Why people with dementia’s sleep is affected and how you can help.
Experts aren’t exactly sure why, but changes in the brain that occur with Alzheimer’s disease and other forms of dementia often lead to sleeping problems.
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Those with Alzheimer’s and dementia sometimes lose awareness of the time of day, so getting them to bed at night can be challenging. Up to 20% of people with Alzheimer’s also experience late-afternoon confusion and agitation, known as sundowning, and many others with dementia experience nighttime restlessness and sleep cycle changes. Some medications also have side effects that can impact sleep, and all together, these factors can make bedtime a difficult part of the day for caregivers.
If you’re caring for a person with Alzheimer’s or another form of dementia, try these tips to help them sleep better.
Creating a regular daily schedule for people with Alzheimer’s or dementia can help them sleep more restfully at night, says Ruth Drew, director of information and support services at the Alzheimer’s Association.
“As much as possible, try to establish a routine including consistent times for waking up, eating meals and going to sleep,” Drew says.
2. Promote daytime activity
To encourage restful sleep, keep the person’s days active, Drew suggests. Research has proven that walking during the day can help people with Alzheimer’s or dementia sleep better at night.
“Discourage afternoon napping and plan more challenging activities such as doctor appointments, trips and bathing in the morning or early afternoon,” Drew says.
Judy Berry, founder of Dementia Specialist Consulting and founder and past owner of Lakeview Ranch Inc., a residential care centre for people with dementia, emphasises the importance of addressing emotional and spiritual needs in addition to physical needs. She suggests building activities into everyday moments to help seniors find meaningful purpose each day.
“It’s not just about the planned activities; it’s about engaging them in conversation throughout their daily activities, including bathing, dressing, toileting, eating, etc.,” she says. “Finding opportunities for them to help you or others and contribute something will keep them from sleeping in a chair.”
She says this could look like spending time with animals or small children, playing instruments, listening to music, making art or spending time outdoors. Or you could have the loved one help you prep or clean up meals to keep them engaged and active, she says.
3. Get out in the natural light
Exposure to bright outdoor light during the daytime can help people with Alzheimer’s or dementia keep their circadian rhythm (the body’s inner clock) on track, helping them to better recognize when it’s time to go to bed.
Exposure to natural light can also help with mood, Berry says. If the person isn’t able to go outside due to their abilities or the weather, she recommends making sure they have exposure to plenty of natural light via windows. She built her residences with full ceiling skylights and big windows and found that even in the Minnesota winter, it provided beneficial light. For older adults who can’t go outside or live in dwellings without much natural light, you can try using a light therapy box that simulates sunshine to help recreate natural light indoors.
4. Customise a calming environment
Having a relaxing routine can help people with Alzheimer’s or dementia sleep — and stay asleep — easier. But this should be individualized to the person’s wants and needs. For example, Berry says, some people may feel relaxed by lowering lights, and others might enjoy a glass of milk. And while some people may feel calmed by music, other people might be irritated by it. Additionally, some people with dementia sleep best in a dark room while others get scared by the dark and prefer night lights, Berry says. Find out what helps soothe your loved one and make them feel secure at bedtime, she explains.
5. Prepare for sundowning
“People with dementia may experience increased confusion or agitation in the late afternoon; this is sometimes referred to as ‘sundowning,’” Drew says.
If you keep your home well lit as the sun goes down, it can help reduce agitation since dark shadows can make the surroundings more confusing for those with dementia, she says.
6. Limit caffeine intake
Too much caffeine during the day can interfere with sleep at night for anyone, but this is especially true for people with Alzheimer’s. Caregivers should help their loved ones limit their caffeine consumption during the day to sleep easier at night. Nicotine and alcohol can also be stimulating, so try to reduce or eliminate their intake of those substances, as well.
7. Make sure you’re rested
While you may be pouring your energy into caring for your loved one, don’t forget about your own needs, too.
“It is also important for caregivers to consider their own energy levels and make sure they are getting adequate rest,” Drew says. “If a caregiver is stressed or exhausted at the end of the day, the person they’re caring for may pick up on this and exhibit agitation themselves.”
8. Change your expectations
Caregivers typically have the perception that it’s a problem if someone with dementia doesn’t want to sleep at a “normal” time, but Berry says it’s unwise to force seniors to sleep when we think they should.
“Seniors with dementia are always fighting for their independence, respect and dignity when it appears someone is forcing them to do what they don’t want to do,” she says, such as going to bed or the toilet when we think they should.
Everyone has different circadian rhythms, she says, and the person might be restless for reasons that aren’t immediately visible.
“Persons with dementia are always whole human beings with feelings and emotional needs, and choice is a basic human right,” she says.
If someone is resisting bedtime, there’s usually an unmet need that isn’t being seen, whether it’s fear of an unfamiliar place or person, darkness or feeling unsafe.
If your loved one doesn’t want to go to bed or wakes up in the middle of the night and doesn’t want to go back to sleep right away, stop viewing this as a problem, Berry says.
“Offer them a snack and a cup of tea and ask for their help with your chores, or just sit and talk and listen to them,” she says. “You will learn a lot, and most times they will go back to bed willingly. You should always be trying to identify their emotional need and validate their feelings.”
9. Don’t overlook medical issues
If you are still concerned about the person’s sleep problems, speak to their doctor, Drew says.
“There are a number of medical issues, such as urinary tract infections, incontinence problems or sleep apnea, that can disturb sleep but can be treated with medical attention,” she says.
10. Ask about medication
Non-drug approaches are preferable, Berry says, especially because commonly prescribed psychotropics can have severe negative side effects for those with dementia. She recommends trying melatonin, an over-the-counter hormone that helps some people with sleep.
If none of these measures work and you’re feeling exasperated, a doctor might be able to prescribe a medication to reduce late-afternoon agitation and/or help them sleep. While medications can trigger other side effects, they can be helpful in desperate times for both caregivers and their loved ones to establish a sleep routine. Caregivers should consult their loved one’s primary care doctor or neurologist to determine the best treatment and course of action.
11. Consider getting outside help
If you’re the sole caregiver of a loved one with Alzheimer’s or dementia, it can be exhausting, especially if they have frequent nighttime awakenings.
For family caregivers, “sometimes it becomes necessary to hire a home care aide who stays up at night and can just be with [the senior] when they want to get up and [who] does not rush them back to bed,” Berry says.
At her facility, she had an open bed so families could drop off their loved one to stay overnight. Whether or not the senior slept, it provided the family caregiver some much-needed sleep and respite, and they were able to pick up their loved one in the morning, Berry says. See if there’s a facility in your area that offers this service.
While nighttime can feel like a struggle for those caring for loved ones with Alzheimer’s or dementia, know that these changes can make a massive impact, and plenty of help and resources are out there if you need them.
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