Alzheimer’s and Sleep: Expert Answers to 6 Common Questions

18 Comments

Sleep issues are a well-documented side-effect of most manifestations of dementia, particularly Alzheimer's disease.

This presents a problem for caregivers; if a loved one isn't sleeping, neither are they.

"Quite often, the lack of sleep is what first causes a caregiver to look at placing a loved one in a facility," says Maureen Bradley, L.P.N., C.D.P., director of the Alzheimer's care programs at several skilled nursing facilities run by Royal Health Group.

Many of these sleep deprived caregivers are plagued by the same questions: How do I get my dad to sleep through the night? Why does my loved one sleep all day? Why does my mom get so anxious at night?

Here are some answers to 6 of these common questions:

  1. Does Alzheimer's cause sleep problems?
    Yes, Alzheimer's can wreak havoc on a person's ability to fall (and stay) asleep. Suddenly adopting an irregular sleep schedule, and sleeping more than usual are both common side-effects of the disease, according to Emerson Wickwire, Ph. D., Sleep Medicine Program Director at Pulmonary Disease and Critical Care Associates in Columbia, MD. "As Alzheimer's progresses, a person's circadian rhythms tend to become desynchronized. They may become prone to dozing intermittently throughout the day, then experience difficulty sleeping at night," he says.
  2. Is my loved one "sundowning?"
    Sundowing refers to the collection of behaviors exhibited by someone suffering from Sundowner's syndrome, a dementia-related disorder that makes a person anxious and agitated as night falls. If your loved one is sundowning, they may become restless, pace around, shadow you, or even wander off. These behaviors typically start to occur sometime between 3:00 in the afternoon and 7:00 in the evening and may continue throughout the night, according to Bradley.
  3. Why do people with Alzheimer's have unusual sleep cycles?
    The precise cause of sleep problems in Alzheimer's sufferers is currently unknown, though many factors likely play a role. Wickwire points out that the disease alters the areas of the brain that regulate hormone secretion, appetite and cognitive functioning. Messing with any or all of these elements may result in restless nights. Bradley adds that some other contributors to unusual sleep cycles may include: a lack of activity during the day, or an inability to recognize a familiar environment, such as a bedroom.
  4. Is it okay to let someone with Alzheimer's sleep all day?
    This is a tough question to answer. At night, people with late-stage Alzheimer's spend up to 40 percent of their time lying awake in bed, according to the Alzheimer's Association. These sleepless nights typically translate to drowsy daytimes. According to Bradley, boredom is another big contributor to daylight lethargy. "Caregivers are often afraid to upset a loved one, so they just let them sleep," she says. But, letting a loved one lie in bed for too long during the day may make them more prone to waking up in the middle of the night. Bradley suggests trying to keep a loved one engaged and active during the day. It doesn't have to be anything special: adult day care activities, physical exercise, special outings, even simple errands can keep your elderly loved one engaged and active. If your loved one absolutely needs to rest, Wickwire recommends scheduling 20-30 minute naps during the day—enough to refresh them, without interfering with nighttime sleep.
  5. What about sleeping pills?
    "I don't like sleeping pills," says Bradley. "They put a person at risk for falls and cause them to feel hung over the next day." Indeed, research consistently indicates that, for older adults, the risks associated with prescription sleep aids outweigh the potential benefits. (Learn more about how a senior's fall risk may be increased by prescription sleep aids)
  6. How can I help a loved one with Alzheimer's sleep through the night?
    Unfortunately, expecting your loved one to get a solid night's sleep may be a pipe dream. But, that doesn't mean there aren't strategies you can try. In addition to keeping a person active and engaged during the day, the National Institutes of Health (NIH) urges caregivers to use other non-medical interventions, such as sticking to a routine and avoiding caffeine and alcohol, to reduce sleep problems in people with Alzheimer's. Drawing the blinds to block out nighttime darkness, making sure a loved one gets some sun exposure during the day, and crafting a sleep-inducing bedroom environment (proper temperature, comfortable bedding), are additional recommendations for getting a person with Alzheimer's to sleep sounder. If your loved one does wake up in the middle of the night, don't encourage them to try and go back to sleep. Bradley says it's better to get them started on a task, such as folding laundry, or reading a book, rather than trying to get them to stay in bed once they're awake.
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18 Comments

