How to Handle Dementia-Related Sleep Disturbance

Though dementia is most commonly associated with memory loss, it can touch many different aspects of a loved one’s life. One of the most challenging for caregivers is when a loved one experiences sleep disturbance—such as excessive napping during the day; insomnia; nighttime terrors and anxiety; and difficulty staying asleep without constantly waking up.

Anyone who has ever had a bad night’s sleep knows how stressful sleeping issues can be. Poor sleep can make you feel grouchy, lightheaded and unable to focus throughout the day. It can make you anxious at night that you won’t be able to sleep well again, and the stress continues to build if you repeatedly sleep poorly. The same is true for loved ones with dementia. Sleep disturbance can make them feel stressed and anxious, and can lead to behavior problems. It can also negatively affect you as the caregiver. Providing care for a loved one with sleep disruption is just as stressful, and can also cut into and shift around your sleep schedule.  

Why does dementia cause sleep disruption?

According to Mayo Clinic, around 25 percent of people with dementia experience sleep disturbance. In cases of severe, late-stage dementia, this number increases to 50 percent. But what causes these issues? 

For some, the reasons are the same as those that come along with general sleep disorders experienced by those without dementia, such a sleep apnea, medication side effects, discomfort or other existing conditions like restless leg syndrome.

Others experience a shift in their natural circadian rhythm—the body’s sleep-wake cycle. Research suggests the changes to the brain caused by dementia can disrupt certain processes the body relies on for natural sleep, such as melatonin production. A phenomenon known as “Sundowning” is also commonly seen in people with dementia, which causes increased agitation at night and sometimes even delirium.

To learn more about sundowning, view our overview of the condition and tips to manage it.    

What can I do if my loved one with dementia has trouble sleeping?

An important first step to helping your loved one is recognizing that sleep difficulty is not just a nighttime problem. It can also be impacted by your loved one’s activities during the day. If your loved one is sleeping a lot during the daytime, it may seem like a good thing that they’re making up lost sleep, but this behavior contributes to difficulty sleeping at night. The key is getting your loved one back to a natural sleep-wake cycle, so focus your efforts on building routines that supports activeness during the day and sleep at night. Start by:

• Talking to your loved one’s doctor. They can provide insight as to whether your loved one’s medication or physical condition is contributing to sleep problems. They may also be able to recommend other ways to help based on your loved one’s individual condition. If your loved one is experiencing delirium along with their sleep issues, a doctor should be consulted as soon as possible.
• Sticking to a regular daily schedule. Activities around waking up, eating meals, exercising and going to bed should happen at the same time every day as much as possible
• Limiting caffeine and alcohol
• Keeping your loved one active during the day and early evening, but avoiding activity before bedtime
• Making sure your loved one limits their daytime napping. If a nap is necessary, it should be kept short, to no more than 30 minutes
• Assessing when you schedule meals. Even if your loved one was always a late eater, eating too much before bedtime can make it hard to sleep. On the flipside, early eaters may need a light snack later in the evening so they’re not hungry when they go to bed.
• Creating an environment where your loved one can experience the natural light changes of day and night. For example, during the daytime, your loved one should have some exposure to sunlight to maintain their body’s sleep-wake rhythm, so avoid windowless or heavily curtained rooms. As it gets closer to bedtime, try to avoid brighter lights, so that their body recognizes it’s nighttime.

It can also help to be aware of things your loved one find soothing in moments of distress. Even though the situation can be stressful for you as a caregiver as well, it will help your loved one if you stay calm, talk to them patiently and redirect their attention to something that relaxes them such as gentle music, white noise or a comforting item.  

This article was written as a part of the Expansion of Dementia-Capable Communities within Urban and Rural Settings in Ohio using Evidence-Based and Informed Programming project, funded by the Administration for Community Living, Alzheimer’s Disease Program’s Initiative (#90ADPI0052-01-00). Learn more here.