Fatigue a predictable response to dementia!

While counseling families, or in my support groups, I hear it time and again: “Why does my loved one with dementia sleep so much?” If we understand the nature of brain change caused by dementia, the need for more rest is predictable and logical.

Let’s revisit the basics: By definition, dementia is caused by the destruction of our brain at a cellular level. The brain is actually dying and shrinking. It’s external size gets smaller, and cavities appear inside the brain, interrupting the connections needed to process information. During the progress of Alzheimer’s disease, for example, an adult brain will shrink and decline in weight from three to one pound! Basically, as the disease progresses, our person with dementia has less “processing matter” to work with, and each basic task of daily living – including thinking – becomes harder, sapping available energy.

The same thing happens on a much smaller scale among aging people who do not have dementia. Even when disease-free, our brain shrinks with age and our cognitive ability may decline, but not to the degree that impedes our ability to function. Still, while just getting through the day, we are trying to do the same with less, and this results in fatigue. Thus, many septa- and octogenarians take naps. We accept this as normal.

But our person with dementia is experiencing brain change more severely and at an accelerated rate. As their disease progresses, their brain must work harder to get results. The erosion of their senses makes it more difficult to tolerate or “shut out” noise and distraction. They have a harder time processing and making sense of the information that enters through their eyes and ears. The small daily activities that require manual dexterity become harder – even impossible — to do.

As a result, a person with dementia may find it quite exhausting to perform routine tasks like communicating, eating, grooming, or trying to understand what is going on around them. Very simply, it wears them out! Fatigue sets in, and they need more rest just to get through the day.

As care partners, we should not be so concerned, or try to interfere with their need to take naps. It is what they need, and in the end it gives us respite as well. Can it worry us? Yes, but certainly not more than the disease itself.

A second factor may include the onset of depression caused by dementia. It is estimated that 40 percent of people with Alzheimer’s disease suffer from significant depression. One of the common emotional responses to depression is to just “shut out” the world. We sleep to avoid, or to find relief from the stress and psychic pain that comes with depression.

Your loved one is sleeping more as a natural response to Cognitive Fatigue. Cognitive fatigue is a unique kind of tiredness. It is a common problem that can happen after a mild, moderate, or severe brain change. As a result, our brain has to work harder to concentrate on tasks it used to perform with ease. The need for rest, respite, and more sleep in a natural response.
Consistent with the basic principles of Validation Therapy, try to give your loved one what they need, including rest and time to recoup. We do this because we all deserve the best.

Until next time remember: “We all deserve the Best”
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