I love the article - and have a piece to add to it. Gradual changes, not instant, and add reassurance, acceptance. I've worked overnights or bedtimes many years, and after 9 pm, i put my focus onto gently but consistently guiding the process of small routines the person uses, to prepare themselves for bed. Teeth brushing, undressing, bathroom, etc.

And I keep that focus on timing as my top priority - when my 104 year old lady wanted to stay in her recliner in her study, rather than get up at bedtime and walk all the way to the back bathroom to start nighttime routines for bed, I worked repeatedly to urge her to get up, using every trick in the book (kind tricks, but still, distracting her from outbursts, then gently returning to the, OK, let's get up prompts). I brought her walker and placed it in position for her to get up. I raised the recliner, even an inch at a time, to avoid her resistance. It was VERY helpful and no matter how much trouble she sometimes gave me, she always thanked me when she climbed into her bed and could rest. It helped if other caregivers used the same focus on other nights, so she would expect the habit of getting up and getting ready for bed.

But some carers just wrote down that she refused, and they left her in the recliner when she argued and refused and criticized them. But I vowed never to leave at 11 pm, without her safe and settled in bed, so I redoubled my efforts, supportive friendliness, but guiding her process an inch at a time.

Once she was standing, she was into the routine, and walked to the back and allowed all other routines. But while she was still sitting, it was sometimes a major challenge to get her up (and there were times when she stated clearly that she loved watching me struggle - and I just sighed in frustration, but told her again, that I do it because I know it's important to her, even telling her, that if she stays in the chair, she will soon start to confuse night and day, and not remember anything. She understood that risk, and my concern, and together we made it happen.

If my client woke during the night, I always responded right away, the first call, but delayed any responses after that, listening for signs of distress. Again, I worked to reassure but diflect her from any complicated topics, like finances for instance.

I assured my nightime clients if they called out and were anxious, that I have found that things often look darker during the night. So many times, we find ideas in the morning, so it is wasted time to fuss over over issues at night - plan to set it aside, and we can worry in the morning.

Again, I focus on the gradual lessening of awake moments, and always decreasing my role of conversing with them. Some nights if they are anxious, I might just sit silent in a chair nearby, gradually stopping responding to their comments, dozing, If they keep trying to talk with me, I move the chair farther away, but still, just be a presence, which makes them feel less alone, yet not engaged in conversation.

This gradual process, reassurance and guidance has always worked, with very few night exceptions.

If I can't find any other way, I may suggest a shared cup of cocoa, but the next night, I delay any repeat of this act, which could become a habit, keeping them awake. Gradual is the key, keep the focus. I use a similar self acceptance of small gains and gradual improvement for my own awake nights.
Well maybe Bradley can come over in the wee hours and read that book or fold laundry with my loved one....while I get the sleep I need to survive and function the next day. Unrealistic advice for those caring for a loved one at home. If you do get up and do this it will become habitual...just common sense.
Very good, if not very encouraging, article. Lewy Body Dementia also involves sleep disturbances. And if we had not been able to solve that problem I could not have kept my husband home with me. (Our solution was a drug, but not a sleeping pill.)

I would love to have Castle care for a loved one at night! If a caregiver can afford overnight in-home care for the loved one, and can find someone as skilled as Castle, that seems to be an excellent approach. But it is obviously not something a son or daughter or spouse trying to care for a loved one on our own could manage.

So many aspects of caring for someone with dementia would be much more manageable with in-home care. So many aspects of caring for someone with dementia would be much more manageable with unlimited money.