As most of us will have experienced at one time or another, not being able to sleep, or not sleeping well can become literally a nightmare. For those living with dementia, not getting a good night’s sleep can be particularly acute and really affect their quality of life, and that of those caring for them.
This guide explains how to help dementia patients sleep. You can also find out more about common sleep problems, get tips on how to keep dementia patients in bed at night and read our helpful FAQs.
Why dementia patients don't sleep well
Depending on the stage of dementia the sleep pattern can change from sleeping too little to sleeping too much. As dementia progresses it is not unusual for the pattern to deteriorate. What makes things a little trickier is that dementia can make it harder for someone to communicate what is wrong. For example, they might not be able to tell you that they’re in pain. This is why it becomes even more important to pay close attention to other types of communication such as facial expression and body language. Below, we have outlined some issues which can cause dementia patients to not sleep well.
Changes in the brain
The disruption to the body’s circadian rhythm (more commonly known as our body clock) means the alignment to the 24-hour day is off balance, which impacts the sleep-wake cycle. This disruption will make it harder for people with dementia to realise whether it is night or day.
Sundowning can also affect sleep as it is harder for someone with dementia to calm down after an acute episode of confusion or anxiety.
Some drugs used to treat dementia can cause night-time stimulation and dream disturbances.
Light disturbance in a sleeping area such as lamps or landing lights being left on, can cause confusion as to whether it is night or day. This can result in night-time wandering.
Specific types of dementia
All types of dementia can cause sleep problems. Sleep disturbances are particularly common with Lewy-body dementia and Parkinson's disease dementia due to the physical changes to the brain and the association with REM sleep behaviour disorder.
For people with dementia, waking up from a dream can be especially confusing. Distinguishing between the dream and reality becomes more difficult which in turn can make it harder to fall back to sleep.
Pain within the body, particularly joint pain, is a part of advanced ageing. So it is no surprise that older patients with dementia experience uncomfortable nocturnal sleep disorders.
Napping during the day
We've all been guilty of this at some point, and know the consequences all too well. Frequent naps in the day time, especially when taken lying in a bed, will make it much harder to get to sleep at night.
How to help dementia patients sleep better
Although night times can prove difficult for those with dementia, there are certain things you can do to help. Here are 12 ways to encourage a better sleep pattern:
Check for other medical conditions
Both sleep apnea and restless leg syndrome are associated with increasing age and have symptoms which will easily wake someone with dementia. To identify if your parent or partner has sleep apnea, you may have to watch them while they sleep. Someone with this condition will pause when they breathe, almost momentarily stopping breathing. This momentary lack of air can wake someone up, and is really quite frightening for the person sleeping next to them as they wait for the next breath.
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If you are finding it particularly hard to help someone with dementia with their sleep, and its affecting your ability to care for an elderly relative, it may be a good idea to share some of the care responsibilities with a live-in carer, like those found on our best live-in care companies page.
FAQs about dementia sleep problems
Caring for a patient with dementia and sleep problems is hard work. When the dementia patient is not sleeping well, it is very easy to become exhausted yourself. To give the best care, the carer needs to look after themselves. In addition to the following questions that some people have asked regarding how to get dementia patients to sleep at night, you should visit our guide on caring for someone with dementia.
My mum suffers from dementia and excessive sleep. She sleeps during the day and sleeps very little at night. Is it ok to let her sleep all day?
If possible we recommend encouraging her to take fewer and shorter day time naps, at the same time and place if possible (in a chair not a bed). Keeping to a routine full of activities can help keep her awake during the day, and work some way towards night-time sleep problems. Try regularly getting her up for short walks (outside if possible) and maximise daylight in rooms. Sensitively wake her up if she does fall asleep outside of a routine nap time.
I care for more than one person with dementia and wonder how to keep dementia patients not sleeping in bed at night? Should I put them to bed straight away?
