Getting Better Sleep When Your Loved One Has Dementia

You thought Dad was finally asleep. But pretty soon you realize he's gotten out of bed again. It's 1 a.m. and you're exhausted.

Senior man in slippers leaving the room in the dark

We've learned so much recently about the relationship between sleep and brain health. Recent studies reported in JAMA Neurology and at the 2017 Alzheimer's Association International Conference confirmed that poor sleep quality can lead to a buildup of the amyloid plaques that cause the symptoms of Alzheimer's disease.

On an everyday — and every night — basis, sleep and memory are closely intertwined. We go to bed with a day's worth of memories in our head. But most of those memories are fleeting. It is during sleep that the memories of the day are sorted and stored. If we sleep poorly or not enough, our recollection of the previous day is likely to be fuzzy.

And the old saying "a good night's sleep clears the mind" is literally true. While we're sleeping, the brain's waste removal mechanism, called the glymphatic system, removes cellular debris that could raise our risk of dementia. Dr. Maiken Nedergaard of the University of Rochester Medical Center explains why this only happens as we slumber. "The brain only has limited energy at its disposal and it appears that it must choose between two different functional states — awake and aware, or asleep and cleaning up." Dr. Nedergaard provides a good analogy: "You can think of it like having a house party. You can either entertain the guests or clean up the house, but you can't really do both at the same time."

The relationship between sleep and dementia goes both ways. Just as poor-quality sleep raises the risk of Alzheimer's disease and related disorders, these conditions also can have a devastating impact on sleep quality ... and family caregivers are caught up in the sleeplessness cycle.

Caregivers are well-familiar with "sundown syndrome," when in late afternoon and early evening, just as the caregiver is most tired, their loved one becomes restless, agitated and very much awake. Their loved one may resist going to bed, refuse to stay in bed, and get up again and again in the night, leaving the caregiver exhausted the next day.

What causes these sleep disturbances, and can anything be done?

Neurologists believe that Alzheimer's disease causes disruptions in the body's circadian rhythm — the 24-hour cycle that controls body temperature, hunger, sleeping and wakefulness. Dementia leaves a person's sense of day and night reversed and fragmented. The effect is magnified when the person has unmet needs that they can't express, such as hunger, thirst, pain, loneliness or boredom.

The National Institute on Aging recommends that caregivers improve their loved one's sleep by creating an environment more conducive to calm and sleepiness near the end of the day. Close the curtains and blinds at dusk. Reduce noise and clutter and the number of people in the room. Have the person take part in a quiet activity, like folding napkins. Offer a small snack and drink. Play soothing music, read quietly to your loved one, or put on a familiar old TV program. Don't give them coffee or other caffeinated drinks late in the day. If their sleep problems persist, talk to their doctor, who might diagnose underlying causes such as a urinary tract infection or medication side effects.

Supporting the caregiver's sleep

Most people with dementia do best at home, among familiar surroundings, where they feel more oriented and independent. Familiar daily routines provide comfort and stability. Continued proximity to family and friends preserves a sense of social connectedness. But a patient's sleep disturbances can have a profound negative effect on the health of family caregivers. According to McGill University experts, sleep problems are the most frequent reason given in a family's decision to place a loved one in a care facility.

It's understandable. Sleep deprivation takes such a toll on family caregivers and, as we saw above, even threatens their own brain health. If there is a dementia caregiver in your family, this person needs help and respite. Have a family meeting. Contact your local aging services department. Respite care may be available at a local nursing home or assisted living facility, but sometimes this change of routine can be upsetting and agitating for your loved one.

Many families hire professional in-home care to keep their loved one safe and cared for at home while preserving the health of family caregivers. In-home care can be provided overnight so the caregiver can sleep. And that's just the beginning. If you hire from an agency that provides memory care training for its caregivers, the caregiver can promote better sleep in so many ways:

Supervision and transportation for appropriate activities. Loneliness can be distressing for people with dementia. If they're bored, they might take long naps during the day and then not be sleepy at night. The professional caregiver can help your loved one with appropriate activities — crafts, music, cooking, looking at photo albums, and whatever else your loved one enjoys. The caregiver might take your loved one to community activities for people with dementia. Professional caregivers can provide light housekeeping services and laundry — and as a bonus, having your loved one help with these tasks provides an extra measure of activity and a sense of accomplishment. The caregiver also will be alert to signs of overstimulation.

Woman with Alzheimer's and a professional caregiver in the garden

Encourage your loved one to exercise. Physical activity earlier in the day promotes good sleep at night. The caregiver can take your loved one for a walk around the neighborhood or to a dementia-friendly exercise class at the local senior center, or can help them work out to a dementia-safe exercise video. Your loved one and the caregiver might even have a home dance party, featuring your loved one's favorite music.

Get your loved one into the sunshine. Just as creating a calm environment at bedtime can help people with dementia wind down for the night, exposure to bright light during the day can help reset the body clock of a person with dementia, say experts. It may be unsafe for your loved one to go out alone, but with the caregiver at hand, they can sit on the front porch, putter around in the garden, or visit a local park.

Provide medication reminders. In some cases, a person's doctor will prescribe medications to help them sleep better at night. It's important that these drugs be taken as recommended. The caregiver can remind your loved one to take their medication, pick up prescriptions at the pharmacy, and be alert for side effects such as confusion, dizziness or lethargy.

Help with bathing, dressing, grooming and using the toilet. People with Alzheimer's may resist taking a bath or shaving. They may have trouble dressing. They may forget to go to the toilet until it's too late. Trained caregivers know how to overcome this resistance gently and with sensitivity, in a way that preserves your love one's dignity and reduces agitation.

In-home care can be provided for a few hours per week, all the way to round-the-clock assistance. Helping with the cost is a great way for other family members to support the well-being of not only their loved one with dementia, but also family caregivers.

For information on topics related to home care and healthcare, visit our Home Care and Healthcare Advocacy group on LinkedIn.

Right at Home, Inc. is a national organization dedicated to improving the quality of life for those we serve. We fulfill that mission through a dedicated network of locally owned providers of in home care services.