Key Pointers I’ll Be Discussing Today:

• Explore the link between excessive sleep and dementia; stay informed about recent research findings.
• Understand how vascular dementia may impact sleep patterns.
• Explore underlying causes and symptoms of dementia.
• Recognize the connection between sleep apnea and dementia for treatment/management.
• Specific strategies on sleep talking and vascular dementia.
• Learn about management techniques and treatments of sleep disorders like insomnia alongside dementia care.
• Highlight non-pharmacological approaches like lifestyle adjustments to promote sleep.
• FAQs and clear answers on sleep disturbances in dementia.

Are you waking up in the middle of the night recently or experiencing sleep disruptions on a routine basis?  When you face sleeplessness, you may not immediately link that to dementia.

However, I’ve researched on emerging sleep and health news, and I will be discussing in the later sections. As I’ve conducted a detailed research I’ve come to the conclusion that the two may be intertwined.

But which comes first – Dementia or Sleep issues? It’s a bit of a ‘Chicken-and-Egg’ situation. While there’s no definitive answer sleep experts strongly believe that dementia is influenced by sleeplessness and vice versa.

One more interesting fact that I’ve come across is – sleeplessness can be an early symptom of cognitive disorders like Alzheimer’s disease.

I’ve detailed on this fascinating connection in this blog. Let’s start.

[Further on, I’ve prepped a blog on ‘How to combat sleeplessness and fall asleep quickly’. You can give that a quick-read if you’ve time.]

Dementia and Sleeplessness: Bidirectional Impact

There’s a concrete interrelation between sleeplessness and dementia. And this is a topic of growing interest recently.

I’ve done the research for you to explore it.

• Dementia and Sleeplessness

Modern research shows an association between sleep problems and increased risks for dementia or death over an eight-year period.

Individuals who consistently slept fewer than five hours per night were twice as likely to develop dementia compared to those who slept six to eight hours.

• Impact of Dementia on Sleep

People with dementia often experience disrupted sleep patterns. They may struggle to fall asleep, wake up during the night, or feel fatigued upon waking.

It is crucial that you begin to understand this connection, and not overtake it for overall well-being. I’ve mentioned strategies below that can help mitigate risks and improve sleep quality for those around you who are affected by dementia.

New Study On Sleep And Dementia: Updated Findings

1. Case Study 1

In a compelling new study led by Harvard Medical School, over 2,800 individuals aged 65 and older have highlighted a significant connection between sleep duration and dementia risk. The findings are striking:

a) Those who slept fewer than five hours per night were twice as likely to develop dementia and

b) Twice as likely to experience mortality.

The researchers meticulously adjusted for various factors, including age, marital status, race, education, health conditions, and body weight, to ensure the robustness of their results.

2. Case Study 2

Meanwhile, a collaborative effort across Europe, encompassing France, the United Kingdom, the Netherlands, and Finland, has added further weight to the growing body of evidence linking sleep and dementia. This extensive study revealed that:

a) Consistently sleeping six hours or less at ages 50, 60, and 70 increased the risk of developing dementia by 30%.

b) The average age of dementia diagnosis in this cohort was 77 years.

By accounting for socio-demographic, behavioral, cardio-metabolic, and mental health factors, and confirming their findings, the researchers provided a comprehensive analysis of the impact of sleep duration on dementia risk.

3. Case Study 3

Adding another layer to this research, scientists from the University of Surrey and the Dementia Research Institute Center for Care Research & Technology have explored an innovative approach to mitigating dementia risk. They have employed Alpha Closed-Loop Auditory Stimulation (aCLAS) to influence alpha brain rhythms, aiming to enhance sleep quality and potentially reduce the risk of dementia.

4. Case Study 4

Another recent study by American Academy of Neurology (Science Daily) further adds that highly irregular sleep patterns may significantly increase the risk of developing dementia.

Are You Suffering From Dementia and Sleeping a Lot?

Contrary to the findings on dementia and sleeplessness, at times people with dementia often find themselves sleeping excessively during the day. This may be actually due to brain and neural damage caused by the disease.

It’s safe to say that if your patient has dementia and is sleeping a lot it is a symptom of disease progression. What’s more intriguing is that it can lead to sleep disruptions in your nighttime sleep cycle as well.