According to the Alzheimer’s Association, patients can spend up to 40% of their time lying in bed awake, this equates to sleeping too much during the day. If the patient does get up, don’t try to get them back to bed. Try to restart a small bedtime routine instead of putting them straight to bed. Keep lights low, take them to the toilet, play relaxing music or read to them for a bit to calm them down.
Could I use sleeping tablets for a limited time, just to help the person I care for with dementia get back into a routine of sleeping throughout the night?
However tempting this may be, the use of sleeping pills for dementia patients can be just too dangerous as they are at risk of falling. The morning ‘hangover’ effect that sleeping medication leaves a person with can exacerbate the dementia patient's symptoms of confusion, anger and irritability. Try promoting better sleep strategies and sleep aids for dementia instead. If the person with dementia constantly wakes and gets up, and is at high risk of falling, then a doctor may decide that sleeping pills for a dementia patient can be used for short period of time. Always talk to a GP first as they are used to being asked how to get dementia patients to sleep at night.
They wake up a lot during the night to use the loo and I'm worried they may get lost or confused. Should I wake up too to help them?
It is normal that older people will need to use the loo more often during the night. This can be difficult if a person also has dementia as they might forget why they're up, where the toilet is or that they should go back to bed. Start by looking at your parent’s drinking and eating habits. If they are eating and drinking large amounts in the evening this will increase the need for them to visit the toilet. Limit their intake from late afternoon and enjoy a main meal at lunch. Next make the route to and from the toilet as clear as possible by using signs and plug-in nightlights. Try using pictures if it helps. It might also help to make the lights in the bathroom motion activated for when they get there. If you are still worried or you find they still get lost, it may be that you will have to help them. A monitor or bed-exit sensor will help you to wake up when you need to.
What can I do to help my dad with dementia sleep better at night? He suffers from sundowning and often won't sleep until extremely late.
From late afternoon it’s important to remain calm and stick to the bedtime routine, as your dad may pick up on your stress causing him distress. Try to find a balance between your dad not being over-tired while still being tired enough for bed. This might mean experimenting with naptimes. Natural daylight is wonderful for helping to reset a disrupted body-clock, so you should consider simply sitting outdoors or next to a bright window when your dad starts to show signs of agitation or restlessness. Find more tips on how to deal with Sundowning here.
My dad has dementia and is moving into residential care. Are there any care homes with dementia units?
Yes, there are. These residential units will allow your dad to live in a home environment with the benefit of trained staff on hand to help care for him. It may also be worth considering finding a care home in the right location to enable friends and family to visit regularly. This may be more fitting for your dad and ease the transition.
If your parent/partner suffers from restless leg syndrome they move or twitch their legs uncontrollably, especially during the evenings and night-time. They may also experience tingling, burning and fizzing sensations in their legs too. Symptoms can be relieved by rubbing and stretching legs - but it can be so bad that it wakes the person up. If you discover that your parent/partner has either of these medical conditions, it’s wise to see a GP and ask for help.
Get the lighting right
To aid a more restful night’s sleep the bedroom should be as comfortable as possible. Using blackout curtains are a good idea during night-time to eliminate outside disturbances. Research suggests that light therapy can reduce restlessness and confusion for people with dementia. Should you wish to consider light therapy, it has been proven that violet coloured light promotes drowsiness and a full-spectrum fluorescent light used for the first two hours of the day can be settling. Light therapy that follows a regular pattern can also help with disturbed body clocks.
Safety - if night wandering is a problem, or frequent visits to the loo, you will need to consider some sort of low light to prevent your parent falling in the dark. You may want to invest in a motion sensor night light. A motion sensor light automatically turns on when motion is detected within three metres. It then turns off after 30 seconds of no activity. This means that people with dementia can use the bathroom in the night or get out of bed with less risk of falling. The light is gentle and warm in order to not interrupt sleep.
