How to Manage Sleep Problems in Alzheimer's Dementia (2023)

Sleep problems are common in Alzheimer’s and other dementias. They also commonly drive family caregivers crazy, because when your spouse or parent with Alzheimer’s doesn’t sleep well, this often means that you don’t sleep well.

To make matters even worse, not getting enough sleep can worsen the thinking or behavior of someone with dementia. Of course, this is true for those of us who don’t have Alzheimer’s as well: we all become more prone to irritation and emotional instability when we’re tired. Studies have also shown that even younger healthy people perform worse on cognitive tests when they are sleep-deprived.

Hence getting enough sleep is important, for people diagnosed with dementia, and for their hard-working caregivers. Now, sleep problems do often take a little effort to evaluate and improve. But as I explain below, research has found that it is often possible to improve sleep problems in dementia.

The key is to know what common causes to look for, and then come prepared to provide useful information to the doctor. In this article, I’ll cover:

  • Common causes of sleep problems in Alzheimer’s and other dementias,
  • How sleep issues should be evaluated
  • Proven approaches that help improve sleep in dementia
  • What to know about commonly tried medications for this problem

Common Causes of Sleep Changes and Problems in People with Dementia

It’s hard to manage a problem if you don’t understand why it might be happening. There are several factors that can cause older adults with dementia to have sleep problems. These include:

(Video) Ian Maidment, PhD: Treating Sleep Problems in Those with Dementia

  • Sleep changes with aging. Healthy aging adults do experience changes with their sleep as they age. Sleep becomes lighter and more fragmented, with less time spent in deep REM sleep. One study also estimated that total sleep time decreases by 28 minutes per decade, starting in mid-life. Although these changes are considered a normal part of aging, lighter sleep means it’s easier for aging adults to be woken up or disturbed by any other sleep-related disorders or problems, such as arthritis pain at night. Aging is also associated with a shift in the circadian rhythm, so that many older adults find themselves sleepy earlier at night and hence wake up earlier in the morning. For more, see here:
  • Chronic medical conditions and/or medications. Studies have found that older adults often experience “secondary” sleep difficulties, which means that the sleep problems are being caused by an underlying health problem. Many people diagnosed with Alzheimer’s have additional chronic health problems that may be associated with sleep difficulties. Treating such problems can help improve sleep. Common causes of secondary sleep problems include:
    • Heart and lung conditions, such as heart failure or chronic obstructive pulmonary disease
    • Stomach-related conditions such as gastroesophageal reflux disease
    • Chronic pain from arthritis or another cause
    • Urinary conditions that make people prone to urinating at night, such as an enlarged prostate or an overactive bladder
    • Mood problems, such as anxiety or depression
    • Medication side-effects, and substances such as alcohol (which is known to disrupt sleep).
  • Many sleep-related disorders become more frequent with aging. Common sleep-related disorders include sleep apnea and related conditions (known as sleep-related breathing disorders), which may affect 40-50% of older adults, as well as restless leg syndrome, which is thought to be clinically significant in 2.5% of people.
  • Alzheimer’s and other neurodegenerative diseases change sleep. The brain deterioration associated with various forms of dementia tends to affect the way the brain sleeps. In most cases, this causes less deep-sleep time, and more awake time at night. Problems with the circadian rhythm system (the body’s inner system for aligning itself with a 24-hour day) also become more common in dementia. Furthermore, Lewy-body dementia and Parkinson’s dementia are also associated with a sleep disorder called REM sleep behavior disorder, which can cause violent movements during sleep and can even emerge before thinking problems become substantial.

In short, most aging adults develop lighter sleep as they age, and many older adults have health problems that prompt nighttime awakenings. Sleep-related disorders such as sleep apnea are also common in aging. Older adults with Alzheimer’s and other dementias are likely to be affected by any of these factors that change sleep as people age, plus dementia brings on extra changes that make night-time awakenings more common.

Hence, it’s not surprising that sleep problems are so common in people with dementia! Now let’s talk about what can be done to improve things.

How to Diagnose the Sleep Problems of a Person with Dementia

Like many problems that affect older adults, sleep problems in dementia (and generally in aging) are almost always “multifactorial,” which means that there are usually several underlying issues creating the problem.

Multifactorial problems can be improved, especially if a family and the doctors are diligent about trying to identify as many contributing factors as possible. But you’ll need to start by helping the doctors understand what kinds of sleep-related symptoms and problems a loved one is experiencing.

