Disturbed sleep and insomnia are two of the largest concerns voiced by caretakers of elderly individuals dealing with dementia. In fact, according to The National Sleep Foundation, sleep issues are some of the most commonly cited reasons for placing older loved ones in assisted living or institutional settings. Unfortunately, this change in lifestyle often does more to increase the disturbances in sleep, which can in turn lead to increased trouble with dementia. Tied into this cycle of sleep problems and cognitive decline is also the issue of depression, which can be comorbid with both insomnia and depression.

In the hopes of addressing all three of these issues, researchers from the Netherlands Institute for Neuroscience have looked into treatments that affect change in the body's sleep cycle. Their study, which appears in this month's Journal of the American Medical Association, demonstrates that by increasing the test subjects' exposure to light and complementing that added exposure with melatonin, a hormone involved in the sleep cycle, the team was able to improve not only subjects' sleep, but also their cognitive performance as well.

To reach these conclusions, research was conducted over over five years, with a cohort of 189 individuals comprised of 90 percent women, with 87 percent of the overall group having a positive diagnosis for dementia. Groups in each of the twelve participating institutions were assigned to either bright or dim light exposure and nightly doses of melatonin or placebo. Improvements were observed across many areas, including cognitive deterioration, depressive symptoms, a slowing of functional limitations and overall sleep quality. Individuals who received only melatonin did encounter some negative side effects, primarily increased withdrawn behavior, but this was ameliorated by increased exposure to light.

Light exposure, melatonin, and sleep are inextricably linked, so while these results point to a path of potential treatment, it's unclear to what extent the many benefits seen in the study are simply the result of providing seniors with daily life improvements in areas--like exposure to sunlight--that might have been negatively effected with a move into a more structured care environment. Because sleep is so intimately intertwined with our overall health, the restless sleep that accompanies dementia can be like a double-whammy that leads to a downward spiral of illness. Thus, a more aggressive approach to regulate seniors' sleep cycle, as the Netherlands team has employed in their study, would seem a potentially strong response to the problem. The results that the group has encountered are encouraging, and finding more beneficial recipes for improved sleep could lead to real progress in helping to slow cognitive decline and ease many of the issues that face older individuals who have transitioned into institutional settings.