Good Night, Sleep Tight

THE SITUATION

After a long day of caring for your loved one, it is likely that you could fall asleep the moment your head hits your pillow. However, catching some Z’s may be more difficult for the individual with dementia. Alzheimer’s disease can cause changes in sleep patterns, sleep disturbances and challenging behaviors, leading to more frequent nighttime awakenings. These problems typically worsen as the disease progresses. Making some slight adjustments throughout the day can make a huge difference in a person’s ability to fall asleep—and stay asleep throughout the night.

THE SOLUTION

  • Consult with a physician. Schedule a full medical exam to explore any treatable illnesses or symptoms of dementia that may be affecting sleep. For example, sleep apnea, depression, restless leg syndrome or hallucinations can be contributing factors. Also inquire about the usage and possible side effects of sleeping pills and the best time to administer other medications.
  • Be consistent. Stick to regular routines for waking, eating meals and bedtime.
  • Let the sun shine in. Open the shades and let the sunlight fill the bedroom in the morning. Bright light can normalize a person’s circadian rhythms, which ultimately influence the sleep-wake cycle.
  • Encourage daytime alertness. Make sure your loved one walks or does other forms of physical exercise and mental stimulation during the day
  • Restrict daytime sleep. Although individuals with Alzheimer’s disease tend to fall asleep during the day, due to a reversal in the sleep-wake cycle, it is important that daytime naps are limited, short and earlier in the day. In addition, a bed should be used for nighttime sleeping, not napping.
  • Try to reduce “sundowning.” Sundowning syndrome causes restlessness, agitation, confusion and other disruptive behaviors beginning in the early afternoon and lasting into the evening, which could make bedtime more challenging. Arrange relaxing activities in the afternoon to help reduce this syndrome.
  • Avoid stressful tasks. If activities of daily living such as bathing upset your loved one, schedule them earlier in the day rather than right before bedtime.
  • Limit liquids. An individual should restrict the intake of drinks and foods that contain caffeine (i.e., soda, coffee, sweets) late in the day. Also, limit water and other liquids before bedtime in order to reduce the likelihood of waking up to urinate.
  • Create a calm environment. Keep the room as dark as possible and at the appropriate temperature, and reduce loud noises. Try playing soothing music to set the mood. Put nightlights in the bedroom since complete darkness can cause confusion. If the individual has a stuffed animal or other security object, have it nearby for comfort.
  • Be patient. If your loved one exhibits disturbing behavior, like yelling and wandering, try to remain calm. Don’t argue. Remember to stay positive. Likewise, if the person is restless during the night, see what the person’s needs are, such as using the bathroom, and gently remind him or her that it is time to sleep.
  • Take precautions. Make sure that safety features are in place just in case wandering occurs during the night. This includes nightlights, reducing clutter, gates at the top of stairways and security precautions at exit doors.
    — ALYSSA N. EHRLICH

PREPARE IN ADVANCE

Plan a daily schedule that works for you and your loved one, and aim to follow it each day. By plotting out your day hour-by-hour, you can make sure to place routine activities, doctors’ appointments, visiting, etc. at ideal points throughout the day to avoid sleep problems in the evening.