Here is a list of questions that a group of geriatrics experts recommends, for evaluating sleep problems. (These are addressed to a patient; replace “you” with “your parent” if you are gathering information in preparation to see a health professional about a parent’s sleep issues.)

(Video) Caregiver Training: Sleep Disturbances | UCLA Alzheimer's and Dementia Care Program

  1. What time do you normally go to bed at night? What time do you normally wake up in the morning?
  2. Do you often have trouble falling asleep at night?
  3. About how many times do you wake up at night?
  4. If you do wake up during the night, do you usually have trouble falling back asleep?
  5. Does your bed partner say (or are you aware) that you frequently snore, gasp for air or stop breathing?
  6. Does your bed partner say (or are you aware) you kick or thrash about while asleep?
  7. Are you aware that you ever walk, eat, punch, kick, or scream during sleep?
  8. Are you sleepy or tired during much of the day?
  9. Do you usually take 1 or more naps during the day?
  10. Do you usually doze off without planning to during the day?
  11. How much sleep do you need to feel alert and function well?
  12. Are you currently taking any type of medication or other preparation to help you sleep?
  13. Do you have the urge to move your legs or do you experience uncomfortable sensations in your legs during rest or at night?
  14. Do you have to get up often to urinate during the night?
  15. If you nap during the day, how often and for how long?
  16. How much physical activity or exercise do you get daily?
  17. Are you exposed to natural outdoor light most days?
  18. What medications do you take, and at what time of day and night?
  19. Do you suffer any uncomfortable side effects from your medications?
  20. How much caffeine (eg, coffee, tea, cola) and alcohol do you consume each day/night?
  21. Do you often feel sad or anxious?
  22. Have you suffered any personal losses recently?

Many families will be unsure of how to answer some of these questions initially. So to get the best help from the doctors, it’s best to prepare ahead of time. I always recommend families try to keep a journal related to these questions for at least a week. Some families may also be able to use a sleep tracker or activity tracker, to gather useful information.

Based on the information above, and after conducting an in-person examination to check for other medical issues, a doctor should be able to place the sleep difficulties in one (or more) of the following categories:

  • Difficulty falling or staying asleep
  • Excessive daytime sleepiness
  • Abnormal breathing patterns during sleep
  • Abnormal movements or behaviors during sleep

Sometimes additional testing is necessary, such as a sleep breathing study to evaluate sleep apnea.

Based on the category of sleep problem, and the underlying causes that have been identified, the doctor should then be able to propose a plan for improving the sleep difficulties.

How to Improve Sleep Problems in Dementia

The exact approach to improving sleep in a person with Alzheimer’s or another dementia will depend on what underlying factors are causing sleep problems. Still, certain general approaches have been found to improve the sleep of many people with dementia. These include:

(Video) What's the connection between sleep and Alzheimer's disease? | Sleeping with Science, a TED series

  • Outdoor light or bright light therapy during the day. Bright outdoor light helps keep the circadian signals (the body’s inner clock) on track. For older adults who can’t get outside for at least an hour per day, bright light therapy with a special lamp might help. A study found that bright light therapy in Alzheimer’s patients improved sleep.
  • Increase daytime physical activity. Research has suggested that walking during the day can help improve nighttime sleep in people with Alzheimer’s.
  • Optimize environmental cues for sleep. This means keeping the sleeping environment dark and quiet at night. This is especially important in nursing homes, which have sometimes been found to have staff active at night.
  • Establish a regular routine with a consistent wake-up time. A regular routine can help maintain better sleep. The ideal is to have a consistent bedtime and wake-up time, but many experts believe it’s best to start by focusing on a consistent wake-up time.

A research study published in 2005 found that training dementia caregivers to use these techniques in combination did lead to improved sleep of the care recipients with Alzheimer’s.

Medications to Manage Sleep Problems in Dementia

You may be wondering whether medications can help manage sleep problems in dementia.

To begin with, it is important to check current medications and make sure they are not negatively affecting a person’s sleep. For example, sedating medications during the day may cause a person with dementia to sleep or nap too much, resulting in more awake time at night. Or a diuretic offered too late in the day might be causing extra nighttime urination.

As a caregiver, you may simply want to know: “Isn’t there a medication we can give in the evening, to help my parent sleep better at night?”

