Sleep issues are a well-documented symptom of many types of dementia, particularly Alzheimer’s disease. This presents a serious challenge for families. If a loved one with dementia isn’t sleeping, then neither is their caregiver.

“Quite often, the lack of sleep is what first causes a family caregiver to consider placing a loved one in a facility,” says Maureen Bradley, LPN, Certified Dementia Practitioner, director of Alzheimer’s care programs at several skilled nursing facilities run by Royal Health Group in New England.

Sleep deprived caregivers are often plagued by many of the same questions about their loved ones’ odd sleeping habits: How do I get Dad to sleep through the night? Why does my loved one sleep all day? Why does Mom get so anxious around dinner time? Dementia experts provide answers to these and other common questions below.

  1. Does Alzheimer’s disease 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, PhD, Sleep Medicine Program Director at Pulmonary Disease and Critical Care Associates in Columbia, Maryland. “As Alzheimer’s progresses, a person’s circadian rhythms tend to become desynchronized. They may become prone to dozing intermittently throughout the day and then experiencing difficulty sleeping at night,” he says.
  2. Is my loved one “sundowning?”
    Sundowning refers to the collection of behaviors exhibited by someone suffering from Sundowner’s syndrome, a dementia-related disorder that makes a person increasingly anxious and agitated as night falls. If your loved one is sundowning, they may become restless, aggressive, pace around, shadow you, attempt to “escape” their environment 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,” Bradley explains.
    Read: Understanding and Minimizing Sundowner’s Syndrome
  3. Why do people with Alzheimer’s disease have unusual sleep cycles?
    The precise cause of sleep problems in Alzheimer’s sufferers is currently unknown, although many factors likely play a role. Dr. Wickwire points out that the disease alters areas of the brain that regulate hormone secretion, appetite and cognitive functioning. Damage to any or all these components may result in wakefulness and restless nights. Bradley adds that a lack of activity during the day and an inability to recognize one’s familiar environment, such as a bedroom, can exacerbate sleep issues as well.
  4. Is it okay to let someone with Alzheimer’s sleep all day?
    This is a tough question to answer since every dementia patient is different. According to the Alzheimer’s Association, people with late-stage Alzheimer’s spend up to 40 percent of their time lying awake in bed at night. These sleepless nights typically cause patients to be extremely drowsy during the day. Bradley says that boredom is another big contributor to daytime 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.”
    Instead, Bradley suggests trying to keep a loved one engaged during the day so they’ll sleep better at night. Adult day care activities, physical exercise, special outings, even simple errands can keep your elderly loved one active during waking hours. If a senior absolutely needs to rest, Dr. Wickwire recommends scheduling 20- to 30-minute naps during the day—enough to refresh them, without interfering with nighttime sleep.
  5. Should people with dementia use sleeping pills?
    “I don’t like sleeping pills for seniors, especially those with dementia,” admits Bradley. “They increase a person’s fall risk and can cause drowsiness and a hungover feeling the next day.” Indeed, research consistently indicates that, for older adults, the risks associated with prescription sleep aids outweigh the potential benefits. It’s best to try non-pharmaceutical options for improving sleep before turning to prescriptions drugs.
  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 to improve their rest. 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 set daily routine and avoiding caffeine and alcohol. Making sure a loved one gets some sun exposure during the day, drawing the blinds to block out nighttime shadows and minimize sundowning, and maintaining a comfortable sleeping environment (proper temperature, comfortable bedding, minimal noise, etc.) may also help a person with Alzheimer’s sleep more soundly. If your loved one does wake up in the middle of the night and they can’t fall back asleep, don’t force them to remain in bed. Bradley says it’s better to get them started on a minor task, such as folding laundry or watching a show on TV, to help them relax again.
    If a loved one’s sleep issues become so disruptive that you cannot get adequate sleep yourself, it is important to consider alternative care options. Sleep deprivation can have a severe impact on your mental and physical health, and it can lead to dangerous accidents and lapses in judgement. In-home care services can provide respite both during the day and/or at night, while senior living facilities like memory care residences can guarantee a loved one’s care and safety around the clock.

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