You’ll notice that as the disease advances, it starts to affect memory, communication, and overall cognitive function. Consequently, tasks that were once routine and easy — such as eating or understanding one’s surroundings start to be exhausting. This can prompt one to more frequent daytime sleep.

I understand that this excessive sleep can understandably worry family members. However, some undetected conditions, sleep disorders and infections can also contribute to frequent sleepiness. If your patient’s sleep patterns have changed suddenly, it’s essential to consult a healthcare provider.

• Vascular Dementia and Excessive Sleeping

Q – What is vascular dementia? The term may seem unfamiliar to some. I’ll be explaining the facts in a simplistic way.

A – Vascular dementia is a condition which is marked by cognitive decline due to impaired blood flow to your brain.  This type of dementia is interlinked with changing sleep patterns.

Here’s my take on vascular dementia and excessive sleepiness:

1. Excessive Sleepiness: If your patient is suffering from vascular dementia they may often experience significant ‘daytime drowsiness’. This symptom can appear even before the full onset of dementia, much like a prelude to the main symptoms of cognitive decline.
2. Affected Circadian Rhythms (Sleep Cycle): Disrupted blood circulation is likely to affect your sleep-wake cycle. You can relate this and imagine a clock with gears slightly out of sync. However, unless accompanied by other concerning symptoms, excessive sleepiness is typically not an urgent medical issue.

Clinical Considerations That You Should Make:

• Physical Health: Prolonged bed rest can lead to muscle weakness or pressure sores, making your vigilance crucial to prevent such complications in your patient.
• Mental Well-being: Excessive sleepiness may worsen other dementia-related symptoms, including confusion upon waking.

If you are caring for individuals with vascular dementia, you need to master the art of patience and vigilance. These two skills are essential to ensure your patient restful nights and overall well-being.

Let’s now learn about the sleep disorders that bear a connection with dementia.

Learn All About Dementia And Sleep Disturbances

Sleep Disorders and Dementia

People with dementia frequently experience a variety of sleep disorders. While common among older adults, these disorders are seen at even higher rates in individuals with dementia.

Here are the most prevalent sleep disorders affecting this population:

1. Obstructive Sleep Apnea (OSA): OSA is marked by the collapse of the airway during sleep, leading to brief lapses in breathing. This condition is particularly prevalent in individuals with Alzheimer’s disease, affecting 40% of patients. Moreover, having OSA increases the risk of developing dementia, highlighting the need for effective management of this sleep disorder.
   Here’s more about sleep apnea and the right kind of bedding to ensure you sleep comfortable all through.
2. Restless Legs Syndrome (RLS): Characterized by an overwhelming desire to move the legs, especially at night, RLS is common in individuals with Lewy body dementia. This condition can significantly disrupt sleep and contribute to insomnia, increased discomfort and restlessness.
3. REM Sleep Behavior Disorder: This disorder causes individuals to act out their dreams, sometimes in dangerous ways. It is most commonly found in those with Lewy body dementia and can often be one of the earliest symptoms of this type of dementia.
4. Depression: Although primarily a mood disorder, depression is closely associated with insomnia and other sleep disturbances. Depression is common in people with dementia and tends to become more pronounced as dementia progresses to more severe stages.
5. Periodic Limb Movement Disorder (PLMD): PLMD causes uncontrollable movements of the arms and/or legs at night. Many patients with PLMD also suffer from RLS, compounding the sleep disturbances experienced by those with dementia.
   Among these let me guide you through some of the most common sleep disorders linked with dementia.

· Dementia And Sleep Apnea

In simple words, Obstructive Sleep Apnea (OSA) is a condition where the muscles in your throat relax during sleep, causing breathing difficulties and resulting in hypoxia. This is the state where your brain doesn’t get enough air. It can lead to sleeplessness as you wake up gasping for breath and fatigue and in the morning.

Now, the important fact here is “having OSA significantly increases the risk of developing dementia”.

Patients with OSA may experience the following symptoms.

1. Problems staying focused
2. Trouble making decisions
3. Slower motor movements, affecting tasks like picking things up and writing
4. Increased risk of developing dementia at an earlier age
5. More serious brain issues
6. Other health conditions, such as stroke, diabetes, and high blood pressure

· Dementia and Sleep Talking

Sleep talking, also known as Somniloquy, can be a symptom observed in individuals with dementia. It is when you talk aloud while asleep, and you can either make simple sounds or engage in complex dialogues.

