New Review Highlights Need to Address Sleep Disturbances in Patients with Dementia

A recent review assessed sleep deprivation in individuals with dementia and emphasized its multifaceted impact on patient outcomes and caregiver burden. The report, published in the journal Aging, synthesized recent research findings and offered insights into how sleep disturbances interplay with comorbidities, including cardiovascular disease (CVD), diabetes, anxiety/depression, and thyroid disorders.

Dementia, characterized by progressive cognitive decline, is frequently accompanied by disrupted sleep patterns. These disturbances—ranging from insomnia and fragmented sleep to sleep apnea and circadian rhythm disorders—are reported in up to 70% of patients with dementia, according to corresponding author P. Hemachandra Reddy, PhD, professor, Department of Internal Medicine, Texas Tech University Health Sciences Center, and colleagues.

“These disturbances not only exacerbate the cognitive decline and behavioral symptoms associated with dementia but also significantly impact the quality of life for both patients and their caregivers,” Reddy and colleagues added.

Sleep deprivation's physiological and psychological effects extend to worsening symptoms of associated comorbidities. For instance, cardiovascular conditions, such as hypertension and heart failure, both common in dementia, are exacerbated by sleep apnea and disrupted circadian rhythms. Similarly, diabetes-associated neurovascular complications are amplified by chronic sleep loss, further impairing cognitive and metabolic function.

The review explored how comorbidities compound the challenges of dementia care:

1. CVD: Disorders like atrial fibrillation and myocardial infarction heighten dementia risk through mechanisms such as cerebral hypoperfusion and inflammation. Treating conditions like sleep apnea in these patients could mitigate cognitive decline.
2. Diabetes: Often labeled as "type 3 diabetes" in the context of Alzheimer disease, diabetes is closely linked to cognitive impairment via mechanisms including insulin resistance and chronic inflammation.
3. Mental Health Disorders: Anxiety and depression, prevalent in dementia, are worsened by poor sleep quality, creating a feedback loop of stress and impaired cognition.
4. Thyroid Disorders: Both hypothyroidism and hyperthyroidism are implicated in cognitive decline, with disrupted thyroid hormone regulation linked to worsened sleep quality in people with dementia.

Recommendations for clinicians. The bidirectional relationship between sleep and these comorbidities highlights the importance of a holistic approach to managing dementia,” Reddy and colleagues noted. Non-pharmacological interventions such as cognitive-behavioral therapy for insomnia (CBT-I), light therapy, and structured sleep routines were recommended. They also stated that modifications to the sleep environment—such as reducing noise, controlling light exposure, and maintaining a consistent sleep-wake schedule—can significantly improve sleep quality for patients with dementia. Pharmacological treatments may be necessary in some cases but require careful management. “The risks associated with pharmacological treatments highlight the need for personalized approaches,” investigators cautioned.

The review also stressed the importance of a multidisciplinary approach involving neurologists, geriatricians, sleep specialists, and primary care providers. This ensures that all aspects of a patient’s health, including sleep disturbances and comorbidities, are addressed. Authors also emphasized the importance of early recognition and management of sleep disturbances to slow cognitive decline and enhance the quality of life for both patients and caregivers.

“As the population ages and the prevalence of dementia rises, integrating sleep management into the standard care for dementia will become increasingly important in mitigating the broader impact of this devastating condition,” Reddy et al concluded.

Reference: Mukherjee U, Sehar U, Brownell M, Reddy PH. Sleep deprivation in dementia comorbidities: Focus on cardiovascular disease, diabetes, anxiety/depression and thyroid disorders. Aging. Published online November 20, 2024. doi:10.18632/aging.206157