Problems with sleep can be a common issue for people who live with a dementia diagnosis. Sleep disturbances can be very stressful both for the person with dementia and their families/care partner. It is important for the health and well-being of both the person with dementia and their care partners/family to all get a good night’s sleep.
Always discuss issues regarding sleep disturbance/sleep quality with the GP, to help identify causes and possible solutions, and investigate if other underlying medical conditions may be affecting sleep quality. Consider keeping a ‘Sleep Journal’ to take to the GP appointment.
Sleep difficulties can include:
- Sleeping a lot during the day and being awake/restless during the night.
- The person may go to bed very early in the evenings.
- People with dementia may over time become more sedentary during the day and may need less sleep at night.
- A person with more advanced dementia may have difficulty distinguishing between day/night.
- Disturbing dreams, hallucinations, and agitation following an upsetting situation may all affect sleep quality.
What to Try
Bedroom environment
Try and ensure the bedroom is comfortable and feels ‘safe’ for the person with dementia.
Optimise environmental cues for encouraging sleep. Try and ensure a peaceful home environment in the evenings.
Try to ensure the bedroom is not too hot or too cold. During winter months: consider warm bedding, warm night wear and a warm bedroom rather than using electric blankets or hot water bottles. If using electric blankets, consider purchasing electric blankets with timers.
If the person needs to be able to locate the bathroom easily at night-sensor lights may help.
Consider installing black out curtains in the bedroom. These can help during the summer when the sun comes up early, which can be disorientate a person with dementia to what time it is.
Changes in the environment such as moving to a new home or going on holiday may lead to sleep disturbance. Ensure the person has some familiar items: e.g.: pillow, blanket, small photo frame of family, torch.
Some people with dementia may not recognise themselves in mirrors, and this may cause confusion. Consider removing or covering the mirrors.
Avoid having daytime clothing in view at night, the person may look at the clothes and believe it is time to get up.
If the person has a history of getting out of bed at night and walking around the house or attempting to leave the house, consider, door sensors, motion detectors, etc. Routinely ensure external doors are secure at night.
Ensure lighting inside the house at nights is bright enough that shadows are reduced, but not too much glare.
As the nights get darker – draw curtains early and have good lighting. A person with dementia may believe it is later than it really is if they see it is dark outside.
For some people with dementia a Night/Day clock in their bedroom can be useful, as a guide for showing them if it is night/day.
Other Recommendations
Consider the person with dementia’s individual preferences, previous work history/life roles and how these may be impacting on their sleep patterns. E.g., if the person previously worked as a dairy farmer, they likely have a sleep history of going to bed early and getting up early. Be flexible with your expectations.
- Try to ensure the person you are caring for is getting enough exercise during the day, e.g., short regular walks.
- Maintain a daily schedule. As much as possible, encourage the person with dementia to adhere to a regular routine of meals, purposeful activity, regular exercise, waking up and going to bed.
- During the late afternoons/early evenings: provide calm activities. Avoid loud noise. Avoid TV programs which may be ‘aggressive/upsetting’.
- Ensure the person has time each day outside or is seated beside a window for exposure to sunlight.
- Plan more active days. Discourage naps in late afternoon.
- Encourage the person with dementia to eat a healthy/nutritious diet.
- Avoid caffeine, alcohol, and heavy meals later in the day. Offer a light snack/warm milk etc before bed.
- If possible, try and get into a routine of going to the toilet before bed to help reduce the risk of getting up in the night for toileting.
- Before bed consider calming background music.
If the person has very disrupted night’s sleep – consider setting up a roster of family to help by taking turns at night caring for the person with dementia.
If eligible – use DSL funded Carer Support days to get some respite.
If the person with dementia wakes during the night
- Gently remind them of the time and that it is time for sleep.
- If the person is awake and upset, approach them in a calm manner. Try and find out if there is something he/she needs.
- Encourage/assist them to use the toilet.
- Avoid arguing, offer reassurance. Validate. Use humour.
- Keep the bedroom/house lights at a low setting.
- If the person needs to ‘pace’, ensure they are able to do this safely and with supervision. Remove any known hazards, e.g., if the person is likely to use the toaster – remove toaster from sight at bedtime.
If the person with dementia refuses to get out of bed in the mornings:
- If the person you are caring for refuses to get out of bed, try and stay calm. Leave the room and try again a short time later.
- Consider their daily routine and preferred activities, as a way of encouraging them to get up. E.g.: ask for their assistance with feeding a pet, collecting mail, etc.
Treat the person with respect and try and understand the reason(s) behind their behaviour.
Finally, Be Kind to Yourself
Be aware of the importance of care partners also getting sufficient sleep. Prioritise time for you to get enough rest.
You are human. None of us are perfect-especially during these times at home.
Look after yourself and try to get enough rest.
Take care of yourself, as well as your family member who has dementia.
Feel free to contact us at Dementia Waikato if you need to talk about any issues you are having with the person you are caring for. Phone 07 929 4042 or via email info@dementiawaikato.org.nz