How to help a person with dementia sleep at night

Most of us will know that a lack of sleep or difficulty falling asleep can affect our mood. And for those with dementia, it can be even more of a problem, affecting their quality of life and the people caring for them. According to Mayo Clinic, sleep troubles may affect up to 25% of people with mild to moderate Alzheimer's and about 50% of people with moderate to severe Alzheimer's. Sleep troubles tend to get worse as Alzheimer's progresses, highlighting the need to explore sleep and dementia and ways to support it better. It's not the dementia that causes sleep disruption, but the symptoms interfering with their sleep cycle, making it harder to maintain a regular sleep pattern.
 

Understanding sleep problems in dementia

Sleep disturbances are widespread for people with dementia - disturbed sleep, including sleep fragmentation, abnormal sleep duration, and sleep disorders, are all risk factors for dementia. Dementia patients, sleep–wake cycles can be so disrupted that they are neither continuously awake nor asleep for a full hour during a 24-hour period, causing a reduction in a person’s quality of life and difficulty carrying out day-to-day tasks. 
People who have trouble sleeping at night may not feel well-rested when they wake up, potentially leading to increased daytime sleep, which in turn complicates evening sleep, creating a cycle of inconsistent sleeping patterns. Gradually, if these sleep problems happen often, they can make dementia symptoms more severe.
 

Why do people with dementia have trouble sleeping?

Many factors can influence a person with dementia's ability to sleep, such as:

• Medication side effects
• Changes in the brain
• Light
• Dreaming
• Sundowning
• Health conditions
• Naps during the day
   

What are common sleep disturbances in dementia?

There's a range of behaviours that can cause dementia sleepiness. These behaviours may be baffling for people around them to understand, but being aware of the causes can help you support them better. 

Sundowning

Sundowning is when a person with dementia experiences adverse feelings, including anxiety, agitation and hallucinations, when light conditions change, particularly during the late afternoon or dusk. Episodes can vary – symptoms may last a few minutes or a few hours. Longer episodes may last into the night, disrupting sleep. 

Frequent wakeups

Because of the changes in the brain that disrupt the body's internal body clock, people with dementia may find it difficult to differentiate whether it's day or night. As well as this, frequent wake-ups can be due to feeling uncomfortable, pain or needing to use the bathroom. 

Restless leg syndrome

A medical condition where people have the urge to move their legs to stop unpleasant sensations. This condition may cause people to get up at night and walk around to ease the unpleasant feeling. Some people may have this because of anxiety or any other mood disorder. 

Napping in the day

If a person experiences fragmented sleep at night, they’ll likely find themselves feeling sleepier than usual during the day. It’s common for people with dementia to take naps during the day to combat daytime sleepiness. 

How does sundowning affect sleep?

During a sundowning episode, people with dementia can experience a range of adverse emotions, from agitation or orientation. In some cases, it can intensify – fatigue and sensory overload typically cause this. As a result, this makes it difficult for someone to settle down or to sleep. They may pace around or become aggressive as a way to cope or self-soothe with their symptoms, leading to a disrupted sleep routine.
 

Tips for improving sleep for people with dementia

Take the time to adapt your home to be as dementia-friendly as possible, so people with dementia can live their day-to-day as comfortably as possible. Here’s how to help someone sleep better: 

Creating a sleep-conducive environment

A calm and comfortable environment can optimise their wellbeing. Colours can have a profound effect on behaviour as they stimulate the senses and evoke emotions, so consider choosing calming colours like soft blues, greens and neutrals. Avoid contrasting colours as this can cause confusion and agitation in dementia patients. Using dimmer lights is best too, as they’re less overwhelming for dementia patients. 

How to make a bedroom suitable for a good night’s sleep

You want to ensure you have the best sleep environment, ideally with a cool temperature between 18 °C and 22 °C. This temperature range works alongside the patterns of our core body temperature. Opt for comfortable bedding – it may be the case that your mattress or mattress topper is not suitable for your sleeping style, so it's essential to consider one that meets your needs and preferences. Decorating your bed with aesthetically pleasing bedding can make your bed a more welcoming and comfortable place to sleep in. 

Manage noise levels and light in the bedroom

Because many people with dementia are highly sensitive in their environment, you want to keep noise and light levels to a minimum. Too much noise and bright lighting can cause unpleasant symptoms such as anxiety, making it more difficult to fall asleep. Consider blackout blinds to create a calmer environment. Opting for white noise is a good choice too, as it masks any disturbing noises and helps people to fall asleep quicker. 

Establish a routine

This helps to regulate a person’s internal body clock better. Over time, your body will grasp the idea of the habits you are doing and tell your brain you are ready for bed. Ideally, start your nighttime routine 30 – 60 minutes before bedtime, which will help reduce anxiety and confusion once you get into bed. 

Promote certain activities before bed

By incorporating nighttime rituals, you prime your body and mind for restful sleep. Decide on a bedtime that’s in alignment with your schedule or the time you wake up. Encouraging them to stick to it as a consistent, helps train your brain to feel sleepy at bedtime naturally. Natural sleep aids for people living with dementia:

• Calming music
• Reading a book
• Warm bath
• Listening to relaxing music
• Yoga
• Deep breathing exercises

Encouraging daytime activity

Taking part in activities during the day does wonders for your health and your sleep. It reduces daytime sleepiness and anxiety, contributing to a better transition into sleep. Light physical activity, such as walking or gardening, is perfect for you. Try to do this for at least 20–30 minutes during the day for optimal health and sleep results.
 

How does diet affect sleep quality?

According to the National Library of Medicine, not eating enough fat, carbohydrates, or protein has been linked to less or worse quality sleep. Both caffeine and alcohol have been found to reduce sleep quality, especially if taken within two to three hours before bedtime. Foods that contain the amino acid tryptophan, on the other hand, have been found to improve sleep quality. This suggests that poor nutrition can cause sleeping problems, as well as obesity, increasing the risk of sleep apnoea.
 

When to seek help for sleeping

Random days when you struggle to sleep may not be a cause for concern. However, there are some signs you should be aware of that signal the need for help, such as persistent sleep disturbances, changes in behaviour and severe agitation.
 

Where to get help for problems with sleep

If you are experiencing sleep problems or have concerns regarding your sleep, consider talking to a healthcare provider. You can speak to a GP or nurse, and they can identify whether your sleep problems are caused by a mental health disorder or something else such as a urinary problem. They can determine what you need to help with your sleep, such as therapy, or they refer you to a specialist.

Every day we support people with dementia to continue leading meaningful lives for as long as possible. Call our friendly team today to see how we can help or find out more on our website.