A structured environment is key to easing some of the sleep-related problems facing people with Alzheimer's disease, said experts at Baylor College of Medicine in Houston.

The most common problem for those with Alzheimer's disease is a fragmented or erratic sleep pattern that usually occurs in the later stages of the illness.

"It is normal to have sleep changes as we age, such as waking up earlier in the morning, going to bed earlier, frequent awakening in the night and a decrease in deep sleep time," said Dr. Susan Rountree, assistant professor of neurology at BCM. "Patients with dementia can have other problems like obstructive sleep apnea or restless leg syndrome that disrupt sleep."

Restless nights

Waking up during the night or not being able to sleep at an appropriate bedtime becomes a problem when the person suffering from Alzheimer's disease is roaming the house, unfamiliar with his or her surroundings.

"A primary contributor to the sleep problem is lack of day time stimulation and opportunities for socialization," said Dr. Mary Kenan, assistant professor of neurology. "If you sleep all day because there is nothing else to do, you'll be up all night."

Many people with Alzheimer's disease struggle to maintain a daily schedule on their own. They may lose the ability to pursue favorite hobbies, and may avoid social settings that can confuse or agitate them. All this can contribute to day time napping which can then lead to wakeful nights.

"Structure and routine needs to be set up through family and friends or a paid caregiver if possible," Kenan said.

Replace naps with activities

Caregivers can help people with Alzheimer's disease avoid erratic sleep habits or night time wakening by establishing a strict bedtime and a definite waking time. They can also help them increase activity during the day. They might consider supervised walks in the park or enrollment in a wellness program specifically for those suffering from dementia.

Rountree says using over-the-counter sleep aids can cause problems. In some cases, she said, they might make the dementia symptoms worse. Certain prescription medications can also worsen problems with memory or confusion and increase the risk of falls in elderly individuals. Giving special attention to sleep hygiene is very important before using medications. Finding a way to keep people with the disorder active during the day and stop napping is the first option families should try.

"Seek a doctor's advice when theses approaches fail," Rountree said.