Dementia affects everything, including sleeping patterns. You may be able to sleep at night, but your live-in parent or loved one with dementia unfortunately may not. If they’ve taken to night wandering, you’ll worry they might turn the stove on or even try to leave the house, which means you might have a hard time getting enough sleep, as well.
How do you keep family members with dementia or Alzheimer’s disease from getting out of bed so you both get a better night’s sleep?
Tips to keep dementia and Alzheimer’s patients in bed at night include:
- Keep the person hydrated and well-fed
- No caffeine in the late afternoon or early evening
- Make a bedtime routine
- Be active and get regular exercise together
- Get physical and mental conditions treated
- Check their medications
- Make the room comfortable
When you can’t get restful sleep at night, that makes you a poor caretaker for your parent or loved one with dementia. Yet when they’re the reason you can’t sleep, the matter becomes more complex still.
Keep reading for more information to get your loved one with dementia to stay in bed.
Why Can’t Dementia Patients Sleep At Night?
If your parent or loved one with dementia keeps you up more nights than not, it’s not because they mean to. There are usually underlying causes.
Following are some possible reasons that sleep problems like falling asleep and staying asleep become increasingly harder for dementia patients.
Restless Leg Syndrome And Related Conditions
According to the National Institute of Neurological Disorders and Stroke, about 10 percent of the United States population could have restless leg syndrome – with or without a dementia diagnosis.
It’s more common in women but happens in men, as well. For example, my husband suffers from a related condition called periodic limb movement disorder, which makes his muscles twitch while he is sleeping and this affects his sleep quality.
Restless leg syndrome causes pain and discomfort in the legs unless moving them. They might feel burning or tingling and even charley horses.
Thus, even if older adults with dementia wanted to sleep, their restless leg syndrome or similar condition would force them into another sleepless night.
They might decide to get out of bed to relieve the discomfort in their legs and then lose track of what they’re doing. Then you wake up and find them rummaging through the house in the middle of the night.
Certain Medications
We’ll talk more about this later, but it’s a good idea to check the medications your parent or loved one with dementia takes.
Medications might cause sleep changes, such as making it difficult for a dementia patient to slip into a sound sleep or maybe making them sleep throughout the night. By adjusting their dosage or switching to a different medication, this problem can alleviate itself.
Sleep Apnea
Sleep apnea is a sleep disorder that causes a person to stop breathing intermittently. Age is one risk factor, so it’s your parent or loved one with dementia might have undiagnosed sleep apnea.
Even once a doctor diagnoses sleep apnea, it can still be hard for someone with the condition to always get a good night’s sleep.
Insomnia
If your parent or loved one with dementia has become an insomniac but never was before, it’s likely because of their dementia. In one study on insomnia, a group of geriatrics experts reported that, “Insomnia is a common problem in older people, especially in patients with mild cognitive impairment (MCI) whose circadian rhythm is often compromised.”
Additionally, according to a 2014 publication in the journal Neurology Clinical Practice, “insomnia occurs in one-fourth to one-third of patients with dementia.”
Insomnia can make it impossible to sleep even when a person wants to (trust me, I’m a middle-aged woman who experiences occasional bouts of insomnia despite my best efforts to get a good night’s sleep!). It often requires medical intervention to get under control.
Sundowning
We’ll talk about sundowning more in the next section. For now, what you should know is that, according to the Alzheimer’s Association, “People living with Alzheimer’s and other dementia may have problems sleeping or experience increased confusion, anxiety, agitation, pacing and disorientation beginning at dusk and continuing throughout the night (referred to as sundowning). Although the exact cause is unknown, these changes result from the disease’s impact on the brain.“
As mentioned in the quote, the reason it’s called sundowning is that it begins late in the afternoon or in the evening, AKA at the time of day when the sun goes down.
If a dementia patient has a severe case of sundowning, it can be very hard for them to sleep.
Depression And Anxiety
Although some people assume that those who are depressed do nothing but sleep, depression can cause sleeplessness as well.
So too can a dementia patient’s anxiety (anxiety is a common symptom of dementia, according to the Alzheimer’s Society (UK). Along with affecting the person’s quality of life, it can keep them tossing and turning all night, especially if they’re having a rare moment of lucidity.
Medical Conditions Or Pain
Are you aware of all the medical conditions your parent or loved one with dementia has currently? Are these medical issues being treated or actively managed?
If not, then pain or other symptoms from a medical condition can cause sleep disturbances.
Dementia
In many cases, it’s dementia itself that keeps dementia patients awake throughout the night.
According to Mayo Clinic, those with mild or moderate dementia have sleep issues at a rate of 25 percent. That number increases to 50 percent for those diagnosed with severe dementia.
Why Does Sundowning Happen At Night?
You’ll recall from the prior section that sundowning causes a dementia patient to become agitated and confused as the day wanes and night is about to fall. Why does sundowning happen when it does?
Read our tips for calming someone who has dementia.
Well, as we said, medical experts still aren’t exactly sure.
That said, the consensus as of this writing is that one’s circadian rhythm (body clock) falling out of whack that could cause or worsen sundowning symptoms.
These factors might also increase the rate of symptoms or their severity:
- Boredom
- Depression
- Stress
- Hunger
- Dehydration
- Untreated health problems
- Faded light and large shadows that might trigger agitation
- Drinking alcohol or caffeine too close to bedtime
- Mental exhaustion or fatigue
- Lack of sleep
In my opinion, health issues and hospital visits trigger sundowning, too.
