Alzheimer's: Managing sleep problems

Sleep problems and Alzheimer's disease often go hand in hand. Understand what contributes to sleep problems in people with Alzheimer's or other dementia — and what you can do to help.

Common sleep problems related to dementia

Many older adults have problems sleeping, but people with dementia often have an even harder time. Sleep disturbance may affect up to 25% of people with mild to moderate dementia and 50% of people with severe dementia. Sleep disturbances tend to get worse as dementia progresses in severity.

Possible sleep problems include excessive sleepiness during the day and insomnia with difficulty falling asleep and staying asleep. Frequent awakenings during the night and premature morning awakenings are also common.

People with dementia might also experience a phenomenon in the evening or during the night called sundowning. They might feel confused, agitated, anxious and aggressive. Night wandering in this state of mind can be unsafe.

Obstructive sleep apnea is also more common in people with Alzheimer's disease. This potentially serious sleep disorder causes breathing to repeatedly stop and start during sleep.

Factors that might contribute to sleep disturbances and sundowning include:

Mental and physical exhaustion at the end of the day
Changes in the body clock
A need for less sleep, which is common among older adults
Disorientation
Reduced lighting and increased shadows, which can cause people with dementia to become confused and afraid

Supporting a good night's sleep

Sleep disturbances can take a toll on both you and the person with dementia. To promote better sleep:

Treat underlying conditions. Sometimes conditions such as depression, sleep apnea or restless legs syndrome cause sleep problems.
Establish a routine. Maintain regular times for eating, waking up and going to bed.
Avoid stimulants. Alcohol, caffeine and nicotine can interfere with sleep. Limit use of these substances, especially at night. Also, avoid TV during periods of wakefulness at night.
Encourage physical activity. Walks and other physical activities can help promote better sleep at night.
Limit daytime sleep. Discourage afternoon napping.
Set a peaceful mood in the evening. Help the person relax by reading out loud or playing soothing music. A comfortable bedroom temperature can help the person with dementia sleep well.
Manage medications. Some antidepressant medications, such as bupropion and venlafaxine, can lead to insomnia. Cholinesterase inhibitors, such as donepezil, can improve cognitive and behavioral symptoms in people with Alzheimer's but also can cause insomnia. If the person with dementia is taking these kinds of medications, talk to the doctor. Administering the medication no later than the evening meal often helps.
Consider melatonin. Melatonin might help improve sleep and reduce sundowning in people with dementia.
Provide proper light. Bright light therapy in the evening can lessen sleep-wake cycle disturbances in people with dementia. Adequate lighting at night also can reduce agitation that can happen when surroundings are dark. Regular daylight exposure might address day and night reversal problems.

When a loved one wakes during the night

If the person with dementia wakes during the night, stay calm — even though you might be exhausted yourself. Don't argue. Instead, ask what the person needs. Nighttime agitation might be caused by discomfort or pain. See if you can determine the source of the problem, such as constipation, a full bladder, or a room that's too hot or cold.

Gently remind him or her that it's night and time for sleep. If the person needs to pace, don't restrain him or her. Instead, allow it under your supervision.

Using sleep medications

If nondrug approaches aren't working, the doctor might recommend sleep-inducing medications.

But sleep-inducing medications increase the risk of falls and confusion in older people who are cognitively impaired. As a result, sedating sleep medications generally aren't recommended for this group.

If these medications are prescribed, the doctor will likely recommend attempting to discontinue use once a regular sleep pattern is established.

Remember that you need sleep, too

If you're not getting enough sleep, you might not have the patience and energy needed to take care of someone with dementia. The person might also sense your stress and become agitated.

If possible, have family members or friends alternate nights with you. Or talk with the doctor, a social worker or a representative from a local Alzheimer's association to find out what help is available in your area.