Why Do Dementia Patients Have Bad Dreams?

We all dream, regardless if we remember what we dreamt or not. There are many theories associated with dream content, but when it comes to certain categories, such as nightmares or recurring dreams, specific conditions can influence what we experience while we sleep.

While focusing on nightmares, for instance, there appears to be a link between these frightening dreams and conditions such as depression and obstructive sleep apnea. Why does  this occur and how do dreams influence dementia patients?  Is there something you can do to intervene?

The Link Between Bad Dreams and Dementia

Although dementia is complex, accounting for a number of conditions, one thing is certain — the brain and one’s level of cognitive functioning are negatively affected. One area that is significantly affected throughout the progression of dementia, is sleep. Perhaps you can relate?

At this time, scientists are not exactly sure why sleep disturbances occur among this population. With that being said, sleep is a highly complex phenomenon that is most certainly rooted in neurologic function — and due to degenerative effects, it’s not surprising that dementia would affect one’s sleep cycle.

Although nightmares can increase across all dementia patients, bad dreams tend to be highly prevalent among patients with Lewy body dementia. In many cases, sleep disturbance may be apparent years before a diagnosis is made — which we will discuss below.

Among this population, the most common sleep disturbance are nightmares, accompanied by violent movements. They may try to act out their nightmares, hitting or yelling in fear. This is what’s known as RBD — rapid eye movement sleep behavior disorder.

Do You Suffer From REM Sleep Behavior? You May Be At Risk

Based on evidence-based research, it’s tough to ignore the strong link between those who physically act out their dreams and their overall risk of dementia. In fact, it was found that middle-aged men who were physically active during their dreams, known as REM sleep behavior, were five times more likely to develop dementia.

While focusing on the men who do suffer from this disorder, up to 80 percent will go on to develop dementia. Although we often focus on Alzheimer’s, as mentioned, this phenomena is associated with the condition known as dementia with Lewy bodies — the second most common form of dementia.

In fact, within one study, it was found that thirty-four of 37 patients with both dementia and RBD, met the criteria for dementia with Lewy bodies. In comparison, Alzheimer’s does not appear to be commonly associated with this disorder — although these patients experience other sleep-related symptoms, such as sundowning.

Within one review, published in Drugs & Aging, it was stated that the estimated prevalence of this disorder in adults is around 0.4-0.5%, however, the frequency is significantly higher in those with Lew body dementia and Parkinson’s. Researchers believe that this disorder occurs due to a lack of normal REM muscle atonia, as well as a lack of normal suppression of locomotor generators.

Based on the research, it appears that RBD may be a clear indicator, predating the onset of neurodegeneration by several years. After the onset of this disorder, the five-year risk of developing a neurodegenerative condition after onset ranges anywhere from 18 to 45 percent. When aiming to address this disorder, clonazepam is generally prescribed, followed by melatonin.

How Medication Influences Sleep

Speaking of drugs, medication is also a key area of interest, as various drugs can influence sleep quality. Moving away from dementia with Lewy bodies, individuals suffering from any level of cognitive impairment which requires medication, are at risk for drug-induced nightmares.

Within one study, Alzheimer’s patients were examined in terms of nightmare development. Since this disease causes a loss of cholinergic function in the brain, the acetylcholinesterase inhibitor, known as donepezil, was administered. Although this drug can improve cognitive performance, it also influences sleep quality and the manifestation of dreams.

Researchers found a clear association between nightmares and an evening dose of donepezil among Alzheimer’s patients. In comparison, when the dose was taken in the morning, none of these patients reported nightmares — meaning, the time of intake is relevant. It was concluded that donepezil activates the visual association cortex during REM sleep.

This has also been seen among patients with MCI — mild cognitive impairment. It has been concluded that the use of donepezil may cause over-activation of the cholinergic nervous system, resulting in more severe and frequent sleep issues. If you’re concerned about any medications currently prescribed to you or your loved one, speak with your physician.

Also, if you or your loved one suffer from any comorbid conditions and take a number of medications, these drugs are known to induce nightmares and insomnia:

• Alpha-blockers — Used to treat high blood pressure, as they help relax muscles and improve blood flow. Some examples include alfuzosin, prazosin, doxazosin, and silodosin.

• Corticosteroids — Used to treat inflammation, targeting conditions such as arthritis, lupus, and gout. Some examples include cortisone, methylprednisolone, prednisone, and triamcinolone.

• Cholinesterase inhibitors — As mentioned, these dementia drugs are used to treat memory impairment and mental fluctuations. Examples include donepezil, galantamine, and rivastigimine.

• Statins — Used to treat high cholesterol — examples include atorvastatin, lovastatin, rosuvastatin, and simvastatin.

Of course, each individual patient is unique, but it appears that bad dreams may be caused by a combination of factors. As the brain deteriorates, it’s clear that sleep is affected — whereas the medications prescribed for problematic symptoms may increase the severity and frequency of bad dreams.

If you sleep in a bed with your partner, who suffers from RBD, for instance, you need to address any safety concerns. When individuals violently act out dreams, they may place their partner or themselves at risk. Meaning, modifying the sleep environment is highly recommended. For example, move the bed away from the window and remove any objects that may cause harm.

Continue to work with a physician to continually implement the best possible treatment plan, while remaining mindful of any symptoms that need to be more thoroughly addressed — as well as the selection of dosage of all currently prescribed medications.

References:

https://www.ncbi.nlm.nih.gov/pubmed/15630600
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2649672/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2954417/
http://onlinelibrary.wiley.com/doi/10.1111/j.1440-1819.2006.01474.x/full