My mom went through it as her terminal brain tumor progressed. A few years later, my dad had a mild heart attack and that trauma, combined with a hospital stay, really messed with his sleep-wake cycle.
When either parent was going through it, they would look out the window, see the bright light of mid-day and swear that it was the middle of the night.
When I would stop by after work (in my work scrubs), it would upset my father because he thought I was on my way to work in the morning and he worried that I would be late because I was helping him.
I have never experienced sundowning myself, so I can only liken it to possibly being similar to that feeling you have when you wake up from a deep sleep and are momentarily disoriented – only sundowning can’t be shaken off.
What Helps Dementia Patients Sleep At Night?
To reduce a dementia patient’s sundowning symptom severity and help them get a more restful night’s sleep, let’s look at the suggestions from the intro.
Keep The Dementia Patient Hydrated And Well-Fed
As we talked about in the last section, both dehydration and hunger can worsen sundowning, which might make it harder for a dementia patient to fall asleep.
In my mom’s case (brain tumor), this was true – she was on high doses of steroids to try to shrink the tumor and they made her ravenous. So she had a hard time understanding that it was midnight because her empty stomach insisted it was noon and time to eat!
If you’ve ever been sent to bed without dinner, then you know that hunger pangs can interrupt your sleep. A dementia patient might awaken in the night (if they ever fell asleep at all) and try to get something to eat in the kitchen, waking up the whole family.
Keep your parent or loved one with dementia fed and hydrated. Give them a nourishing meal in the evening and perhaps a post-dinner snack several hours before they’re going to go to sleep.
They should be drinking hydrating fluids such as water throughout the day.
No Caffeine Late In The Afternoon And Thereafter
While a dementia patient can drink other beverages besides water, caffeinated beverages should have a hard cut-off late in the afternoon.
You want to cease the consumption of caffeine ideally before sundowning would start. Even if a dementia patient asks for a caffeinated beverage such as coffee or soda at night, you should decline every time.
To be on the extra-safe side, you might want to keep caffeinated beverages out of reach from the dementia patient. This prevents them from drinking caffeine after you go to bed.
Make A Bedtime Routine And Stick With It
Dementia patients do best with a reliable and predictable daily routine that includes waking and going to sleep at the same time.
The schedule might reduce a dementia patient’s rate of agitation, restlessness, and aggression. Your stress as the caretaker or adult child is also lessened since you know what’s coming.
Although it will take several nights to get a bedtime routine going, once you do, it will be worthwhile for both yourself and your parent or loved one with dementia.
Be sure to follow the routine moving forward. Even on weekends, the dementia patient shouldn’t change their sleep schedule.
Be Active During The Day Together
Although dementia patients can’t endure strenuous exercise, activities such as walking, tai chi, yoga, swimming, seated exercises, activity boards, and even dancing are suitable for them.
You should set aside some time every day for you two to exercise together. The physical activity will tire out the person and hopefully make it easier for them to fall asleep.
Get Any Physical And Mental Conditions Diagnosed And Treated
As we made clear earlier in this article, depression, restless leg syndrome, and countless other physical and mental health conditions can impede a dementia patient’s ability to sleep. You’ll recall that that includes dementia itself.
If your parent or loved one with dementia doesn’t already have a treatment regimen with their doctor, then beginning one is within their best interest.
Check Medications
A whole laundry list of medications can cause or intensify insomnia in dementia patients, including the following:
- Statins
- Chondroitin and glucosamine
- H1 antagonists
- Cholinesterase inhibitors
- Angiotensin II-receptor blockers
- ACE inhibitors
- SSRI antidepressants
- Corticosteroids
- Beta-blockers
- Alpha-blockers
As we mentioned before, if your parent or loved one with dementia is on the above medications, then it’s worth talking with their doctor about adjusting their dosage or possibly trying another type of medication altogether.
Make The Room Comfortable
Is the dementia patient’s bedroom even comfortable enough to go to sleep?
The room should be at a temperature of around 65 degrees Fahrenheit and dark. The environment should also be quiet.
How Do You Get Someone With Dementia To Go To Bed?
Perhaps your problem isn’t with your parent or loved one with dementia sleeping throughout the night, but actually going to bed in the first place.
How do you get them to agree to go to their rooms and try and get some shuteye?
Well, many of the habits we recommended in the last section would absolutely apply. You should get your parent or loved one with dementia in to see a doctor and ensure they’ve been properly diagnosed with any physical and/or mental health ailments.
Change their medication, provide opportunities for physical activity, and cut out caffeine before sundowning symptoms can begin.
These things will naturally make the dementia patient more tired so they should hopefully be more willing to go to bed on their own.
How Do You Stop Dementia Patients From Getting Out Of Bed?
When a caregiver’s sleep patterns keep getting interrupted, it’s very easy to feel at the end of your rope. You might even have the idea to use physical restraints to keep your parent or loved one with dementia in their beds.
Although this may sound like a good idea, it really isn’t. You could erode trust in your relationship with the dementia patient, which will make caring for them in the future much more difficult.
Instead, what many caretakers do is lift the height of the bed rails in the person’s bed. Raising the safety rails doesn’t make it impossible for them to leave their bed, but it certainly does make it more difficult!
Conclusion
When a parent or loved one with dementia won’t sleep or stay asleep, it’s detrimental to their health and your own. You both need sleep to be your best, and that starts with understanding what keeps dementia patients awake and then treating the issue at the root cause.
Good luck!