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Centre for Elderly and Nursing Home Medicine (SEFAS)

The SLEEP.PAIN.DEM study

Does pain treatment improve sleep in nursing home patients with dementia?

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Sleep problems are common symptoms of dementia and pain. Previous studies show that nursing home patients on average spend 13 hours a day in bed, but only sleep ¾ of that time.

The cause of sleep problems is often multifactorial and it is challenging to differentiate between sleep problems due to normal aging, to the presence of pain or depression, or due to dementia. The cause of sleep problems is manifold and complex. Sleep problems in older people have been related to the presence of untreated pain and also to depression. Studies suggest that sleep problems in patients with dementia increase with the severity of pain symptoms. This is further complicated by the demented persons’ reduced ability to communicate their experiences. It is quite possible that some patients receive sleep medication when actually a pain condition is keeping them awake.

Poor quality of sleep is associated with negative consequences, such as reduced memory and reaction time. These functional outcomes can be particularly negative for the elderly, since such symptoms can be misinterpreted as cognitive decline due or a further reduction of their cognitive abilities due to dementia. Previous studies also indicate that sleep problems increase the use of health resources, and reduce quality of life. There is need for further knowledge about how sleep disturbances among patients with dementia are expressed, and how they may be treated.

Method

SLEEP.PAIN.DEM is a randomized, placebo-controlled study which investigates if individual pain treatment has positive effect on sleep in nursing home patients with dementia. Actigraphs are used for registering sleep and circadian rhythm. We have included 108 long-term patients recruited from 47 nursing homes throughout Norway, and started analyzing data.