This behavior is often a result of the changes in the brain associated with dementia, which can lead to a disruption in sleep patterns and at times sleeplessness.

In dementia patients, sleep talking can be accompanied by other sleep disturbances such as:

1. vivid dreams
2. agitation
3. confusion upon waking.

You may notice that your patient talks about imaginary events or responds to non-existent stimuli, which can be a bit disconcerting.

It’s my advice to manage sleep talking by ensuring a calm and safe sleep environment. Again, you should address any underlying medical conditions of your patient. Once identified, consult your healthcare professional over phone or by visiting them for appropriate interventions.

Vascular Dementia & Sleep Talking

During vascular dementia patients suffer from reduced blood flow to the brain. It often leads to a range of sleep disturbances, including sleep talking. During sleep talking your patient starts to verbalize during sleep from simple sounds to complex conversations.

In vascular dementia patients sleep talking may be more pronounced due to the brain’s compromised state. Individuals with vascular dementia might exhibit sleep talking alongside other symptoms too.

Some of these symptoms are:

1. vivid dreams
2. agitation, and
3. confusion upon waking.

You need to first ensure a safe and calm sleep environment and cozy bedding for your patient that can help manage these disturbances.

Symptoms of Dementia

Dementia and sleeplessness are interwoven in a complex pattern. For understanding this you first need to identify the symptoms of dementia. This sleep disorder comprises a range of symptoms associated with cognitive decline severe enough to interfere with your daily life.

Here are the primary symptoms of dementia.

• Memory Loss: One of the earliest and most common symptoms, affecting recent memories and leading to repeated questions and forgetting appointments or events.
• Difficulty in Communication: Struggling to find the right words, follow conversations, or understand language can be significant indicators.
• Confusion and Disorientation: People with dementia often become lost in familiar places and may not recognize familiar faces.
• Difficulty with Complex Tasks: Managing finances, following a recipe, or planning can become challenging.
• Changes in Mood and Behavior: Increased anxiety, depression, paranoia, agitation, and even aggression are common emotional and behavioral changes.
• Impaired Judgment and Problem Solving: Making decisions and solving everyday problems can become difficult, leading to poor judgment and risky behaviors.
• Loss of Initiative: A noticeable decline in motivation, leading to withdrawal from work or social activities.
• Difficulty with Motor Functions: Some types of dementia affect movement, causing unsteady walking, difficulty balancing, or trouble with fine motor skills.
• Visual and Spatial Difficulties: Problems with perception, judging distances, and identifying colors or contrasts can occur, making tasks like driving hazardous.

But behind the symptoms there are certain root causes that need to be identified and eliminated as an early precautionary measure. Let’s learn about them.

Causes of Dementia

There are several types of dementia, each type having specific root causes behind them. I’ll be explaining these types and causes of dementia one at a time. As mentioned earlier, dementia is caused by damage to brain cells that affects their ability to communicate, leading to cognitive decline and impaired functioning.

Let me now mention the several conditions that can lead to dementia.

1. Alzheimer’s Disease: The most common cause of dementia, Alzheimer’s is characterized by the buildup of amyloid plaques and tau tangles in the brain. This causes cell death and brain shrinkage​.
2. Vascular Dementia: I’ve noted on this one before. This type of dementia occurs due to reduced blood flow to the brain, often following a stroke or a series of mini-strokes. The lack of adequate blood flow deprives brain cells of oxygen and nutrients, leading to their death.
3. Lewy Body Dementia: Caused by the presence of abnormal protein deposits called Lewy bodies in the brain, this form of dementia leads to symptoms that overlap with both Alzheimer’s and Parkinson’s disease.​
4. Fronto-Temporal Dementia (FTD): This type involves the degeneration of nerve cells in the frontal and temporal lobes of the brain, which are responsible for behavior, personality, and language​.
5. Mixed Dementia: In some cases, a person may exhibit features of more than one type of dementia, such as a combination of Alzheimer’s and vascular dementia​.
6. Parkinson’s Disease Dementia: Many people with Parkinson’s disease develop dementia in the later stages of the disease due to the spread of Lewy bodies throughout the brain.
7. Huntington’s Disease: This genetic disorder causes the progressive breakdown of nerve cells in the brain, leading to dementia along with movement disorders​​.
8. Creutzfeldt-Jakob Disease: A rare, degenerative brain disorder caused by prion proteins that lead to rapid and severe dementia​.
9. Conditions: Dementia can also be triggered by other conditions such as traumatic brain injury, chronic alcoholism, certain infections (e.g., HIV), and vitamin deficiencies (e.g., B12)​.

