Alzheimer's disease’s Insomnia

Jeonghyun Choi^*
*Correspondence: Jeonghyun Choi, Department of Rehabilitation Science, Graduate School of Inje University, Gimhae, 50834, Republic of Korea, Email:

Introduction

One of the most prevalent forms of dementia, Alzheimer's disease affects a sizable portion of those over 65. It has been determined that sleep disturbance is a very common occurrence in people with the neurodegenerative disease, with possible adverse effects on health, quality of life, cognition and caregiver dynamics. Recent research suggests that sleep deprivation may contribute to the pathophysiology of Alzheimer's disease, making insomnia a potential target for slowing the course of the illness. In general, diagnosing and treating sleeplessness may be difficult and people with Alzheimer's disease sometimes have additional complications. Data on treatments are often scarce. However, there are several non-pharmacological and pharmaceutical therapies that may be taken into account for therapy [1].

Description

Biological, psychological and social variables frequently combine to impact insomnia, which is a common but complicated sleep condition characterised by difficulties getting or staying asleep as well as daytime repercussions. The stresses associated with the illness that come from these possibly contributing domains might cause sleep to be even more disturbed in the context of Alzheimer's Disease (AD). Sleep-related biological structures and processes can be changed by alterations in neuronal architecture brought on by the buildup of neurofibrillary tangles made of misfolded -amyloid (A) and hyperphosphorylated tau proteins. Decreasing social signals and alterations in living conditions might impair circadian entrainment, compromise sleep hygiene and aggravate emotional states, all of which have an adverse effect on one's capacity to fall asleep [2]. The already difficult challenge of controlling insomnia may become even more difficult with age and AD due to a rise in concomitant sleep disorders and medical illnesses.

For good physical and mental health, sleep has to be met in both amount and quality. Disrupted sleep has been shown to affect cognitive performance, raise the risk of other poor health outcomes, such as cardiovascular disease and significantly influence quality of life. These are already areas of worry with ageing in general and AD adds even more reason for concern. Treatment of sleep disturbance in this population is even more crucial given the increasing body of data that suggests that poor sleep quality might worsen the underlying illness process that contributes to AD [3].

Due to the subjective character of symptoms and the often degraded perception of sleep disturbance in the context of dementia, diagnosing and tracking the effectiveness of treatment in instances of AD and insomnia might be more challenging than in the general population. This affects the results of both clinical and academic studies. Objective measurements might be challenging to determine, hence proxy indicators of sleep disturbance using technologies like actigraphy are frequently used. The caretaker's perspective throughout the history may be useful and the conversation may include an assessment of how the patient's symptoms may affect the caretaker-patient bond [4].

The first line of treatment for insomnia is non-pharmacological. Along with identifying and treating other sleep and medical comorbidities that contribute to sleep disturbance, it is important to address lifestyle and sleep hygiene issues. Based on its long-term efficacy and usually benign side effect profile, Cognitive Behavioral Therapy for Insomnia (CBT-I) is the most effective therapy for insomnia. This probably also applies to AD patients, however occasionally effectiveness may be constrained by cognitive function. In certain trials, nonpharmacological treatments like bright light therapy have shown some promise for improving symptom severity.

Certain clinical situations that may occur during the treatment of insomnia may call for the consideration of pharmaceutical interventions. This may be a feasible scenario given the increased difficulties associated with sleep disturbance in AD, yet prescription methods also call for greater prudence in light of potential side effects in this group. Melatonin, tricyclic antidepressants, nonbenzodiazepine receptor site-specific -aminobutyric acid agonists, herbal and over-the-counter substances are some of the substances with historical clinical use. However, there is only weak quality evidence to support their use for insomnia in the general population and even less information is available regarding patients with AD. Suvorexant, a newer drug in the dual orexin receptor agonist (DORA) family, has FDA approval for treating insomnia in mild-to-moderate Alzheimer's disease (AD), although further research is needed to strengthen this claim and offer usage recommendations [5].

Conclusion

Sleep disturbance in AD is still a challenging but important problem. It offers a chance to enhance both patient and caregiver quality of life, maybe enhance general health and cognitive function and perhaps even slow the advancement of underlying disease pathology. The etiologies and methods of treating insomnia in the general population can be complex and AD offers additional potential aggravating variables to take into account. The cornerstone of treatment for insomnia in AD should be non-pharmacological therapies; however, doctors have access to a number of pharmaceuticals if supplementary therapy is required if behavioural approaches are impractical or ineffective because of dementia or other disease-related variables. Individualized treatment plans for specific patient situations are recommended, along with careful observation of the outcomes of therapies. To better guide care and advance the capacity to enhance sleep in AD, further research and evidence supported by high-quality randomised placebo-controlled trials are required.

Acknowledgement

None.

Conflict of Interest

No potential conflict of interest was reported by the authors.

References

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