Dementia and Sleep: 8 Tips to Keep Nighttime from Becoming a Nightmare

About Juliet Holt Klinger

Senior Director of Dementia Care

Juliet is a passionate advocate for people living with dementia and their families. She is deeply committed to improving the cultural acceptance of those with cognitive differences. As our gerontologist and Senior Director of Dementia Care, Juliet develops person-centered care and programming for Brookdale’s dementia care communities. But if you ask her, Juliet says she continues to learn every day from the true experts, those living with dementia and their care partners. Juliet believes we need to move beyond the concept of caregiving, which implies a one-sided relationship, and embrace the idea of care partnering. Care partnering is about relationships built on cooperation—a two-way street promoting person-centered care and mutual feelings of purpose, where the person living with dementia also plays a strong role in shaping their care and daily routine. We are here to partner, learn and grow with our residents and families to make aging a better experience. After volunteering in nursing homes in high school, Juliet knew she wanted to work with older adults. While working on her bachelor’s degree in social work at the University of Iowa, she completed an Aging Studies Certificate program, before there were formal gerontology programs available. At Iowa, Juliet also had the chance to study with pioneers in the field of dementia care, an opportunity that shaped her passion for caring for those living with dementia. Trained as a gerontologist, with a master’s degree from the University of Northern Colorado, Juliet joined Brookdale in 2004. She is a seasoned senior living executive with more than 30 years of experience designing and executing innovative Alzheimer's and dementia care programs and living environments in both assisted living and skilled settings.

Recently, I was visiting a Brookdale community and met Renee, the daughter of a new dementia care resident. Renee told me she was her mother’s full-time care partner prior to the move. I asked how they were both adjusting to her mother’s new living arrangements and she lit up. She said her mother loved her new home and had transitioned quickly. Renee said the most beneficial part of the move for her as a care partner was that she was actually sleeping again. “Mom had her days and nights turned around, and sometimes I would stay up all night with her. It was really bad for both of us.” Unfortunately, this is a common issue.

Night can become an anxious time as dementia progresses. The disease may interfere with the sleep/wake cycle in the brain, leading to overnight restlessness and daytime drowsiness, which can make symptoms worse. It may also rob care partners of the rest they need, leading to chronic and even dangerous exhaustion.

For all adults, aging tends to change sleep patterns. Typically, people begin waking up throughout the night, sleeping fewer hours and achieving a lower percentage of deep sleep. All of these issues also affect those with dementia as they age, but they can be more pronounced. The synchronized circadian sleep rhythm becomes disrupted, breaking sleep up into several segments over a 24-hour period. This can cause excessive sleepiness during the day and insomnia at night.

In addition, a few forms of dementia are associated with certain sleep disorders. People living with Alzheimer’s are more likely to wander at night, while those with vascular dementia may experience altered breathing while sleeping. Parkinson’s can cause daytime drowsiness, or sudden onsets of sleep, and dementia with Lewy Bodies can produce hallucinations and the more frequent awakenings at night due to vivid dreams.

While sleep medication might seem like an answer to the problem, research has not proven that it helps. In fact, a number of studies show that it can lead to more sleep disturbances rather than less. Plus, these medications can negatively affect cognition, which increases confusion for people living with dementia. However, there are a number of helpful steps care partners can take that don’t involve drugs. They include:

1. Checking with a physician to make sure a physical condition such as undiagnosed pain or a urinary tract infection isn’t the culprit.

2. Ensuring exposure to natural light during the day.

3. Making sure the person with dementia exercises for least 30 minutes a day, although not within four hours of bedtime.

4. Providing purposeful things to do throughout the day. Being engaged in meaningful ways discourages daytime sleeping and contributes to feeling pleasurably tired in the evening.

5. Not serving alcohol, caffeine and large meals as bedtime approaches.

6. Scheduling a bathroom visit right before going to bed.

7. Using time-honored methods for relaxing, such as a short massage, a warm bath or snuggling with a pet.

8. Limiting screen time before bed or using an amber-colored nightlight. Studies show white light interferes with a person’s ability to return to REM level sleep. Shutting off electronic devices or switching them to the night shift setting can help. Amber light doesn’t affect a person’s ability to sleep like white light does.

Dementia’s impact on sleep is something to take very seriously. Just as Renee did with her mom, care partners should carefully consider how much it is compromising their own health and ability to cope. Chronic exhaustion can become dangerous, even causing accidents and injury.

If the issue can’t be addressed, it may be time to consider a dementia care community, where teams of specially-trained people can provide the care that’s needed both day and night. This ensures high quality of care for the person with dementia and enables family members to get the rest they need to continue their invaluable role of cherishing their loved one.