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Review any medication being taken
The side-effects of some dementia drugs may not promote a restful sleep, so chat to your parent’s doctor about the optimum time of day to take them. Don’t be tempted to give sleeping pills to someone with dementia, as hypnotics or sedatives can exacerbate confusion.
We’ve detailed the medications used in the treatment of dementia to help you understand the different types and those that might affect sleep.
Keep the patient active during the day
Plan daily activities; go for a stroll outdoors, meet family members and friends, and if happy and able - visit a specialist group, such as a dementia cafe. Exposure to natural daylight is important to regulate the body clock, and getting out and about is the best way to enjoy good physical health. This will also help to tire and promote better sleep.
Get into a good routine
If possible, try and make bedtime and wake-up time the same everyday. Try and establish a nightime and morning routine as this will help signal to them what time of day it is. Things that can encourage better sleeping habits include a bath, playing music, brushing teeth, a hot milky drink or even the scent of lavender on a pillow from a scented spray.
A scented pillow spray can help overcome restlessness or trouble drifting off. The smell of the lavender blend naturally encourages sleep. This is particularly helpful to those in the later stages of dementia when it is common for patients to respond to the sense of smell.
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Avoid alcohol or caffeine from late afternoon onwards
Avoid tea and coffee from late afternoon onwards and take care with other foods that may also be hiding stimulants. Some fizzy drinks and even chocolate may have enough caffeine to keep your parent awake. Also avoid alcohol three hours before bedtime for a better quality and more consistent sleep.
Drink plenty of fluids throughout the day
It is very important that people with dementia stay hydrated. Drinking little and often is the best way to stay hydrated, without constantly needing the toilet. Dehydration can cause added confusion and illnesses such as urinary tract infections (UTIs). It is best to encourage consumption of most daily fluids in the early and middle hours of the day to avoid getting up for the bathroom in the night. If the person you care for enjoys an evening cup of tea, try switching it for decaf.
Adjust eating patterns
For some, it is difficult to fall asleep after a big meal, especially if the food contains a large amount of sugar. Limit the intake of food in the evening to a healthy snack or light meal. You could also try having dessert after lunch instead of dinner and eating dinner earlier in the evening. If you are struggling to get your parent/partner to eat full stop, we have some really useful advice and tips in our guide to help someone with dementia eat more.
Make day-time napping part of the routine
Preventing a parent from napping completely might be unnecessary and even exacerbate sleep problems. Try instead to regiment napping as much as possible. Promote napping at the same time and place each day, and for the same short length of time. Experiment with different times so that your relative is still tired when it comes to bed time. Make it a routine to nap in a chair and not in bed, to encourage lighter sleeping. You can also plan more mentally stimulating activities for after a nap, to help your parent to wake up.
Stop confusion over time
Keep clocks visible and clear in the bedroom and around the house. Dementia-specific clocks can help as they make it really clear whether it is day or night time.
Comfort them should they wake in the night
If your parent gets up in the middle of the night, try to establish the cause for waking. Sit and talk with them for a while quietly in low light. Keep them relaxed and repeat actions they associate with bed time such as soft music until they are ready to return to their bedroom.
A wireless bed exit pad and alarm can help alert you if someone with dementia awakens and is prone to wandering in the night. A motion sensor pad is placed on the mattress. As soon as someone gets out of bed, a wireless signal is sent to the alarm which can be up to 90 metres away. It won't go off if they just roll over, only when their weight is completely off the sensor. It is a smart way to remotely monitor whether your parent is still in bed, which can even help you to sleep better - safe in the knowledge that you will be alerted should they get up.
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And finally, do everything you can to promote relaxation
Create a restful environment in the evening and stick to a night-time routine. During mid-stage to advanced dementia there is advice that suggests someone with dementia shouldn't watch TV or read a book as they can find this difficult and become frustrated; playing soft music may be a better alternative. You could even try reading to them. The bedroom should be comfortable, not too hot, not too cold and with cosy, breathable bedding.
Find more general tips for elderly parents on how to get a better night’s sleep.