As a caregiver for a loved one with dementia, your days are challenging, but sleep disruption makes them even more so.
A poor night of sleep can do more than ruin your day, especially if it happens frequently. A consistently off-kilter circadian clock (i.e., sleep/wake cycle) can result in poorer functional status and quality of life, and lead to dangerous disease development and progression. Plus, older adults with dementia are more likely than others to have sleep disturbances, and these disturbances tend to worsen as the disease progresses. These disturbances often disrupt the sleep of their caregivers as well.
The good news? Proper “sleep hygiene” rituals can help you fall asleep and stay asleep and reset your disrupted circadian clock.
Remember, a healthy, well-rested version of yourself can be a far more effective caregiver than a groggy, foggy, unhealthy version, so take these tips to heart.
The circadian rhythm: The body’s natural sleep/wake cycle
Chronic sluggishness and fatigue during the day and a general feeling of being drained can signify circadian misalignment. This can make you feel fairly miserable throughout the day, but circadian misalignment can also have harmful effects on your mental and physical health.
What are circadian rhythms?
Circadian rhythms are physical, mental and behavioral changes that follow a 24-hour cycle. In general, these “rhythms” strum to the beat of the light/dark cycle of daylight vs. nighttime. The most obvious example of a circadian rhythm is the sleep/wake cycle—sleeping at night and being awake during the day. Other examples include the body-temperature cycle and the cycles in which a number of hormones are secreted.
What are biological clocks, and why must they all march to the beat of the same drum?
We have “biological clocks” that act as natural timing devices that regulate the cycle of our circadian rhythms. These clocks are actually clusters of specific molecules (proteins) that communicate with cells throughout the body. Nearly every tissue in every major organ system contains biological clocks. Scientists call these biological clocks located within the tissues “peripheral clocks.”
In the ideal scenario, these peripheral clocks in the major organ systems (e.g., heart, lungs, muscle, stomach, liver and brain) work together in symphony to meet the demands of the increased activity and attention during the day and ensure restorative sleep at night. When all clocks are marching to the beat of the same drum and working together as they should, we feel great during the day—alert, sharp and energetic.
However, if even one of these peripheral clocks falls out of beat, the sluggishness-fogginess-sleepiness trio rears its ugly head, and we become at higher risk for diseases such as cancer, cardiovascular disease and diabetes.
The key question is: What keeps all of these peripheral clocks in sync?
The symphony director: The master clock of the circadian system
The answer is the suprachiasmatic nucleus (SCN), a structure of about 20,000 nerve cells (neurons) located in the hypothalamus of the brain that receives direct input from the eyes. When daylight (note that it has to be light from the sun) enters the eyes, the SCN signals to all the peripheral clocks to start to do their intricate hormone-protein dance that makes us alert, sharp and energetic during the day.
Zeitgebers, ‘sleep hygiene’ and other ways to regulate your circadian rhythm
The sun is considered what scientists call a zeitgeber (German for “time giver”), which is any environmental or social cue that influences and helps to synchronize biological rhythms, including circadian rhythms.
Natural daylight is the most prominent zeitgeber, but others include food/meal times, temperature and exercise.
The good news? Research indicates that we can leverage the four zeitgebers below to regulate or even reset our circadian rhythm if our biological clocks have gone awry.
Light therapy
The power to control our exposure to light is a relatively new development, considering the modern lightbulb was invented less than 150 years ago. Our bodies are built to respond to the natural rising and setting of the sun, not the unpredictable and ongoing stimulation of light of the modern world—the glare of headlights, the glow of street lamps, or the continuous blue light ambiance of computer and phone screens.
But this is an easy fix:
- Regulate sunlight exposure: It’s important to control how much light you’re exposed to, and variance is key: The greater variance of light intensities you expose yourself to between your daytime activities vs. nighttime, the more robust your circadian system will be.
- Reduce blue light: The cells of the SCN are more reactive to blue light (e.g., the light that comes from electronics like your phone, computer or TV screen) than any other type of UV ray. Exposure to blue light at night decreases melatonin (the hormone that helps you sleep) levels and activates your nervous system. Both of these effects lead to decreases in both sleep quality and daytime alertness.
The greater variance of light intensities you expose yourself to between your daytime activities vs. nighttime, the more robust your circadian system will be.
Scheduled meals
Constant consumption of food – or eating at irregular times – can disrupt our circadian function, which can then lead to metabolic syndrome. Even short durations of circadian misalignment can produce pre-diabetic conditions in the body.
Eating your meals at regular, consistent times will regulate and improve your sleep and also your metabolism, thus impacting your overall health.
Eating your meals at regular, consistent times will regulate and improve your sleep and also your metabolism.
Scheduled exercise
Exercising daily at the same time each day can strengthen your circadian system (i.e., improve sleep), speed up the repair of your circadian system, and help readjust it if it gets out of whack due to night shift work, jet lag or perhaps a few dementia-related midnight-wandering episodes.
Scheduled sleep
The brain region that controls sleep is closely intertwined with the SCN and has a bidirectional communication system that’s difficult to disentangle. An irregular sleep schedule weakens the amplitude – or strength – of the periphery body clocks and short-circuits the electrical activity in the SCN, thus causing overall disruption to your circadian rhythm.
Going to bed and waking up at the same time each night and morning, respectively, are critical to the health of your circadian system.
Going to bed and waking up at the same time each night and morning, respectively, are critical to the health of your circadian system.
Your overall health and vitality affect the livelihood of your loved one in every possible way. Their well-being correlates with yours, which means your self-care – and thus sleep – should be a priority. Therefore, instead of considering the four “sleep hygiene” tips listed above as self-indulgent luxuries beyond your reach, consider them another part of your loved one’s care plan.
