Sleep Disturbance and Sundowning

Dementia is a change in how the brain works. Since sleep and sleep cycles are largely controlled by the brain it is reasonable to assume that these changes in the brain can affect sleep as well. Sleep is also strongly impacted by the environment and mood. Your loved one may be more affected by changes in the brain, in their environment, or both. Understanding what is affecting their sleep may help you find the best solutions for them.

Some people with dementia have an increase in restlessness or agitation that begins late in the day. This is known as “sundowning” and it tends to worsen as the dementia progresses. This state of distress can make it much more difficult to fall asleep and stay asleep. Factors that can worsen sleep problems and sundowning include:

• Mental and physical exhaustion—agitation can be worse at the end of a long day. An exhausted caregiver may also feel tired and frustrated and send unintentional cues.
• Lower lighting—shadows and poor vision may increase confusion as daylight fades.
• Decreased need for sleep—common in older adults or may be the result of daytime naps.
• Difficulty separating dreams from reality

Waking up disoriented can lead to wandering which stops a good night’s sleep and can lead to safety problems.

Tips for a Better Night’s Sleep

A regular sleep routine will help cues your body to settle down for the night. Routines can also be comforting to people who have dementia and avoid surprises that may be distressing. To develop a sleep routine:

• Set bedtime at the same time each night and wake up at the same time each morning, even on weekends. Set an alarm clock for the same time every morning to help you follow this routine.
• Develop a sleep ritual—a ritual may be taking a hot bath, drinking a cup of herbal tea, listening to music, or reading a book.
• Do not watch TV or use screens, since they can make sleeping difficult.
• Cut down on stimulants—alcohol, caffeine, and smoking can make it difficult to fall sleep.
• Avoid eating before sleeping— Eating too close to bedtime can lead to nighttime waking. Plan to finish eating 2–3 hours before bed.
• Regular exercise—Exercise during the day can help to relieve tension and may improve sleep. Avoid exercising too close to bedtime.

Safety steps for those that wander in the night include:

• Use night lights—to help with evening trips to the bathroom.
• Install door and window locks if wandering is a concern. Motion sensors and door alarms may also help alert family members to wandering.

Agitation can be common problems in those with dementia. Work with the medical team to find ways to help reduce agitation. Options include behavioral interventions, hobby activities, music, massage, or aromatherapy. It may take trial and error to find which works best for you.

If you are caring for a loved one with dementia, you should also make sure that you are getting enough sleep yourself. Ask for help from family members and friends if possible. Talk to your loved ones doctor and elder care specialists to see what services may be available to help you out.

Sleep Medication

While medications may be prescribed to treat existing conditions, they are not usually prescribed to treat sleep disturbances in those with dementia. Sleep medications can increase disorientation and increase the risk of accidents, such as falls.

If you or a loved one is having dementia-related sleep issues, talk to a doctor to help find treatment options. The doctor may also run some checks to make sure there aren’t other medical issues causing sleep problems.