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Sleep in dementia and caregiving – assessment and treatment implications: a review

Published online by Cambridge University Press:  15 October 2010

David R. Lee  and
Alan J. Thomas
David R. Lee*
Affiliation:
Wolfson Research Centre, Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, U.K.
Alan J. Thomas
Affiliation:
Wolfson Research Centre, Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, U.K.
*
Correspondence should be addressed to: Dr. David R Lee, Senior Research Associate, Wolfson Research Centre, Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, U.K. Phone: +44 191 248 1331; Fax: +44 191 248 1301. Email: D.R.Lee@newcastle.ac.uk.
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Abstract

Background: The increasing prevalence of dementia will precipitate a significant burden in terms of the costs of caring for people with dementia over the next 30 years; sleep disturbances in dementia are an important factor contributing to this burden.

Methods: We reviewed sleep disturbances in people with dementia and their carers and describe the various diagnostic, assessment and treatment strategies available to physicians in the management of this clinically significant problem.

Results: Sleep disturbances in people with dementia and their carers (i) are highly prevalent; (ii) impact significantly on quality of life of both people with dementia and their carers; (iii) increase the rate of cognitive decline; and (iv) accelerate the breakdown of community-based care. The training of physicians in the assessment and treatment of sleep disturbances in dementia and caregiving is scant despite a wide range of assessment strategies and treatment approaches, which comprise both pharmacological (including hypnotic/sedative medications) and non-pharmacological approaches (including: environmental; psychobehavioral; exercise and activity; and multi-component interventions). Specific diagnostic criteria for sleep disturbances in people with dementia and their carers remain lacking despite established criteria for general insomnia. Further to this, proposed changes to diagnostic criteria for DSM-V do not include a specific focus for the diagnosis and management of sleep disturbances in people with dementia or their carers.

Conclusions: This review suggests that the improved training of physicians to meet the needs of these vulnerable groups of older people is a priority, especially in the context of a rapidly increasing demand for accurate, early diagnosis and efficient management of sleep disturbance in these groups.

Keywords

insomniaelderlycognitive impairmentcarerdiagnosistreatmentassessmenttraining
Type
Review Article
Information
International Psychogeriatrics , Volume 23 , Issue 2 , March 2011 , pp. 190 - 201
Copyright
Copyright © International Psychogeriatric Association 2010

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