Dementia and Sleep: Tips for Helping Your Loved One With Dementia Sleep Better

Dementia and sleep problems often go hand in hand. The connection between dementia and sleep is a common source of stress for family caregivers. When your loved one with Alzheimer’s disease or another form of dementia doesn’t sleep well, you probably don’t get enough sleep either.

Read on to understand the causes of sleep problems in people with dementia and get tips for better sleep.

Common sleep problems in people with dementia

Sleep changes are common in older adults with and without dementia. Many seniors experience changes in the quality of their sleep, the number of hours they sleep, and how much time they spend awake at night. In fact, older adults’ total sleep time decreases by about 30 minutes per decade starting in middle age.

Sleep problems are even more common in people with dementia. The type and severity of sleep disturbances may vary depending on the cause of your loved one’s dementia and the stage of their disease. Sleep problems associated with dementia tend to get worse as the disease progresses.

Your loved one with dementia may experience the following sleep problems:

• Difficulty maintaining or falling asleep, which can be caused by insomnia, problems with the sleep cycle, side effects of medication, or other factors.
• Sundown syndrome, which is common in people with Alzheimer’s and other forms of dementia, can contribute to problems with sleep. Sundown syndrome refers to increased confusion, agitation, anxiety, and aggression in the evening or during the night.
• Problems with movement during sleep, such as restless legs syndrome — which is characterized by an uncomfortable urge to move the legs during periods of rest — or rapid eye movement (REM) sleep behavior disorder, which makes people act out their dreams.
• Breathing disorders during sleep, such as sleep apnea, which affects about 50% of people with Alzheimer’s.

Do people with dementia sleep a lot during the day?

Some people with dementia sleep excessively during the daytime. They may feel like they can’t stay awake, and they may take long naps that interfere with nighttime sleep and overall quality of life.

Excessive daytime sleepiness is more common in people with Parkinson’s disease dementia or Lewy body dementia than in those with Alzheimer’s. Some factors that may contribute to excessive daytime sleepiness include:

• Insufficient sleep at night
• Sedating medications
• Damage to brain cells caused by dementia
• Changes in sleep pattern caused by dementia
• Mental health conditions, such as depression
• Other sleep disorders, such as sleep apnea

Dementia and sleep problems: causes

Researchers and doctors don’t understand exactly why dementia affects sleep, but up to 70% of people with cognitive impairment have sleep disturbances, according to a review of studies on disturbed sleep and dementia. Changes in the brain associated with dementia seem to affect the structure of sleep and the circadian rhythm, which helps regulate the physical, mental, and behavioral changes the body goes through in 24 hours.

Other factors that may contribute to poor sleep in dementia include:

• Less exposure to sunlight, which affects the sleep cycle
• Physical or mental exhaustion at the end of the day
• Chronic pain
• An environment that is inadequate for sleep, such as a noisy or bright room before bedtime
• Medication side effects
• Diet, such as excessive caffeine or alcohol

Sleep problems in people with dementia often have multiple causes. Talk to the doctor about your loved one’s specific symptoms. The doctor may have questions about your parent’s sleep habits, medications, diet, and any other health conditions to diagnose what’s disrupting their sleep.

How to get dementia patients to sleep at night: 8 tips for better sleep

If you’re caring for a family member with dementia, improving sleep is probably a priority. Adequate rest can improve your loved one’s mood, health, and quality of life — and your own. Here’s how you can help your family member with dementia get a better night’s sleep.

1. Treat pain and other medical conditions. Treating chronic pain may help improve your loved one’s sleep. If a condition such as sleep apnea or restless legs syndrome is disturbing your parent’s sleep, seeking medical treatment may also help.
2. Create a soothing environment. Make sure your loved one’s room is set up to promote good sleep. The room should be dark, quiet, and cool (between 60 and 67 degrees Fahrenheit).
3. Check for medication side effects. Many people with dementia take several medications. Some of these drugs, such as stimulants or diuretics, can interfere with sleep. In some cases, it’s possible to switch medications or change the time of day a certain drug is given to help improve sleep.
4. Encourage physical activity during the day. Help your loved one with dementia get some exercise each day. For example, you make take a walk together each morning. It’s best to schedule physical activity early in the day, because being excessively tired in the evening may increase agitation.
5. Get some sunlight. Get outside or into bright lights soon after waking up in the morning to help regulate the sleep cycle. Dim the lights in the evening when it’s close to bedtime.
6. Establish a sleep schedule. Try to get your loved one to go to bed at the same time each night. Creating a calming bedtime routine may also help. For example, you may dim the lights and play soothing music before bedtime.
7. Limit daytime naps. Sleeping excessively during the day can contribute to poor sleep at night.
8. Avoid stimulants. Caffeine, alcohol, and nicotine may disrupt sleep.

Sleep aids: medications, melatonin, and dementia

In some cases, the doctor may prescribe medications to help your loved one sleep. However, older adults with cognitive impairment are more likely to experience side effects from sleep-inducing drugs, so those medications aren’t usually recommended for long-term use.

Some studies show melatonin may improve sleep in people with mild to moderate dementia. It may also help reduce agitation and confusion late in the day. Check with your loved one’s doctor before starting any over-the-counter supplements or sleep aids.

Sleep problems and dementia: how to cope

What if lifestyle and environmental changes don’t help? How do you keep dementia patients in bed at night?

As dementia progresses, sleep problems along with other difficult dementia symptoms tend to get worse. This may be a good time to evaluate whether you need additional support to help ensure your loved one’s health and safety and your own. Learning what to expect at each stage of dementia can help you plan for adequate care.

Here’s what you should know when caring for someone with dementia and sleep problems:

• Don’t use physical restraints. Many people believe it’s best to restrain their loved ones in bed at night to prevent wandering. This may do more harm than good. Instead, if you have a bed with guard rails, raise the rails. This may help to deter them from climbing out of bed and wandering.
• Don’t do it alone. Consider taking shifts with another family member or looking into respite care. Respite care, or short-term care, gives you a chance to take a break while providing a safe environment for your loved one.
• Reduce stimulation. To allow for a calming, soothing environment, avoid loud noises or a lot of activity during the evening and night.
• Prioritize your health and rest. Taking care of a loved one with dementia and sleep problems may take a toll on your own mental health. Consider getting help from family members or exploring other care options, such as memory care, which provides 24-hour specialized care for people with memory loss.

Neikrug AB, Ancoli-Israel S. “Sleep-wake disturbances and sleep disorders in patients with dementia.” 
https://www.uptodate.com/contents/sleep-wake-disturbances-and-sleep-disorders-in-patients-with-dementia.

SleepFoundation.org. “Alzheimer’s disease and sleep.” 
https://www.sleepfoundation.org/articles/alzheimers-disease-and-sleep.

National Institute on Aging. “6 tips for managing sleep problems in Alzheimer’s.” https://www.nia.nih.gov/health/6-tips-managing-sleep-problems-alzheimers.