Sleep and dementia

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By Mark Eric Dyken MD and Kyoung Bin Im MD

In dementia, degeneration of central sleep-wake mechanisms frequently leads to sleepiness and insomnia with sundowning. Violent dreams and REM sleep behavior disorder can herald a synucleinopathy when degeneration affects brainstem motor systems. In some cases, it has been speculated that sleep apnea might result from degeneration of medullary respiratory centers. The optimal treatment of sleepiness and insomnia associated with sundowning has not been well-established as many medications have risks that outweigh their benefits; however, REM sleep behavior disorder often responds to clonazepam, and continuous positive airway pressure therapy can improve cognition in some cases associated with obstructive sleep apnea.