People that live with a form of dementia, often have certain issues when it gets dark at the end of the day and into the night. This is referred to as sundowning. As a caregiver to someone that is affected by sundowning, you may notice that in the late afternoon or early evening, that they have increased confusion, agitation and anxiety issues. You may also notice that they have difficulties in both falling, and staying, asleep.
Many people with various forms of dementia experience changes in their sleep patterns. Scientists do not completely understand why this happens. As with changes in memory and behavior, sleep changes somehow result from the impact of dementia on the brain. Many older adults without dementia also notice changes in their sleep, but these disturbances occur more frequently and tend to be more severe if a dementia is present. There is evidence that sleep changes are more common in later stages of the disease, but some studies have also found them in early stages.
Many people with a dementia wake up more often and stay awake longer during the night. Brain wave studies show decreases in both dreaming and non-dreaming sleep stages. Those who cannot sleep may wander, be unable to lie still, or yell or call out, disrupting the sleep of their caregivers. Experts estimate that in the late stages of dementia, individuals may spend about 40 percent of their time in bed at night awake and a significant part of their daytime sleeping. In extreme cases, people may have a complete reversal of the usual daytime wakefulness-nighttime sleep pattern.
A person experiencing sleep disturbances should have a thorough medical exam to identify any treatable illnesses that may be contributing to the problem. Examples of conditions that can make sleep problems worse include: depression, restless legs syndrome – a disorder in which unpleasant “crawling” or “tingling” sensations in the legs cause an overwhelming urge to move them, or sleep apnea-an abnormal breathing pattern in which people briefly stop breathing many times a night, resulting in poor sleep quality.
Treatment for sleep disturbances include both medication and non-medication approaches. Medications are not considered to be a long-term solution, as they do not appear to improve sleep quality for older adults. Long-term use can also increase the chance of falls. Non-medication approaches include getting regular exercise (but not just before going to bed) and avoiding alcohol, caffeinated drinks, and nicotine. Make sure the bedroom is a comfortable temperature, and provide security objects and nightlights if needed. Soft music may also promote sleep. Seek morning sunlight exposure or purchase a light that emits high intensity blue-light and place it near them during the day. Move daytime clothing out of sight, so that it doesn’t act as a trigger to get dressed. It’s a good idea to aim for regular meal times, bedtimes and wakeup times. Try a light snack before bed, including herbal tea or warm milk. Make sure pain medication is given before bed, if needed. If your person with dementia does get out of bed during the night, encourage them to do something quiet like read or listen to relaxing music. Discourage doing anything stimulating such as watching television. Try to stay calm and avoid arguing. Remember, they are not intentionally staying awake. If you can, gently guide them back to bed. If your person gets up at night without you waking, you may want to invest in a monitoring device such as a bed alarm, to notify you when movement is detected.
As a caregiver you must be able to get a good night’s sleep yourself in order to cope with the day ahead. If your person with dementia is restricting your uninterrupted sleep, then I suggest that you ask a family member or a friend to help you out a couple nights a week, or more. You could also consider hiring someone to come into your home during the nights to care for your loved one with dementia, so that you can get your rest. As a caregiver, you must take care of yourself first, or you will be physically and emotionally unable to care for anyone else.
For more information on how to manage behavior and sleep problems associated with dementia, please contact your local Alzheimer’s Society. They are an excellent resource for caregivers!