Disturbed sleep and difficulties around bedtime are very common in people with dementia. This often means that if you care for someone with dementia, neither of you gets enough sleep.
Reasons why a person with dementia may have sleep issues include:
- disturbance to their body clock
- sleeping excessively during the day
- a reduction in the sleep hormone, melatonin
- confusion at bedtime (often called sundowning) or if they wake in the night
- pain
- medication side effects
However, by establishing good habits during the day, at bedtime and during the night, you can help the person with dementia to sleep better.
Spending time in natural daylight is known to improve sleep, but many people with dementia spend most of their time indoors.
If possible, support the person to get outside each day. You could try:
- a walk around the block
- a trip to a park or garden centre
- sitting in the garden
Consider asking friends, family and neighbours to help with taking the person outside – they will often be glad to support you.
If the person has mobility problems that make it hard for them to go out, simply sitting by a window in natural light, or in an open doorway, may help to improve their sleep.
Many people with dementia become sleepy during the day, but too much daytime sleep can affect their ability to settle and stay asleep at night.
If the person with dementia likes to nap during the day:
- encourage them to sleep earlier in the day – for example, late morning or after lunch. This may help to ease confusion as the day goes on, without affecting night-time sleep
- keep naps to 30-60 minutes long – it may be tempting to allow the person to sleep for longer, but shorter naps may improve their night-time sleep
Think about what the person with dementia eats and drinks throughout the day – there may be a link between their diet and how well they sleep.
- Offer a main meal at lunchtime, and a lighter meal in the evening
- Try to limit sugary food, especially later in the day
- Aim to reduce the amount of caffeine the person consumes – you could switch to decaffeinated tea and coffee
- Offer a herbal tea, such as camomile, or a warm milky drink before bedtime
- If the person tends to need the toilet at night, it may help if they drink less in the hours before bed – but don’t restrict drinking in the day
- Alcohol affects sleep, so if the person enjoys a glass of wine or beer in the evening, encourage them to switch to low- or zero-alcohol varieties
Some people with dementia become increasingly confused and anxious in the evening.
For example, they may believe that they need to go home, even if they are already at home, or that they have to collect their children from school, but they are now adults.
They may pace, shout, argue or try to leave the house.
This is known as sundowning.
Having a nightly routine can be reassuring and calming for the person with dementia and help prevent sundowning. You could try:
- supporting the person to have a warm bath or shower, or to sit with a warm hot water bottle in a cover, or a cosy blanket
- drawing the curtains and turning on lights before dusk, so the person is less aware of the change from daylight to darkness
- spending some relaxing time together, eg listening to music or reading a chapter of a book to them
- switching off the TV an hour before bed
- keeping mobile phones, tablets or computers out of the bedroom, or setting them to night-time mode – this will help to prevent overstimulation and exposure to ‘blue light’, which can affect sleep patterns
Being safe, warm and comfortable in bed will help the person with dementia settle and sleep well throughout the night.
- Keep the bedroom at a comfortable temperature – 18-21˚C suits most people
- Make sure the person’s nightwear is comfortable and suitable for the season
- If they wear incontinence products, check that these are comfortable and will last the night
- Ensure their bedding is suitable for the weather and comfortable to sleep in. Many people prefer soft fabrics and a heavier top cover. You could also use a hot water bottle or electric blanket to warm their bed, but don’t use them overnight as they may cause overheating
- Make sure the person can lie comfortably. You could provide extra pillows to help with this, or there are many types of support cushion available to buy, such as V-shaped pillows and wedge cushions
- Put an easy-to-read clock next to their bed if they are able to tell the time, so if they wake, they are more likely to understand whether it’s time to get up
- Use blackout curtains or blinds, especially in the lighter summer months, and draw them at the same time each evening
- If the person tends to get up in the night to use the toilet or walk around, leave a nightlight on in their room, hallway and/or bathroom
Sometimes, medication can aid sleep, but this must only be used under the guidance of a GP or pharmacist.
To speak to a dementia specialist Admiral Nurse about a stay in hospital or any other aspect of dementia, please call our free Dementia Helpline on 0800 888 6678 (Monday-Friday 9am-9pm, Saturday and Sunday 9am-5pm, every day except 25th December), email helpline@dementiauk.org or you can pre-book a phone or video call with an Admiral Nurse.