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Living With Alzheimer's >> Behavior Basics | 04.24.15

Sleep disturbances: when resting at night becomes erratic

The normal patterns of sleep — awake during the daytime and retiring after dark — can become disrupted for people with dementia. This usually occurs because the person is only alert for relatively short periods of time during the day, and then alternates those times with short naps. This throws normal sleep habits into disarray, which can stress caregivers who need to follow more traditional schedules.

Often a complete day/night reversal can occur. In these cases, the person with dementia sleeps during the day and is active all night. This can also place an enormous burden on caregivers.

Why is this happening?

Older people, even those without dementia, tend to nap more often during the day and wake frequently during the night. Since seniors may spend less time outside, the lack of natural light can also rob their bodies of the biological cues that lead to a normal sleep/wake cycle.

Dementia-related conditions only add to the problem, since nerve damage in the brain further confuses the body’s internal clock. Other complications may also aggravate insomnia symptoms, including pain, depression, anxiety, delusions or unintended side effects of medication.

Some possible causes for erratic sleep patterns:

  • Reduced exposure to daylight
  • Lack of activity during the day
  • Uncomfortable environment (noise, heat, cold)
  • Physical discomfort (hunger, thirst, need to urinate)
  • Emotional needs (loneliness, need for affection)
  • Disturbances with internal clock (see “Sundowning”)
  • Hallucinations/delusions
  • Depression
  • Pain
  • Improper diet
  • Drug side-effects

How should you respond?

If a person’s internal clock has become confused, you may be able to “reset it” using simple bedtime rituals and other routines. Try to keep the person on a regular sleep schedule by providing reminders about the time of day. During that time, make sure distractions are removed and try to keep the person calm and comfortable.

Before relying on sleep medications, be sure to check with your doctor. The effect of these drugs, even non-prescription sleep aids, can have an unpredictable effect on those with dementia and could actually worsen the problem.

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