How Does Dementia Affect Sleep?

Caring for someone with dementia can be a challenge. It can be even harder if your loved one doesn’t have a regular sleep pattern and needs around-the-clock care.

“Sleep disturbances are common in dementia,” says clinical health psychologist and caregiver expert Lucille Carriere, PhD. “Poor sleep is a top reason why caregivers consider moving their loved one into a memory care facility.”

Dr. Carriere and behavioral sleep medicine expert Michelle Drerup, PsyD, DBSM, discuss the link between dementia and sleep. They also offer tips on what caregivers can do to help their loved ones and themselves.

Sleep problems linked to dementia

People with dementia can experience different types of sleep problems, including:

• Difficulty falling and staying asleep.
• Sleeping too much during the day and being awake at night.
• Trouble distinguishing day from night.
• Waking up in the night confused, fearful or anxious.
• Wandering during the night.

Stages of dementia and sleep

Sleep issues can vary depending on the individual, type of dementia and disease stage. In general, the likelihood of a person with dementia experiencing sleep disturbances increases as the disease progresses.

“A typical pattern in advanced dementia is frequent periods of wakefulness at night and excessive sleeping during the day,” explains Dr. Drerup. “People may sleep longer overall, but the quality of their sleep is often poor.”

Why does dementia affect sleep?

Healthcare providers aren’t sure exactly what causes sleep disturbances in people with dementia. It’s likely due to multiple factors, like:

Brain changes

The underlying disease causing dementia can affect the area of your brain that controls your internal clock. People with dementia may also produce less melatonin, a hormone that helps promote sleep.

Behavioral changes

The behavioral symptoms of dementia can interfere with sleep. Some people with dementia, including Alzheimer’s disease, experience a syndrome called sundowning.

“Sundowning causes confusion and restlessness in the late afternoon and evening,” says Dr. Carriere. “It can make preparing for bedtime and falling asleep very difficult.”

Sleep disorders

Sleep disorders interfere with sleep and can occur with other dementia-related sleep problems. Common sleep disorders include:

• Rapid eye movement (REM) sleep behavior disorder causes you to act out your dreams with aggressive behaviors such as kicking, punching or yelling.
• Restless legs syndrome causes uncontrollable leg movements at night.
• Sleep apnea causes short breaks in your breathing that interfere with sleep.

Age-related factors

As you get older, you’re more likely to have trouble getting a good night’s sleep, says Dr. Drerup. Insomnia and sleep apnea are more common in older adults. Illness, pain and medications can also affect sleep.

Effects of poor sleep

Poor sleep can wreak havoc on your mood, energy and ability to perform everyday activities. It’s also linked to physical health conditions, like:

• Diabetes.
• Cardiovascular disease.
• High blood pressure.
• Overweight/obesity.

For people with dementia, a lack of sleep can magnify dementia-related behavioral, cognitive (thinking) and emotional symptoms. And caregivers may find themselves less equipped to engage with their loved one.

How to get a good night’s sleep with dementia

But a good night’s sleep can be within reach for you and your loved one. Helping someone with dementia get enough rest may involve changing their habits or environment. Dr. Carriere and Dr. Drerup offer six tips to help develop a better sleep schedule:

1. Set routine sleep and wake times

Going to bed and waking up at the same time each day can help maintain a consistent sleep schedule. It also provides cues that can reduce day-night confusion.

2. Create a calming bedtime routine

Reducing stimulation before bed and in the sleep environment can make it easier to fall and stay asleep:

• Cue bedtime with soothing activities like a bath, massage or gentle music.
• Reduce stimulation by avoiding caffeine late in the day and turning off devices an hour or so before bedtime.
• Provide a quiet, relaxing bedroom. If you can’t reduce sound, a white noise machine might help.

3. Limit napping

You may not be able to cut out daytime napping entirely. If naps help your loved one function better, try limiting the length of the nap. And avoid naps in the late afternoon or evening.

4. Encourage activity

Physical and social activities can benefit sleep and overall health. Getting outside or spending time in a sunny window can also help people with dementia distinguish day from night.

5. Ensure a safe environment

For people with dementia who wander during the night, safety is a top concern. Dr. Carriere recommends using a range of strategies to prevent wandering:

• If restless, provide reassurance and refocus attention to enjoyable activities.
• Attend to basic needs such as toileting and hydration before bed.
• Keep keys, coats and hats out of sight.
• Install door alarms and locks.
• Secure exterior doors and use safety covers on doorknobs.

6. Check medications

Certain medications can cause agitation or alertness in people with dementia. A healthcare provider can review medications and adjust as needed to reduce these effects.

Also, be vigilant about medications your loved one receives in the hospital. When in doubt, talk to the healthcare team about potential side effects.

Are sleep aids safe?

Not all sleep aids are safe for people with dementia. Many prescription sleep medications affect brain health. Over-the-counter sleep aids, such as melatonin or nighttime pain relievers, may also not be appropriate.

“Even sleep medications people have taken for years can affect their brain differently when they develop dementia,” notes Dr. Drerup. “Check with your healthcare provider before giving any medications. Your provider can help assess the risks and benefits of a sleep aid and decide if it’s a safe option.”

Caregiver support

It’s challenging to manage nighttime disruptions while also providing care and support during the day. Over the long term, juggling both can be unsustainable and lead to burnout.

If you’re not getting adequate sleep, Dr. Carriere recommends seeking help right away from your medical team. Potential resources for your loved one may include:

• Medical providers such as neurologists or gerontologists can help manage sundowning, assess medications and recommend behavioral strategies.
• A clinical psychologist or sleep psychologist can address specific behaviors and develop an action plan. Ask your provider for a referral or find a professional in your area through the Society of Behavioral Sleep Medicine or the Board of Behavioral Sleep Medicine.
• An occupational therapist can help you establish daily routines and activities to improve chances for a better night sleep, as well as provide sleep hygiene recommendations.

And think about your self-care. Can you bring someone in during the evening or night so you can rest? Getting the help you need can improve your well-being. It can also keep your loved one at home longer — a goal for many families.

Do sleep problems cause dementia?

Research shows sleep apnea and sleep deprivation may increase your risk of dementia. But there’s no clear evidence that poor sleep causes dementia, states Dr. Carriere.

“It’s important to look at dementia risk from a broader perspective,” says Dr. Drerup. “Many factors increase your risk, probably more than sleep. Your lifestyle plays a huge role.”

These steps can help reduce your risk of dementia:

• Get active.
• Limit alcohol use.
• Maintain a healthy weight.
• Manage chronic conditions like high blood pressure or diabetes.
• Prevent and treat hearing loss.
• Quit smoking.
• Seek help for depression.

If you find yourself worrying about sleep, you could be making things worse. Either way, it’s a sign you should talk to a healthcare provider about how you can improve your sleep. Don’t hesitate to get the care you need so you or your loved one can feel better.