It’s true that sleeping pills, sedatives, and tranquilizers exist, and they are often prescribed to help keep people with dementia quieter at night. These include antipsychotics like olanzapine, risperidal, and quetiapine, benzodiazepines such as lorazepam and temazepam, sleeping medications like zolpidem, or even over-the-counter sleep aids (which usually contain some form of sedating anti-histamine).

(Video) Dementia Caregiving Sleep

Unfortunately, all these medications are likely to cause concerning side-effects in people with dementia, namely worse cognition and increased fall risk. The antipsychotics have also been associated with a higher risk of dying. Last but not least, comprehensive scientific review articles conclude that in clinical trials, these drugs do not conclusively improve sleep.

Hence, the recommendation of experts in geriatrics is that these medications should generally be avoided, and only used as a last resort once behavioral approaches (e.g. setting a routine, more walking, etc.) have been tried.

That said, there are a few medications that may be less risky, and are sometimes used:

  • Melatonin. Melatonin is a hormone involved in the sleep-wake cycle. A Scottish study found that 2mg of melatonin nightly improved the sleep of people with Alzheimer’s. However, a more recent randomized trial of melatonin in people with dementia was negative. Also, in the U.S. melatonin is sold as a poorly-regulated supplement, and studies have found that commercially sold supplements are often of questionable quality and purity.
  • Trazodone is an older weak anti-depressant that is mildly sedating. It has long been used by geriatricians as a “sleeping pill” of choice, as it seems to be less risky than the alternatives. A small 2014 study found that trazodone improved sleep in Alzheimer’s patients.

To summarize, although medications are often used to manage sleep problems in dementia, most of them are pretty risky. So it’s better to avoid sedatives until you’ve exhausted all other options.

Non-drug approaches like plenty of outdoor light, regular exercise, a stable routine, optimizing chronic conditions, and checking for pain often help. Plus, these usually improve the person’s quality of life overall.

(Video) Sundowning, Sleeplessness & Alzheimer's: How to Cope in the Evenings

Remember, sleep is important for health, and it’s especially important for family caregivers.

For more on sleep in older adults (whether or not they have Alzheimer’s), see these posts:

This article was last updated by Dr. K in August 2022.

FAQs

What can you give dementia patients to help them sleep? ›

What is the best sleep aid for dementia patients? There is no one best sleep aid for seniors with dementia. However, some studies show that melatonin supplements may improve sleep in older adults with dementia when combined with bright light therapy.

How do you keep a dementia patient in bed at night? ›

How to Keep Dementia Patients in Bed at Night
  1. Consistent Schedule. One of the best ways to help loved ones with dementia sleep at night is keeping them on a regular, consistent schedule. ...
  2. Daily Exercise. ...
  3. Monitor Naps. ...
  4. Nighttime Routine.

Why do Alzheimer's patients not sleep at night? ›

The sleep-wake cycle—also called circadian rhythm—is the internal clock in our body that initiates physical processes related to wake and sleep. When this cycle is disturbed in Alzheimer's patients, the result is not sleeping at night and sleeping too much during the day.

How do you stop dementia patients getting out of bed? ›

Dementia and Falling Out of Bed: Prevention Tips

Lowering the bed. Adding a fall mat to the floor at the bedside to prevent injury. Providing transfer enablers, such as a bed cane, halo or transfer pole can be helpful for residents that are usually able to self-transfer.

How do you get an Alzheimer's patient to sleep? ›

Set a quiet, peaceful mood in the evening to help the person relax. Keep the lights low, try to reduce the noise levels, and play soothing music if he or she enjoys it. Try to have the person go to bed at the same time each night. A bedtime routine, such as reading out loud, also may help.

What is the best sedative for dementia patients? ›

Commonly used drugs: In older adults these include:
  • Lorazepam (brand name Ativan)
  • Temazepam (brand name Restoril)
  • Diazepam (brand name Valium)
  • Alprazolam (brand name Xanax)
  • Clonazepam (brand name Klonopin)

What to give Alzheimer's patients to calm down? ›

Try to keep a routine, such as bathing, dressing, and eating at the same time each day. Build quiet times into the day, along with activities. Keep well-loved objects and photographs around the house to help the person feel more secure. Try gentle touching, soothing music, reading, or walks.

What are signs that dementia is getting worse? ›

increasing confusion or poor judgment. greater memory loss, including a loss of events in the more distant past. needing assistance with tasks, such as getting dressed, bathing, and grooming. significant personality and behavior changes, often caused by agitation and unfounded suspicion.

