Dementia and sleeping problems

Problems with sleeping are a common occurrence for people with dementia. Some people sleep during the day and are awake and restless at night. Some are no longer able to tell the difference between night and day, while others are simply not as active as they used to be and therefore need less sleep.

This can be difficult for carers who may need help to manage this common but distressing problem.

Causes of sleeping problems

It is important to try to recognise what may be causing the problem – is it the environment, the dementia or the medication they are taking? Understanding the cause will help you to decide which strategies may be helpful. Some carers find that keeping a log or diary helps them to see a pattern of behaviour that may be developing and identify the problem.

Physiological or medical causes

Sleeping problems may be caused by physiological or medical causes including:

• Brain damage – the dementia has affected the ‘biological clock’ in the brain which directs our sleep patterns.
• Illness – such as angina, congestive heart failure, diabetes or ulcers.
• Pain – caused by such things as arthritis.
• Urinary tract infections – which cause a frequent need to urinate.
• Leg cramps – or ‘restless legs’, which can indicate a metabolic problem.
• Depression – which causes early morning wakening and an inability to get back to sleep.
• Side effects of medication – such as diuretics.
• Snoring and sleep apnoea.
• Less need for sleep – as a person gets older, they often need less sleep.

Things you can try include:

• Discuss with the doctor the possibility of stopping or changing diuretic medication, as this may be contributing to the problem.
• Arrange a medical check-up to identify and treat physical symptoms.
• Treat pain with an analgesic at bedtime if the doctor agrees.
• Discuss with the doctor whether sedatives may be contributing to the problem.
• Ask the doctor whether an assessment for depression may be necessary.
• Ask the doctor about possible side effects of medication.
• In some situations, it may be necessary to consider discussing with the doctor the appropriateness of either using tranquillising medication or sleeping medication. The latter may be helpful in the short term to establish a better sleep cycle, but both types of medication can have negative effects such as increased confusion.

Environmental causes

Sleeping problems may be caused by environmental causes including:

• The bedroom may be too hot or too cold.
• Poor lighting may cause the person to become disoriented.
• The person may not be able to find the bathroom.
• Changes in the environment, such as moving to a new home or having to be hospitalised, can cause disorientation and confusion.

Things you can try include:

• Keep the environment as consistent as possible.
• Check whether the person is too hot or cold on wakening. Dementia may affect their internal thermostat.
• Shadows, glare or poor lighting may contribute to agitation and hallucinations, so provide adequate lighting.
• Nightlights might help cut down on confusion at night and may assist the person to find the bathroom.
• If finding the bathroom is a problem, a commode next to the bed might help.
• Make sure the bed and bedroom are comfortable and familiar. Familiar objects may help to orient the person.
• Avoid having daytime clothing in view at night, as this may make the person think it is time to get up.
• Make sure that the person is getting adequate exercise. Try taking one or two walks each day.

Other causes

Other causes of sleeping problems may include:

• Going to bed too early
• Sleeping too much during the day
• Overtiredness, causing tenseness and inability to fall asleep
• Insufficient exercise so that the person does not feel tired
• Too much caffeine or alcohol
• Feeling hungry
• Agitation following an upsetting situation
• Disturbing dreams.

Food and drink

Some suggestions include:

• Cut down on caffeine (coffee, cola, tea, chocolate) during the day and cut out altogether after 5pm.
• Cut down on alcohol and discuss the effects of alcohol and medication with the doctor.
• If you think the person may be hungry at night, try a light snack just before bed or when they wake up.
• Herbal teas and warm milk may be helpful.

Daily routines

Some suggestions include:

• Try not to do any tasks that may be upsetting to the person in the late afternoon.
• If the person refuses to go to bed, try offering alternatives such as sleeping on the sofa.
• If the person wanders at night, consider allowing this but check that the house is safe.
• Try a back rub before bed or during wakeful period.
• Try a softly playing radio beside the bed.
• Gently remind the person that it is night-time and time for sleep.

Other considerations

Problems with sleeping or late evening agitation are often a stage in dementia that eventually passes. Many people with dementia sleep more during the latter stages of the illness. Sleep problems are among the most difficult symptoms of dementia for carers. Carers must be able to get adequate sleep themselves. Plan regular periods of rest and regular breaks for yourself as well as for the person with dementia.

Where to get help

• Your doctor
• Your local community health service
• Your local council
• National Dementia Behaviour Management Advisory Service Tel. 1800 699 799 – for telephone advice, assessment, intervention, education and specialised support (24 hours)
• National Dementia Helpline Tel. 1800 100 500
• Commonwealth Carer Respite Centre Tel. 1800 059 059
• Carer Resource Centres Tel. 1800 242 636
• Aged Care Information Line Tel. 1800 500 853

Things to remember

• Problems with sleeping are common for people with dementia.
• There are things you can try to help manage sleeping problem.
• Understanding the cause can help carers decide which strategies may be helpful.
• Carers also need rest and regular breaks.

You might also be interested in:

• Dementia.
  
• Dementia - changed behaviours.
  
• Dementia - communication issues.
  
• Dementia - different types.
  
• Dementia - early planning will help.
  
• Dementia - safety issues.
  
• Dementia - support services are available.
  
• Dementia - through all its stages.
  
• Dementia and sundowning.
  
• Dementia and wandering.
  

Want to know more?

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Alzheimer's Australia Victoria

Fact sheet currently being reviewed.
Last reviewed: May 2012

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<a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Dementia_and_sleeping_problems?open">Dementia and sleeping problems - Better Health Channel</a><br/>
Sleep problems are common for people with dementia. Some people sleep during the day, leaving them awake and restless at night. Sleep problems may be caused by medication, pain or depression. This can be difficult for carers who may need help.

Content on this website is provided for education and information purposes only. Information about a therapy, service, product or treatment does not imply endorsement and is not intended to replace advice from your qualified health professional. Content has been prepared for Victorian residence and wider Australian audiences, and was accurate at the time of publication. Readers should note that over time currency and completeness of the information may change. All users are urged to always seek advice from a qualified health care professional for diagnosis and answers to their medical questions.

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