Addressing Sleep Disturbances in Dementia Patients

It can be difficult to manage sleep disturbances in dementia patients as a caregiver. Dementia-related sleep disturbances may include changes such as insomnia and restless nights. These changes often lead to daytime drowsiness and increased mood swings, leaving both patients and caregivers feeling exhausted. If unaddressed, sleep problems could exacerbate cognitive decline, cause mood swings, and impact overall quality of life.

Understanding why these disturbances occur and learning strategies to manage them can positively impact the lives of both caregivers and those living with dementia.

Sleep problems are common in dementia due to changes in the brain that affect the body’s internal clock, known as the circadian rhythm. This internal clock helps regulate the sleep-wake cycle, which can become disrupted in people with dementia. As a result, dementia patients may experience confusion about time. This confusion makes it difficult to differentiate between day and night.

Additional factors that contribute to sleep disturbances include:

• Age-related sleep changes: As people age, they spend less time in deep sleep and are more likely to wake up during the night. Dementia amplifies these natural changes.
• Reduced activity during the day: If a person with dementia is less active, they may feel less tired at night, making it harder to fall asleep.
• Medications: Certain medications used to treat dementia symptoms or other conditions (e.g., anxiety, depression, pain) may interfere with sleep.
• Sundowning syndrome: Sundowning refers to increased agitation, confusion, and restlessness in the late afternoon or evening, which can prevent restful sleep.
• Physical discomfort: Conditions like pain, incontinence, or breathing issues (such as sleep apnea) can also disrupt sleep.

Dementia-related sleep disturbances can manifest in different ways, including:

• Insomnia: Difficulty falling asleep or staying asleep is common. Dementia patients may spend hours awake during the night, which can leave them feeling tired and irritable during the day.
• Frequent awakenings: Some individuals may wake up multiple times throughout the night, unable to settle back into sleep, which can be stressful for both the person and the caregiver.
• Daytime napping: Those with dementia often struggle to maintain a regular sleep schedule, leading to excessive daytime napping and further disrupting nighttime sleep.
• Sleep apnea: A condition that causes breathing to stop and start repeatedly during sleep. Sleep apnea is more common in older adults and can worsen dementia symptoms if left untreated.
• Restlessness or wandering: Some individuals may become restless or even try to leave the house during the night, putting themselves at risk of injury.

Addressing sleep disturbances in dementia patients requires patience and a multi-faceted approach. Implementing consistent routines and making environmental changes can help improve sleep quality. Here are some strategies that can make a difference:

Establish a Consistent Sleep Routine
Creating a regular sleep schedule is essential for managing sleep disturbances. Encourage your loved one to go to bed and wake up at the same time every day, even on weekends. Limit daytime naps to help maintain this routine.

1. Increase Daytime Activity
   Engage your loved one in physical and mental activities throughout the day to tire them out and promote better sleep. Walking, light exercises, or spending time outdoors can improve sleep by promoting relaxation and regulating the body’s circadian rhythm.
2. Optimize the Sleep Environment
   A calm, safe, and comfortable sleep environment is crucial for better rest. Dim the lights, reduce noise, and ensure the bedroom is at a comfortable temperature. Consider using blackout curtains or a white noise machine to minimize disruptions.
3. Manage Light Exposure
   Exposure to natural sunlight during the day helps regulate the sleep-wake cycle. Try to increase exposure to natural light in the morning and reduce exposure to bright lights, including screen time (TVs, smartphones, tablets), in the evening.
4. Address Underlying Medical Conditions
   Some sleep problems are the result of untreated medical conditions like sleep apnea, pain, or frequent urination at night. Consult with a healthcare provider to address these issues. Treatment of these conditions may involve the use of medications, assistive devices, or changes in diet and hydration habits.
5. Monitor Medications
   Review your loved one’s medications with their healthcare provider to identify any that may be contributing to sleep disturbances. If certain medications are interfering with sleep, ask if adjustments can be made, such as changing the time of day they are taken.
6. Consider Melatonin or Other Sleep Aids (With Caution)
   Some caregivers find that melatonin supplements can help regulate sleep in dementia patients. However, always consult a healthcare provider before introducing any new medication or supplement, as some sleep aids may interact with dementia medications or exacerbate confusion.
7. Address Sundowning Behaviors
   If your loved one is exhibiting sundowning behaviors, establishing a calming pre-sleep routine can help. Gentle activities such as reading, listening to soothing music, or having a warm bath can signal that it is time for sleep.

It’s important to remember that sleep disturbances in dementia patients can have a significant impact on caregivers as well. Sleep deprivation can lead to stress, burnout, and health issues for caregivers. Don’t hesitate to seek support, whether through family, friends, or professional respite care services. Prioritizing your own well-being is crucial to providing effective care for your loved one.

If your loved one is a GUIDE participant, consider utilizing your respite care benefits or attending a Memory Connect caregiver support group. Click here to learn more about GUIDE benefits and how to enroll.

National Institute on Aging. (2020). Sleep Changes and Alzheimer’s Disease. National Institutes of Health. Retrieved from https://www.nia.nih.gov/health/sleep-changes-and-alzheimers-disease

Mayo Clinic. (2023). Alzheimer’s and Sleep: Managing Sleep Problems. Mayo Clinic. Retrieved from https://www.mayoclinic.org/diseases-conditions/alzheimers-disease/expert-answers/alzheimers-sleep-problems/faq-20057824

Cleveland Clinic. (2021). Sleep Problems in Alzheimer’s Disease. Cleveland Clinic. Retrieved from https://my.clevelandclinic.org/health/diseases/9635-alzheimers-disease-sleep-changes