What is the average lifespan of someone with Alzheimer's? ›

On average, people with Alzheimer's disease live between three and 11 years after diagnosis, but some survive 20 years or more.

At what stage do Alzheimer's patients sleep a lot? ›

Sleeping more and more is a common feature of later-stage dementia. As the disease progresses, the damage to a person's brain becomes more extensive and they gradually become weaker and frailer over time.

What is the best medication for sundowning? ›

Risperidone, is one of the commonly used agent, has been shown to decrease nocturnal agitation in nursing home residents. Another study demonstrated reduction of aggressiveness and wandering, as well as increase nighttime sleeping hours in demented patients treated with risperidone.

At what stage of dementia does sundowning occur? ›

Sundowning can happen at any stage of dementia but is more common during the middle stage and later stages.

What are the symptoms of the final stages of Alzheimer's? ›

A person with late-stage Alzheimer's usually:
  • Has difficulty eating and swallowing.
  • Needs assistance walking and eventually is unable to walk.
  • Needs full-time help with personal care.
  • Is vulnerable to infections, especially pneumonia.

What is best sleeping pill for elderly? ›

In the elderly, nonbenzodiazepines such as zolpidem, eszopiclone, zaleplon, and ramelteon are safer and better tolerated than tricyclic antidepressants, antihistamines, and benzodiazepines. Pharmacotherapy should be recommended only after sleep hygiene is addressed, however.

What causes dementia patients to suddenly get worse? ›

Rapidly progressive dementias or RPDs are extremely rare, but can cause dementia to worsen over weeks and months. RPDs can be caused by complex medical conditions such as Autoimmune conditions, cancer, and neurodegenerative diseases – i.e diseases that damage the body's nervous systems.

Do Alzheimer's patients have trouble sleeping? ›

People with Alzheimer's often have problems with sleeping or may experience changes in their sleep schedule. Scientists do not completely understand why these sleep disturbances occur. As with changes in memory and behavior, sleep changes somehow result from the impact of Alzheimer's on the brain.

How do you stop nocturnal confusion? ›

Tips for reducing sundowning
  1. Keep a predictable routine for bedtime, waking, meals and activities.
  2. Plan for activities and exposure to light during the day to encourage nighttime sleepiness.
  3. Limit daytime napping.
  4. Limit caffeine and sugar to morning hours.

Is Alzheimer's worse at night? ›

When you are with someone who has Alzheimer's disease, you may notice big changes in how they act in the late afternoon or early evening. Doctors call it sundowning, or sundown syndrome. Fading light seems to be the trigger. The symptoms can get worse as the night goes on and usually get better by morning.

What meds should dementia patients avoid? ›

Narcotics such as hydrocodone, oxycodone and morphine; muscle relaxants such as cyclobenzaprine, carisoprodol; NSAIDs such as ibuprofen, naproxen should be avoided if possible. If these medications must be used, they should be used at the lowest effective dose for the shortest duration to minimize adverse effects.

What is the longest stage of Alzheimer's disease? ›

Middle-stage Alzheimer's is typically the longest stage and can last for many years. As the disease progresses, the person living with Alzheimer's will require a greater level of care. During this stage, the person may confuse words, get frustrated or angry, and act in unexpected ways, such as refusing to bathe.

What can make Alzheimer's worse? ›

Tronetti: Alzheimer's can be made worse by common things
  • Urinary tract infection (UTI). ...
  • Alcohol. ...
  • Uncontrolled diabetes, hypertension and cholesterol. ...
  • Anti-cholinergic drugs. ...
  • Poor hearing. ...
  • More:Detailed plan a must when prepping dementia patients for hurricane.
27 Aug 2019

Can you give sleeping pills to dementia patients? ›

Sleep medication is not recommended for a person with dementia. However, some doctors may suggest trying it for a short period if the sleep problem is severe, and non-drug treatments have not worked. If the person does take sleep medication, they may become more confused and more likely to fall over the next day.

What is best sleeping pill for elderly? ›

In the elderly, nonbenzodiazepines such as zolpidem, eszopiclone, zaleplon, and ramelteon are safer and better tolerated than tricyclic antidepressants, antihistamines, and benzodiazepines. Pharmacotherapy should be recommended only after sleep hygiene is addressed, however.

