1): p. 1–9.
Stepanski, E.J. and J.K. Wyatt, Use of sleep hygiene in the treatment of insomnia. Sleep Med Rev, 2003. 7(3): p. 215–225.
Morin, C.M., et al., Behavioral and pharmacological therapies for late-life insomnia: a randomized controlled trial. Jama, 1999. 281(11): p. 991–999.
McCurry, S.M., et al., Training caregivers to change the sleep hygiene practices of patients with dementia: the NITE-AD project. J Am Geriatr Soc, 2003. 51(10): p. 1455–1460.
Spielman, A.J., P. Saskin, and M.J. Thorpy, Treatment of chronic insomnia by restriction of time in bed. Sleep, 1987. 10(1): p. 45–56.
Friedman, L., et al., A preliminary study comparing sleep restriction and relaxation treatments for insomnia in older adults. J Gerontol, 1991. 46(1): p. P1–8.
Friedman, L., et al., An actigraphic comparison of sleep restriction and sleep hygiene treatments for insomnia in older adults. J Geriatr Psychiatry Neurol, 2000. 13(1): p. 17–27.
Morin, C.M., et al., Psychological and behavioral treatment of insomnia:update of the recent evidence (1998–2004). Sleep, 2006. 29(11): p. 1398–1414.
Wang, M.Y., S.Y. Wang, and P.S. Tsai, Cognitive behavioural therapy for primary insomnia: a systematic review. J Adv Nurs, 2005. 50(5): p. 553–564.
Montgomery, P. and J. Dennis, Cognitive behavioural interventions for sleep problems in adults aged 60+. Cochrane Database Syst Rev, 2003 (1): p. CD003161.
Morin, C.M., et al., Cognitive behavioral therapy, singly and combined with medication, for persistent insomnia: a randomized controlled trial. Jama, 2009. 301(19): p. 2005–2015.
Wicklow, A. and C.A. Espie, Intrusive thoughts and their relationship to actigraphic measurement of sleep: towards a cognitive model of insomnia. Behav Res Ther, 2000. 38(7): p. 679–693.
Espie, C.A., et al., A controlled comparative investigation of psychological treatments for chronic sleep-onset insomnia. Behav Res Ther, 1989. 27(1): p. 79–88.
Bootzin, R.R. and M.L. Perlis, Nonpharmacologic treatments of insomnia. J Clin Psychiatry, 1992. 53Suppl: p. 37–41.
Bootzin, R.R., A stimulus control treatment for insomnia Proceedings of The American Pychological Association, T.A.P. Association, Editor. 1972.
Nicassio, P. and R. Bootzin, A comparison of progressive relaxation and autogenic training as treatments for insomnia. J Abnorm Psychol, 1974. 83(3): p. 253–260.
McCurry, S.M., et al., Nighttime insomnia treatment and education for Alzheimer’s disease: a randomized, controlled trial. J Am Geriatr Soc, 2005. 53(5): p. 793–802.
Campbell, S.S., et al., Exposure to light in healthy elderly subjects and Alzheimer’s patients. Physiol Behav, 1988. 42(2): p. 141–144.
Shochat, T., et al., Illumination levels in nursing home patients: effects on sleep and activity rhythms. J Sleep Res, 2000. 9(4): p. 373–379.
Ancoli-Israel, S., et al., Increased light exposure consolidates sleep and strengthens circadian rhythms in severe Alzheimer’s disease patients. Behav Sleep Med, 2003. 1(1): p. 22–36.
Winkler, D., et al., Treatment of seasonal affective disorder. Expert Rev Neurother, 2006. 6(7): p. 1039–1048.
Gammack, J.K., Light therapy for insomnia in older adults. Clin Geriatr Med, 2008. 24(1): p. 139–149, viii.
Friedman, L., et al., Scheduled bright light for treatment of insomnia in older adults. J Am Geriatr Soc, 2009. 57(3): p. 441–452.
Dowling, G.A., et al., Effect of timed bright light treatment for rest-activity disruption in institutionalized patients with Alzheimer’s disease. Int J Geriatr Psychiatry, 2005. 20(8): p. 738–743.
Ancoli-Israel, S., et al., Effect of light treatment on sleep and circadian rhythms in demented nursing home patients. J Am Geriatr Soc, 2002. 50(2): p. 282–289.
Dowling, G.A., et al., Melatonin and bright-light treatment for rest-activity disruption in institutionalized patients with Alzheimer’s disease. J Am Geriatr Soc, 2008. 56(2): p. 239–246.
Janssens, J.P., et al., Sleep disordered breathing in the elderly. Aging (Milano), 2000. 12(6): p. 417–429.
Reynolds, C.F., 3rd, et al., Sleep apnea in Alzheimer’s dementia: correlation with mental deterioration. J Clin Psychiatry, 1985. 46(7): p. 257–261.
Hoch, C.C., et al., Sleep-disordered breathing in normal and pathologic aging. J Clin Psychiatry, 1986. 47(10): p. 499–503.
Cohen-Zion, M., et al., Changes in cognitive function associated with sleep disordered breathing in older people. J Am Geriatr Soc, 2001. 49(12): p. 1622–1627.
Ancoli-Israel, S., et al., Cognitive effects of treating obstructive sleep apnea in Alzheimer’s disease: a randomized controlled study. J Am Geriatr Soc, 2008. 56(11): p. 2076–2081.
Ancoli-Israel, S. and L. Ayalon, Diagnosis and treatment of sleep disorders in older adults. Am J Geriatr Psychiatry, 2006. 14(2): p. 95–103.
Weaver, T.E. and E.R. Chasens, Continuous positive airway pressure treatment for sleep apnea in older adults. Sleep Med Rev, 2007. 11(2): p. 99–111.
Chong, M.S., et al., Continuous positive airway pressure reduces subjective daytime sleepiness in patients with mild to moderate Alzheimer’s disease with sleep disordered breathing. J Am Geriatr Soc, 2006. 54(5): p. 777–781.
Cooke, J.R., et al., Continuous positive airway pressure deepens sleep in patients with Alzheimer’s disease and obstructive sleep apnea. Sleep Med, 2009.
Ayalon, L., et al., Adherence to continuous positive airway pressure treatment in patients with Alzheimer’s disease and obstructive sleep apnea. Am J Geriatr Psychiatry, 2006. 14(2): p. 176–180.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
David, R., Zeitzer, J., Friedman, L. et al. Non-pharmacologic management of sleep disturbance in Alzheimer’s disease. J Nutr Health Aging 14, 203–206 (2010). https://doi.org/10.1007/s12603-010-0050-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12603-010-0050-9