Changing Sleep Patterns and Dementia

The changes related to dementia and sleeplessness can be depicted in form of a – U-shaped curve. This simply means that problems arise when your sleep pattern undergoes a change. Either you are sleep deprives or you want to sleep more often.

Changes in sleep patterns are also a common aspect of aging. Notably, sleep pattern changes are more pronounced in individuals with dementia, particularly Alzheimer’s disease.

Our body’s Circadian Rhythm, which regulates our sleep-wake cycle based on environmental cues, is often disrupted in patients suffering from dementia and sleeplessness.

Key Pointers On Changing Sleep Pattern And Dementia:

Circadian Rhythm Disruption

• Dementia leads to changes in the circadian rhythm, affecting the sleep-wake cycle.
• The Supra-Chiasmatic Nucleus (SCN) in the brain, responsible for our internal clock, is damaged in individuals with Alzheimer’s disease, causing irregular sleep patterns.

Sleep Structure Alterations

• People with dementia experience reduced time in deep sleep (slow-wave sleep) and dream sleep (REM sleep). (Learn more about REM sleep in our Video and Blog.)
• They spend more time in lighter sleep stages, which can worsen as dementia progresses.

Comparison with Normal Aging

• Sleep changes in dementia patients are more pronounced and disruptive compared to typical age-related sleep changes.
• Healthy aging adults may experience shifts in bedtimes, longer time to fall asleep, fragmented sleep, and reduced deep and REM sleep, similar to dementia patients but to a lesser extent.

Sleep Duration and Cognitive Decline

• Research indicates a U-shaped relationship between sleep duration and cognitive decline in dementia.
• Both insufficient sleep (less than 7 hours) and excessive sleep (more than 8 hours) are associated with higher risks of cognitive decline.
• Lack of sleep increases levels of Alzheimer’s-related proteins, while longer sleep duration may indicate underlying health conditions impacting sleep quality.

Management and Treatment

• Understanding these sleep pattern changes is crucial for caregivers and healthcare professionals working with dementia patients.
• Managing sleep disturbances can improve quality of life and potentially slow down cognitive decline in individuals with dementia.

Treatment of Sleep Disorders and Dementia

Sleep disorders are common in individuals with dementia, including insomnia, sleep fragmentation, daytime sleepiness, and nighttime agitation.

Dementia and sleep aids for sleep disorders can range from natural methods to medications as I’ve enlisted below.

What Is The Best Sleep Aid For Dementia Patients?

1. Non-Pharmacological Interventions

• Non-drug approaches are often recommended as the first-line treatment for sleep disorders in dementia.
• These interventions include creating a calming bedtime routine, optimizing the sleep environment, promoting daytime activities and exercise, and managing medications that may affect sleep.

2. Melatonin Supplementation

• Melatonin, a hormone that regulates sleep-wake cycles, may be considered as a supplement for individuals with dementia and sleep disturbances.
• It can help promote sleep onset and improve overall sleep quality, especially in cases of sun-downing or delayed sleep phase syndrome.

3. Sleep Medications

• While medications for sleep disorders are generally avoided due to potential side effects and interactions in dementia patients, in some cases, short-term use of sleep aids may be necessary.
• Careful consideration and monitoring by healthcare professionals are essential to balance the benefits and risks of medication use.

4. Light Therapy

• Light therapy, involving exposure to bright light during the day and dim light in the evening, can help regulate the sleep-wake cycle in individuals with disrupted circadian rhythms.
• It is particularly beneficial for those with sun-downing or other nighttime agitation issues.

5. Cognitive Behavioral Therapy for Insomnia (CBT-I) (explained in detail in later section)

• CBT-I focuses on changing behaviors and thoughts related to sleep to improve sleep quality and duration.
• Techniques such as stimulus control, sleep restriction, relaxation training, and cognitive therapy are utilized.

6. Multifaceted Approach

• A multifaceted approach that combines non-pharmacological interventions, light therapy, cognitive behavioral therapy, and judicious use of medications, if needed, is often the most effective strategy for managing sleep disorders in dementia.
• Individualized treatment plans considering the specific sleep patterns and symptoms of each person with dementia are crucial for optimal outcomes.

