Research Project – Sleep Disturbance

One third of the 815,000 people with dementia in the UK currently live in care homes and many of them will experience sleep disturbance. This is often due to disruption of the biological pathways in the brain that regulate sleep, or as a side effect of medications. Sleep disturbance affects the cognition of people with dementia, and increases their likelihood of exhibiting other behavioural and psychological symptoms. Estimates suggest that around 40% of dementia sufferers are also likely to experience sleep disturbance. The condition also has a wider impact in the care home setting due to the resources used managing patients who are restless at night. Sufferers will frequently leave their beds and bedrooms, sometimes becoming agitated and distressed, shouting at or resisting their caregivers.

Understanding sleep disturbance and improving the ways in which it’s treated involves unpicking a complex web of cause and effect, symptom and side-effect. But the potential benefit of improved care strategies for both suffers and care providers are obvious.

The current landscape:

Sleep disturbance has a number of possible underlying causes. In several types of dementia the biological pathways in the brain that regulate sleep are known to be disrupted. Dementia medications such as Memantine also affect peoples’ sleep. Furthermore, many people experience behavioural and psychological symptoms of dementia (BPSD) such as agitation and aggression which are frequently worse in the evening. There may also be environmental factors such as light and noise in care homes, which prevent people from sleeping.

As well as being a problem in its own right, drugs prescribed to manage some of the symptoms of sleep disturbance can have secondary consequences for the sufferer.  One example of this is the way in which antipsychotic medications that are often prescribed mean sufferers are more likely to sleep during the day.

Sleep disturbance often coincides with the later stages of dementia causes symptoms that can be distressing for both the sufferer and their caregivers. It’s clear that improvements in the management of sleep disturbance

Impacts of sleep disturbance in the care home:

People with sleep disturbance are often restless at night, frequently leaving their beds and bedrooms. In some cases people also become agitated and distressed, and may shout, scream and resist their caregivers. The impact of sleep disturbance is considerable; it affects the cognition of people with dementia, and increases their risk of mortality and BPSD, which can lead to prescriptions of harmful antipsychotic medications. They are more likely to sleep during the day, meaning their nutrition suffers as a result of missed meals and drinks.

As well as the physical consequences of daytime sleeping, sufferers are also likely to experience social and psychological effects as they miss activities in the care home and opportunities for social interaction, including family visits. Sleep disturbance also has an indirect impact on other residents in care homes as they are woken when people become vocal or distressed at night. Importantly, care staff find it very difficult to provide care for people who are awake at night, particularly since staffing levels are much lower during night-time hours.

Sleep disturbance in dementia is clearly a very important issue in the care of people living in care homes, yet no studies have recorded the frequency or overall impact of this symptom. As a result it is not possible to provide guidance to care homes on the best way to care for people with disturbed sleep.

Improving understanding and creating better treatments:

The project that HMT is supporting is a studentship in which published literature will be used to identify methods to reduce sleep disturbance in people with dementia. From this, a programme to test potential approaches within care homes will be developed. The studentship will provide valuable information about sleep disturbance in care homes, enabling better guidance for care staff and improved understanding in an area that currently receives little attention. The key output of the study will be the stepped care programme for use at night-time to improve the quality of life of people with dementia and alleviate the impact on other residents.

Dr Doug Brown at Alzheimer’s Society:

‘As well as the vital research we fund to find a cure, supporting research to improve the lives of people with dementia today is crucial and that’s why it’s one of Alzheimer’s Society’s key research priorities. Thanks to fantastic support from organisations like the Healthcare Management Trust, we can fund more projects like this that improve care for the 800,000 people in the UK living with dementia today.’

Chairman of The Healthcare Management Trust, Paul Steele commented:

‘Funding research is seen by HMT Trustees as a core part of the charity’s work. These projects form part of a portfolio of research projects designed to improve the quality of life and treatment of people with dementia and the Trust is proud to support them.’