Rachel Thompson, Admiral Nurse Professional and Practice Development Lead at Dementia UK,talks about how dementia affects sleep and how carers and families can approach sleep disturbance and its possible underlying causes.
Disturbances in sleeping patterns are common among people with dementia and can become more problematic as the condition progresses. Someone diagnosed with dementia can become increasingly restless, confused, agitated, or distressed, particularly as the sun is setting and it becomes dark outside. This is known as ‘sundowning’.
There are many different types of dementia and some people may present with a combination of types. Regardless of which type is diagnosed, each person will experience their dementia in their own unique way. All types of dementia can affect sleeping but for people with specific types of dementia particularly Lewy body dementia or Parkinson’s disease dementia, sleep disturbance can be particularly common due to physical changes in the brain. For people with Lewy Body dementia this can include nightmares or night terrors and/or restless leg syndrome or uncontrolled limb movements.
Medications may also cause sleep problems, for example anti- cholinesterase inhibitor drugs such as Aricept, Exelon and Reminyl, can cause night time stimulation and dream disturbance so where possible these should not be taken in the evening. Pain is also a major contributor to sleep deprivation and is commonly unrecognised and undertreated in people with dementia. If you suspect the person with dementia may be in pain contact your GP.
How do I know if someone with dementia is struggling to sleep?
Look for changes in the person’s behaviour such as frequent waking, getting out of bed and/or increased disorientation or confusion. Deprivation and/or disturbed sleep is also a recognised risk factor for the development of delirium. Sleep can be disturbed by infections, due to an increased need to go to the toilet, dehydration and constipation as the person may be in discomfort. If you suspect these may be present an appointment should be made with the GP to investigate and treat any underlying causes.
If you do not know already, it is important to establish what is the usual pattern for people by asking the person. We are all different and people may have varying sleep patterns and need differing amounts of sleep. It is common for sleep patterns to change as we get older too. It helps to establish regular routines and offer comfort & reassurance. If people are feeling insecure and unsafe, they will feel less able to relax and get to sleep.
If someone gets up in the middle of the night, try to establish any cause for waking and think about sitting with them for a short time in a quiet environment with low lighting before guiding them back to bed. They may need to go to the toilet or be unsure about where they are. Having a night light and a clock which indicates day and night, may help orientate them and reduce distress .
A sleep diary can be used to monitor overall sleep and will help determine whether sleep is adequate. If the person is sleeping for particularly long periods during the day, then think about activities to keep the person occupied. Gentle exercise, access to natural light/getting outside and stimulation in the morning can help establish regular sleep patterns. Activities could include helping with housework, walks in a park, social activities, exercise and watching films.
Better sleep strategies
Firstly try to establish the cause of sleep disturbance as we’ve outlined in this article.
Consider the environment and try to minimise noise levels and use of bright lighting.
Check if the temperature is uncomfortable i.e. too hot or too cold and adjust the persons bedding as required.
Night/day clocks can be used which help clearly indicate that is night time, make sure they can be easily seen from the person’s bed.
Low level light or night lights can help the person find the bathroom and promote orientation.
If the person is away from home and in an unfamiliar environment, try to put familiar things in sight such as photos or prized possessions. This will make them feel more secure.
Think about food and drink; some people like to have a small snack before bed but heavy meals and caffeine based drinks should be avoided prior to sleeping.
Find out about toilet habits; ensure someone has been able to use the toilet prior to getting into bed.
If the person with dementia uses continence aids ensure they are appropriate for night time and are fitted comfortably.
Soft music and relaxation tapes can help the person get to sleep but always consider their own individual tastes, did they have a favourite album they found relaxing beforehand?
Consider the use of aromatherapy particularly lavender oil which may help relaxation
Other things to consider
Sleep disturbances may be a stage that the person with dementia goes through which will subside and settle over time. As dementia progresses people tend to sleep more. If problems persist then medical advice should be sought. Most importantly please discuss concerns with the GP so that any preventable or treatable reason for the sleep disturbance is identified and treated.
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