Dementia & Insomnia Treatment

Insomnia is a common sleep problem in individuals with dementia, affecting both the quality and quantity of sleep. It can lead to daytime sleepiness, irritability, and increased confusion, worsening dementia symptoms.

Here I’ve enlisted some treatment measures of dementia related insomnia in patients.

1. Non-Drug Treatments

• Non-drug approaches are often the first line of treatment for insomnia in dementia.
• These include creating a regular bedtime routine, ensuring a comfortable sleep environment, managing daytime naps, and promoting physical activity during the day.

1. Light Therapy

• Light therapy can help regulate the sleep-wake cycle by exposing individuals to bright light during the day and dim light in the evening.
• This method can be particularly effective for those with disrupted circadian rhythms.

1. Cognitive Behavioral Therapy for Insomnia (CBT-I)

• CBT-I focuses on changing behaviors and thoughts related to sleep to improve sleep quality and duration.
• It may involve techniques such as stimulus control, sleep restriction, relaxation training, and cognitive therapy.

1. Medication Considerations

• Medications for insomnia in dementia are generally avoided due to potential side effects and interactions with other medications. However, in some cases, short-term use of sleep medications may be necessary under medical supervision.

1. Consulting Healthcare Professionals

• It’s essential for caregivers to consult healthcare professionals, such as doctors or sleep specialists, for a comprehensive assessment and tailored treatment plan.

Natural Sleep Aid for Dementia Patients

Natural sleep aids can be beneficial for dementia patients, offering gentle and non-invasive methods to improve sleep quality.

I’d recommend these natural sleep aids for dementia patients.

1. Regular Exercise

• Physical activity during the day can help regulate the sleep-wake cycle and promote better sleep at night for dementia patients.
• Engaging in light exercises such as walking, stretching, or gentle yoga can be beneficial.

2. Establishing a Consistent Sleep Routine

• Creating a regular bedtime routine can signal to the body that it’s time to sleep, helping dementia patients’ transition into a restful state.
• This routine may include activities like taking a warm bath, reading a calming book, or listening to soothing music.

3. Limiting Stimulants

• Avoiding stimulants like caffeine and nicotine close to bedtime can prevent disruptions to sleep for dementia patients.
• It’s essential to monitor the timing and quantity of stimulant consumption throughout the day.

4. Creating a Comfortable Sleep Environment

• Ensuring a comfortable and calming sleep environment is crucial for promoting restful sleep in dementia patients.
• This includes maintaining a cool and dark bedroom, using comfortable bedding, and minimizing noise and distractions.

5. Relaxation Techniques

• Relaxation techniques such as deep breathing exercises, progressive muscle relaxation, or guided imagery can help reduce anxiety and promote relaxation before bedtime.
• These techniques can be especially beneficial for dementia patients experiencing nighttime agitation or restlessness.

6. Herbal Supplements

• Some herbal supplements, such as chamomile tea or valerian root, are believed to have mild sedative effects and can be used as natural sleep aids.
• It’s important to consult with a healthcare professional before using herbal supplements, as they may interact with other medications.

7. Light Exposure

• Exposure to natural light during the day and minimizing artificial light in the evening can help regulate the sleep-wake cycle for dementia patients.
• Light exposure can be enhanced through activities like outdoor walks or spending time near windows during the day.

8. Mindfulness and Meditation

• Mindfulness practices and meditation techniques can promote relaxation, reduce stress, and improve sleep quality for dementia patients.
• These practices focus on being present in the moment and cultivating a sense of calmness and inner peace.

It’s essential to incorporate natural sleep aids into a comprehensive care plan for dementia patients, considering their individual needs, preferences, and overall health.

Top 10 Tips: How to Get Dementia Patients to Sleep at Night?

Getting dementia patients to sleep at night can be challenging. But, it is essential for their overall well-being.

Here are some of my tips to help improve sleep in dementia patients.

1. Tip1: Establish a Consistent Sleep Schedule

Encourage a regular sleep-wake cycle by setting consistent bedtimes and wake-up times for dementia patients. Consistency helps regulate the body’s internal clock and promotes better sleep quality.

2. Tip 2: Create a Calming Bedtime Routine

Develop a relaxing bedtime routine that includes calming activities such as reading a book, listening to soothing meditative music like green noise, or taking a warm bath. Avoid stimulating activities or screens/blue light (e.g., TV, smartphones) close to bedtime, as they can interfere with sleep.

