How to Manage Altered Sleep Cycles in People Living with Dementia

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By Valerie FeurichApril 29th, 2021

How to Manage Altered Sleep Cycles in People Living with Dementia


Strategies for Creating More Rest Time for You and the Person In Your Care
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Are you a caregiver (or care partner, as we prefer to say at Positive Approach to Care®) to a person living with dementia who is experiencing altered sleep cycles? This phenomenon is a common occurrence in people living with dementia, particularly in some forms of dementia such as Lewy Body Dementia (LBD).

People with a healthy brain go through multiple, repeated sleep cycles throughout the night, including falling asleep initially, light sleep, deep sleep, and REM (Rapid Eye Movement) sleep. Normally, we do not wake as we transition through these cycles.

When a person is living with dementia, however, their brain can have trouble transitioning from one sleep state or cycle to the next, waking the person up again instead. Some, particularly people living with LBD, may not be able to get into REM sleep at all.

So, your person living with dementia may be able to fall asleep but may wake two hours later as their brain was not able to transition them to the next cycle. In addition, as dementia progresses, more and more of the hippocampal area will become damaged. The hippocampus helps humans to hold on to a timeline, such as knowing where we are and what day it is. So if it no longer is fully functional, it becomes much harder for a person to realize that it is 11 pm and not 11 am if they wake after a two-hour sleep cycle.

On the other hand, your person living with dementia may not fall asleep at night at all, but may sleep during the day. This may leave you as the care partner entirely exhausted as well, as you are unable to get the needed rest and recovery at night.

While the causes for these altered sleep cycles are multi-factorial, meaning there are lots of factors in play, there are a few things you can try and keep in mind to help you both find a little more rest.
1. See if you can identify any unmet needs before going to bed
While reasons for altered sleep cycles can vary from person to person, unmet needs can also be at play. As dementia continues to alter or destroy parts of the brain, a person may no longer be able to express needs or even identify the need they may be feeling.

As an example, if your person has been rather sedentary throughout the day, they may not have moved enough to activate their bowels. However, as this need becomes more urgent throughout the night, your person may wake during the night in a distressed and agitated state as their brain may no longer be able to identify what that need is and how to relieve it.

It could also be arthritis pain that could trigger them to wake at night as they shift from one position to another?

You may want to try to think through the various human needs listed below and see if there may be any that have not been met and could cause distress during the night.

Emotional Expressions of Need:

Anger

Sadness

Loneliness

Fear

Boredom

Physical Unmet Needs:

Hunger or thirst

Energy level

Elimination (using the restroom)

Discomfort

Pain

By trying to figure out if there's a cause for their restlessness, you have a greater chance of getting a restful night of sleep. While it may not always be an unmet need that is waking the person living with dementia it may simply be that their brain can no longer smoothly transition from one sleep cycle to the next. Being curious and seeing if there is possibly an unmet need can be a good first step to try.
2. Consider their routine and sleep environment
It can be very helpful for people living with dementia to have an established evening and sleep routine, to help calm things down and get them to unwind. Here are some things you may want to try:
  • Cooling down the room as the person is going to sleep can help. While personal preferences differ of course, studies have shown that humans tend to get a better night’s rest in cooler rooms
  • Closing the curtains ahead of sunset can help the person to calm and settle down
  • Make sure that there is not a lot of light in the bedroom that could interfere with their sleep (unless the person is uncomfortable with a completely darkened room, in which case a night light may help)
  • Playing some gentle music or white noise
  • Integrating a cup of tea or similar, warm, relaxing, and non-caffeinated beverage
  • See if they can use the bathroom before lying down
  • Some rocking or quietly sitting for a bit in a quiet space in the house may bring forth calm
  • Maybe see if a backrub, hand massage, or foot rub (depending on their preference) could help your person become sleepy
  • Speaking with a soothing, calmer, quieter, deeper, and even tone of voice
  • Using heavy covers, like a weighted blanket. Some people love them, some people don’t, but it could be worth a try
  • Using a really high-quality incontinence brief that is more likely to hold a lot of urine, lessening the need to wake in the middle of the night
3. Find someone to match their sleep cycle
While this may not be possible for everyone, if you find that your person living with dementia is sleeping well but is on a sleep cycle that doesn’t match yours, you may want to try and see if you can get some assistance from another person. Having a helper that can engage and do things with your person that has value and purpose while they’re awake, may allow you to get some much-needed rest.
4. Investigate if they suddenly start sleeping longer hours
If your person living with dementia is suddenly sleeping longer hours than before, it could mean that their dementia is progressing, but it could also be a sign that something else is going on.

Could they be developing a urinary tract infection? Could it be that they’re dehydrated? Are you doing too many things throughout the day that may leave them entirely exhausted? There are many possible reasons, and it is probably a good idea to look into them.

Try thinking through a few possible scenarios to see if you may want to either change up your routine or possibly get a medical evaluation.
While there is no one-size-fits-all solution for altered sleep cycles as the causes are varied, there are a few things you can try that may help. If at all possible, you may try to get another helper to allow you some much-needed rest and recuperation, because self-care matters and your health and wellbeing are critical to your care relationship.

To say it with the words of author Eleanor Brown: “Rest and self-care are so important. When you take time to replenish your spirit, it allows you to serve others from the overflow. You cannot serve from an empty vessel.”
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5 Comments on “How to Manage Altered Sleep Cycles in People Living with Dementia”

  1. Once again, my “Fairy Godmother “ of Dementia has provided my with a gem of wisdom!!

    I’m adjusting to a new medicine and trying to sleep better and normal. Was on Excelon patch but found it activated my visual cortex too well. Ended up with 5 D dreams. Lol. Greatly entertaining but exhausting that I needed to sleep 16 hours a day! I’m now on a new med (Galantamine) which stops the vivid dreams and consequently allows for more awake time. Presently now adjusting by shifting my 8 hrs of sleep to daytime.

    These tips will certainly help!!

    Thanks!! Merci!!

    Practical Solutions make all the difference in my journey!!

  2. Great article. Something I have given a lot of thought to. My 98 yr old dad lives with us. He has advanced Alzheimers. His sundowning shifted a few months ago from afternoon to evening making it hard to get him to bed. I have paid attention to the items on your list. I have also been using more daylight along with a full spectrum lamp with him during the day for the last few weeks to increase his serotonin production during the day which is also suppose to help the melatonin level increase during the night. That is what they say with a normal brain but I decided to give it a try any way. For the last 2 weeks I have been able to get him back to his regular sleeping time his has less agitation. I don’t know what has made the difference but I will continue with the light for now. Can you direct me to anything written on light therapy with dementia? I have been reading from your website for over a year now. Thanks so much!

  3. Medications can help a lot. My husband with Lewy Body Dementia was waking up several times a night with vivid hallucinations and was also have episodes of fighting in his sleep. I was fearful of medicating him. A low dose of Seroquel 25 mg at bedtime has petty much stopped this behavior and he is still able to awaken to use the bathroom during the night if needed.

  4. Hi, last week I left a reply. I am wondering if it made it to the right destination. I am very interested on any info you may have on using light therapy during the day to help with better sleep with dementia. I have been experimenting with it with my dad and it seems to help. Thanks very much, JoAnn

    1. Hi JoAnn,

      My name is Alejandro and I am a mentor with Positive Approach to Care. Thanks for the interest in the articles and for posting to the site.
      I am not aware of anything that we have put out regarding light therapy. It sounds like you have noticed a difference for your dad since you started using it. Although I am unaware of anything we have done regarding light therapy I will pass around the question to our team to double check and I will email you.

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