Why do dementia patients get restless at night? ›

An upset in the "internal body clock," causing a biological mix-up between day and night. Reduced lighting can increase shadows and may cause the person living with the disease to misinterpret what they see and, subsequently, become more agitated.

Why are dementia patients so restless? ›

What causes restlessness in people living with dementia? They may be a symptom of the physical changes in the brain caused by dementia. A person may become agitated suddenly because of a change or specific cause, such as increased noise or not being able to do something they previously could.

What to give Alzheimer's patients to calm down? ›

Try to keep a routine, such as bathing, dressing, and eating at the same time each day. Build quiet times into the day, along with activities. Keep well-loved objects and photographs around the house to help the person feel more secure. Try gentle touching, soothing music, reading, or walks.

What are signs that dementia is getting worse? ›

increasing confusion or poor judgment. greater memory loss, including a loss of events in the more distant past. needing assistance with tasks, such as getting dressed, bathing, and grooming. significant personality and behavior changes, often caused by agitation and unfounded suspicion.

At what stage do Alzheimer's patients sleep a lot? ›

Sleeping more and more is a common feature of later-stage dementia. As the disease progresses, the damage to a person's brain becomes more extensive and they gradually become weaker and frailer over time.

What is the natural remedy for sleepless night? ›

Avoid chemicals that disrupt sleep, such as nicotine, caffeine, and alcohol. Eat lighter meals at night and at least two hours before bed. Stay active, but exercise earlier in the day. Take a hot shower or bath at the end of your day.

How do you get an elderly person to sleep through the night? ›

Establish a regular sleep schedule. Go to bed and wake up at the same time each day. Be physically active each day, but exercise early in the day and no later than four hours before going to bed. Sleep in a dark, quiet, cool room (between 60 and 67 degrees Fahrenheit).

What is the drug you will give for a elderly patient with difficulty sleeping? ›

Doxepin (Silenor)

Doxepin at low doses (1, 3, and 6 mg) is a selective histamine antagonist (primarily H1 receptor) and is FDA approved for insomnia. Recent studies have shown that low-dose doxepin improves sleep parameters in older adults with a safety profile comparable to placebo.

What time of day is dementia worse? ›

Late afternoon and early evening can be difficult for some people with Alzheimer's disease. They may experience sundowning—restlessness, agitation, irritability, or confusion that can begin or worsen as daylight begins to fade—often just when tired caregivers need a break.

What is the best medication for sundowning? ›

Risperidone, is one of the commonly used agent, has been shown to decrease nocturnal agitation in nursing home residents. Another study demonstrated reduction of aggressiveness and wandering, as well as increase nighttime sleeping hours in demented patients treated with risperidone.

What is the best medication for agitation in dementia? ›

But common ones that can ease agitation include: Medicines that treat paranoia and confusion, called neuroleptics or antipsychotics. Examples of these are aripiprazole (Abilify), haloperidol (Haldol), olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal), and ziprasidone (Geodon).

What should you not do with dementia? ›

I'm going to discuss five of the most basic ones here: 1) Don't tell them they are wrong about something, 2) Don't argue with them, 3) Don't ask if they remember something, 4) Don't remind them that their spouse, parent or other loved one is dead, and 5) Don't bring up topics that may upset them.

How do you distract dementia patients? ›

Family caregivers need to develop distraction techniques like those mentioned below, which can calm situations and divert their elderly loved one's attention.
  1. Play Music. ...
  2. Try Aromatherapy. ...
  3. Start a New Activity. ...
  4. Use Reassurance. ...
  5. Encourage Doing Household Chores.
16 Aug 2019

What are the symptoms of the final stages of Alzheimer's? ›

A person with late-stage Alzheimer's usually:
  • Has difficulty eating and swallowing.
  • Needs assistance walking and eventually is unable to walk.
  • Needs full-time help with personal care.
  • Is vulnerable to infections, especially pneumonia.

Videos

1. How to improve sleep in dementia
(Dementia Careblazers)
2. Dementia and Sleep - how to fix the sleep problems
(drdevsleepdoctor)
3. Understanding Night-Time Problems in Dementia
(Keila Haynes)
4. Sleep Problems with Dementia
(dignityfirstdoctors)
5. Sleep Problems in our Patients with Dementia
(Mandy | Seniors Flourish)
6. Successful Strategies for Addressing Sleep Challenges in Dementia, Dr. Ayati
(Alzheimer's Association California & Nevada)
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