Changes to sleep
Sleep is important for good health and wellbeing. It helps people living with dementia to live as well as possible and function at their best during the day.
It is common for people living with dementia to have sleeping problems.
A person with dementia might:
- sleep during the day and be awake and restless at night
- not be able to tell if it is day or night
- not be as active as they used to be and need less sleep.
Sleeping problems and disrupted sleep patterns can lead to changes in behaviour, such as agitation and aggression.
Causes of sleeping problems
Try to recognise what the cause might be, such as:
- medical or health causes
- the person’s sleeping environment.
This may help you decide on ways to address sleeping problems.
You could keep a diary or log to help identify any behaviour patterns around sleep problems.
Medical or health causes
Possible causes of sleep problems include:
- experiencing pain
- brain damage caused by dementia, affecting the internal ‘clock’ that directs sleep patterns
- illnesses such as angina, heart failure, diabetes or ulcers
- a urinary tract infection that causes a need to urinate frequently
- leg cramps or ‘restless legs’, which can indicate a problem with someone’s metabolism
- depression, which may cause early waking and an inability to get back to sleep
- the side effects of medications such as antidepressants or diuretics
- snoring or sleep apnoea
- changing sleep patterns caused by ageing: some older people need more sleep, some less.
What to try
Arrange a medical check-up to identify physical symptoms. You could ask the doctor about possible side-effects of medication, including:
- stopping or changing diuretic medication
- using pain relief at bedtime
- using sedatives
- the use of tranquilisers or sleep medication; both can have negative effects, including increased confusion.
Ask the doctor if an assessment for depression is necessary.
Consider if any of the following may be contributing to sleeping problems for the person with dementia:
- the bedroom being too hot or too cold
- poor lighting making it hard for them to know where they are
- being unable to find the bathroom
- confusion caused by moving house or being in hospital.
What to try
- Try to keep the environment at a constant temperature.
- When the person wakes, ask if they feel too hot or too cold.
- Provide good lighting to avoid shadows or glare, which can contribute to hallucinations and agitation.
- Consider moving bedroom mirrors if the person is unable to recognise themselves or others in their reflection.
- If it is hard to find the bathroom, try night lights to reduce confusion. Also, consider a commode by the bed.
- Use familiar objects in the bedroom to help with orientation.
- Ensure the bed is comfortable.
- Avoid having daytime clothing in view at night as this may indicate that it is time to get up.
Other possible causes of sleep problems are:
- too much caffeine or alcohol
- feeling hungry
- not enough exercise, which can cause someone to not feel tired
- agitation keeping a person’s mind active and unable to relax
- going to bed too early
- sleeping too much during the day
- being overtired, which can cause someone to be tense and unable to fall asleep
- watching television or using a computer before going to bed
- disturbing dreams.
What to try
Food and drink
- Cut down on caffeine (coffee, tea, cola, chocolate) during the day and do not have any after 5pm.
- Cut down on alcohol and discuss with the doctor the effects of mixing alcohol and medications.
- If the person might be hungry, try a light snack before bed, or when they wake up.
- Consider herbal teas or warm milk.
- Try to encourage the person to get enough exercise, with one or two walks each day.
- In the late afternoon, avoid tasks that may be upsetting.
- If the person is comfortable with a back rub, try that before bed or during wakeful periods.
- Gently remind the person that it is night-time and time to sleep.
- Try a radio or relaxing music playing softly beside the bed.
- If the person refuses to go to bed, offer alternatives such as sleeping on the couch.
- Consider a bath or shower before bed.
- If the person wanders at night, check that the house is safe for them to do so.
- In some situations, consider discussing with the doctor if sedative or sleeping medications are appropriate.
Support for families and carers
Sleep problems are among the most challenging symptoms of dementia.
Sleeping problems or agitation in the late evening are often a stage in dementia that passes. Many people sleep more during the later stages of dementia.
Families and carers also need to get adequate sleep themselves. Try to ensure regular periods of rest and regular breaks for yourself, as well as for the person living with dementia.
Where to get help
National Dementia Helpline
The National Dementia Helpline is a free telephone service that provides information, advice, counselling and carer support. Ask about support groups and programs for family and carers.
Dementia Behaviour Management Advisory Service
The Dementia Behaviour Management Advisory Service supports people living with dementia who experience changes in behaviour that impact their care or the carer.
Call: 1800 699 799
Additional reading and resources