Read all about the effects of blue light on sleep.

3. Tip 3: Optimize the Sleep Environment

Ensure the bedroom is comfortable, quiet, and conducive to sleep for dementia patients. Use blackout curtains, white noise machines, or earplugs to minimize disturbances during the night.

4. Tip 4: Promote Daytime Activity

Encourage physical activity and engagement in stimulating daytime activities for dementia patients. Regular exercise can help regulate sleep patterns and improve overall sleep quality.

5. Tip 5: Limit Daytime Napping

Limit daytime naps to short durations and avoid late afternoon or evening naps that can disrupt nighttime sleep. Encourage your patients to engage in daytime activities to reduce excessive daytime sleepiness.

6. Tip 6: Monitor Medications

Review medications with healthcare providers to identify any that may interfere with sleep or contribute to nighttime awakenings. Adjust medication timing or dosage as necessary to minimize sleep disturbances.

7. Tip 7: Address Anxiety and Agitation

Manage anxiety, agitation, or nighttime restlessness in dementia patients through relaxation techniques, such as deep breathing exercises or mindfulness practices. Address underlying causes of anxiety, such as discomfort or unfamiliar environments.

8. Tip 8: Consider Light Therapy

Light exposure during the day, especially natural sunlight, can help regulate the sleep-wake cycle for dementia patients. Exposure to bright light in the morning and dim light in the evening can promote better sleep at night.

9. Tip 9: Consult Healthcare Professionals

Work closely with healthcare providers, including doctors and sleep specialists, to address sleep issues in dementia patients. Individualized treatment plans and strategies may be necessary based on the specific needs and challenges of each patient.

10. Tip 10: Invest in Quality Bedding

Ensure that the bedding and mattress are comfortable and supportive for dementia patients. Invest in quality pillows, mattress toppers, and bedding materials that promote restful sleep and reduce discomfort.

I’d advice to choose an organic Latex mattress that is hypoallergenic, breathable, and temperature-regulating to create a conducive sleep environment for your patient.

FAQs on Dementia and Sleeplessness

1. What are signs that dementia is getting worse?

Late-stage dementia signs include speech reduced to single words or nonsensical phrases, limited understanding, needing help with most daily activities, eating less, difficulties swallowing, and incontinence.

2. In what stage of dementia do you start facing sleep disturbances?

Sleep disturbances are common in dementia, affecting up to 25% of those with mild to moderate dementia and 50% of those with severe dementia. These issues worsen as dementia progresses.

3. Why do dementia patients not sleep?

Dementia can disrupt the brain’s production of melatonin, a hormone that regulates sleep. As dementia advances, the brain may produce less melatonin, making it harder to fall asleep.

4. What helps dementia patients sleep?

To help dementia patients sleep, keep lights low, reduce noise, play soothing music, establish a consistent bedtime, and consider a calming bedtime routine like reading aloud. Limit caffeine intake.

Disclaimer

The information in this article is for general informational purposes only and is not medical advice. Consult a qualified healthcare professional before making changes to your sleep habits or routines. The tips and recommendations provided are based on general best practices and may not suit everyone. Individual responses to dementia and sleeplessness may vary. Use of apps or devices mentioned is at your discretion. Our editorial team does not endorse any specific products or brands.         

References

1. Wennberg, A.M., Wu, M.N., Rosenberg, P.B. and Spira, A.P., 2017, August. Sleep disturbance, cognitive decline, and dementia: a review. In Seminars in neurology(Vol. 37, No. 04, pp. 395-406). Thieme Medical Publishers.
2. Pase, M.P., Harrison, S., Misialek, J.R., Kline, C.E., Cavuoto, M., Baril, A.A., Yiallourou, S., Bisson, A., Himali, D., Leng, Y. and Yang, Q., 2023. Sleep architecture, obstructive sleep Apnea, and cognitive function in adults. JAMA network open, 6(7), pp.e2325152-e2325152.
3. Kinnunen, K.M., Vikhanova, A. and Livingston, G., 2017. The management of sleep disorders in dementia: an update. Current Opinion in Psychiatry, 30(6), pp.491-497.
4. Wong, R. and Lovier, M.A., 2023. Sleep disturbances and dementia risk in older adults: findings from 10 years of National US prospective data. American Journal of Preventive Medicine, 64(6), pp.781-787.