How does dementia affect sleep?

People living with dementia often experience sleep disturbances that can have a detrimental impact on their health and wellbeing, and can also create significant challenges for the person or people caring for them.

Sleep, or lack of it, is often “the straw that breaks the camel’s back” when making the decision to move into residential care, says Colin McDonnell, Dementia and Wellbeing Consultant with Calvary Care.

“It’s a big thing to try to get people to have good sleep patterns when they’ve got dementia,” he told HelloCare.

Understanding the causes of poor sleep for those living with dementia and having strategies to improve the situation are the first steps to managing the problem.

What causes those living with dementia to have poor sleep?

Sleep disturbances can be caused by a range of factors associated with dementia.

The brain damage caused by dementia can lead to changes in the brain’s circadian rhythms, disrupting sleep.

People living with dementia tend not to get outside as much in the sun, said McDonnell. That can affect their mood, but also their sleep, he said.

Illness, untreated pain, undiagnosed infection, depression, medication, ‘restless legs syndrome’, and simply the fact that the person is less active can all have a detrimental effect on sleep.

Medication can also disrupt sleep, and can be discussed with the person’s doctor. Medication to aid with sleeping is another matter that can be spoken about with the doctor.

Feeling hungry and disturbing dreams may also be a cause of restlessness at night.

Encouraging good sleep hygiene

“Exercise and meaningful engagement helps a person sleep better,” explained McDonnell.

“Make sure they exercise, take them outside, try to get them into the garden, into the sun,” he suggested.

Look out for signs of pain, anxiety, delirium and agitation. During the pandemic, depression, anxiety and agitation are likely to be more common than usual, noted McDonnell.

Look for signs of infection or illnesses that might keep them up at night.

Going to bed too early can also cause restless sleep, as can sleeping too much during the day.

“Quiet times are good, so they can relax a bit, but preferably no sleep during the day,” advised McDonnell.

Environmental issues can also affect sleep. Things to consider:

Check if the person is not too hot or cold.
Avoid unfamiliar environments as much as possible.
Make sure there is enough light for the person to find their way, particularly if the person is in an unfamiliar environment.
Avoid lighting that is flickering, too bright or could cause glare or heavy shadows.
Check that it’s quiet at night for the person – noise at night is enough to disturb anyone’s sleep.
Decrease caffeine intake with decaffeinated coffee and tea, particularly in the afternoons, McDonnell suggested.

At night time, a warm shower before bed, a nice warm drink, a hand massage, a favourite pillow or relaxing music can all lay the foundations for a good night’s sleep.

McDonnell said when residents living with dementia get up at night and see staff in their uniform or work clothes, they sometimes mistakenly believe it’s daytime.

But if staff wear pyjamas or dressing gowns at night, McDonnell has observed the person is much more likely to return to bed when they wake.

“We’ve done that a few times [dress staff in their pyjamas], and some people apologise for waking the staff up,” McDonnell said.

Know the person’s history

As with all dementia care, knowing the person’s history can help create good sleep hygiene by providing a reassuring, familiar and appropriate environment.

Provide opportunities for the person to do “what they really like to do” during the day so they are busy and engaged – this can improve sleep quality.

But even with all the knowledge and goodwill available, sleep can still pose significant problems when caring for someone with dementia, particularly for those at home also caring for other family members, which is increasingly common.

“If a carer has got a job in the daytime, and they're up in the middle of the night trying to settle someone and get them back to bed and find out what they're doing, then they're not getting any sleep either.

“So then they get run down and worn out and can’t cope. They’re busy all day and up all night,” McDonnell said.

“And that’s when the rubber really hits the road and causes more issues almost than anything else,” McDonnell said. “It’s a massive problem.”

For more information about the effects of dementia on sleep and how to help, see Dementia Australia’s fact sheet.