Dear Dr. Rosenberg, My 78 year old mother has Alzheimer’s and is in a nursing home. She sleeps on and off throughout the day and night. There is no rhyme or reason as to when she falls asleep or is awake. Is this common in Alzheimer’s? Is there anything that can be done to help? Most of the time when we come to visit she is asleep.
A: What you are describing is called Irregular Sleep Wake Disorder. It is fairly common in Alzheimer’s sufferers. Their internal circadian clock has become completely disassociated from any semblance of a normal sleep wake schedule. The best treatment is plenty of bright light exposure during the day along with structured activities. In some studies, the addition of small doses of melatonin at night can be helpful.
Q: My 8-year-old is a bed wetter. He snores and a friend of mine tells me I should mention this to our pediatrician. She said the two can be related. Do you agree?
A: Yes, your friend is on top of things. Recent studies have shown that the incidence of bedwetting in children with sleep apnea is 29 percent. That is much higher than the normal rate for children. Even more encouraging is a report that bedwetting was cured in 41 percent of children with treatment of their sleep apnea.
Q: I have read that REM sleep (dream sleep) is needed for memory. I am on an antidepressant called citalopram (Celexa) and I had a sleep study which showed that I had very little REM sleep. The sleep specialist I saw after the study told me that medications such as citalopram depress REM sleep. Does this mean it will affect my memory?
A: Great question and one I am often asked. Recent studies have shown no impairment of memory in those on antidepressants. Antidepressants raise levels of neurotransmitters in the brain such as serotonin. These neurotransmitters help in memory consolidation. It is believed that by raising the levels of these neurotransmitters, the effect of decreasing REM sleep is negated.
Q: I have been working the night shift at a local market for 3 months. I am having a very hard time falling, and especially staying, asleep when I get home in the morning. Would you have any ideas?
A: Yes, what you are experiencing is referred to as circadian misalignment. Your own biological clock is not in sync with your new work hours. There are several things that you can do to improve this, called Shift Workers Sleep Hygiene:
1) Sleep in a cool room upon returning home
2) Use blackout blinds or shades and keep the environment dark
3) Turn off your phones during daytime sleep
4) Consider ear plugs or a white noise generator such as a fan
5) Place rugs in hallways to reduce noise
6) Educate your family members about your need for sleep.
Q: I am a recovering alcoholic. This will be my third attempt to become sober. In the past, insomnia and crazy dreams in the first few months of sobriety drove me back to drinking. I was given Valium to help me sleep the last time, but I became addicted to it. Would you have any advice?
A: What you are describing is not uncommon. Most recovering alcoholics develop problems with sleep during abstinence. This is characterized by a decrease in deep stages of sleep and an increase in dream sleep. Medications such as Valium (diazepam) which is a member of the benzodiazepine family, are to be avoided because of their addiction potential.
However, there are some excellent alternatives — such as sedating antidepressants — that are safe and effective during this period. If you have not already done, so you should consult someone who is skilled and experienced in this field, as you have already experienced that poor sleep can result in a return to drinking.
Dr. Robert Rosenberg, board-certified sleep medicine specialist, will answer readers’ questions by incorporating them into future columns. Contact him at http://www.answersforsleep.com/ or via mail at the Sleep Disorders Center of Flagstaff, (newly Accredited by the American Academy of Sleep Medicine), 1110 E. Route 66, Suite 202, Flagstaff, AZ 86001.
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