Dementias, including Alzheimer’s disease, particularly mid and late stage, often disrupts the sleep-wake cycle. Alzheimer’s patients may have wakefulness, disorientation, and confusion beginning at dusk and continuing throughout the night. The early evening disorientation and confusion is called “Sundowning.” Confusion, under-stimulation, or the opposite – over stimulation, fatigue during the day may result in increased confusion, restlessness, and insecurity at night. Some people develop fear of the dark. There is a delicate balance in trying to achieve a good night’s sleep. Try the following strategies to reduce nighttime restlessness:
Physical activities may help the person feel more tired at bedtime. If the person seems very fatigued during the day, give them a short rest in the afternoon to regain their composure. This can lead to a better night’s sleep. But don’t let them sleep too long – too much daytime napping can increase nighttime wakefulness. Be consistent with the time for sleeping, and keep a routine for getting ready for bed. Developing an afternoon routine such as lunch, a nap, a walk, then perhaps gardening (or other interest) reading, and dinner, a short walk, a desert, watching television and then going to bed may be able to fill the person with enough stimulation so that nighttime sleep comes peacefully.
Try giving the person a bath and some warm milk before bed be careful, too much liquid will lead to urination problems at night.
Provide a comfortable bed, reduce noise and light. A small night light can be peaceful and may reduce confusion.
Try playing the persons favorite soothing music.
Close the curtains and try to reduce outside noises such as traffic or a loud television or stereo in another room.
Some people with Dementia, particularly Lew Body Dementia, imagine things in the dark and become upset. Stuffed animals or a pet may soothe the patient and allow them to sleep.
Have the person use the toilet right before bedtime. Place a commode next to the bed for nighttime urination. Walking to the bathroom in the middle of the night may wake the person up too much, and then they can’t get back to sleep.
The person may prefer to sleep in a chair or on the couch, rather than in bed. Furniture must be designed so that the patient won’t fall out while sleeping. The best recliner chairs are soft and evenly distribute the body weight to reduce the chance of “bed sores”. Even good beds can contribute to bed sores, primarily because of pressure points on various parts of the body, particularly the hips, buttocks and back. Changing positions either in a chair or in bed can help reduce this very important nighttime sleeping issue.
If the patient paces during the night, make sure that the spouse - primary daytime caregiver can sleep. Pacing requires either a very safe room for the patient to pace in, or else another caregiver who takes over at night.
If night wakefulness has gotten too difficult to manage, consult with a healthcare professional if you wish to try administering sleeping pills. If the person is taking medications for Alzheimer’s or psychotropic drugs, be sure to have that list available for the doctor.
Restraining the person in bed should be considered as a last resort, preferably left to hospitals. If falling out of bed becomes a habit, more than a couple of times, then consider partial bed railings. These partial railings have a support that fit between the box spring and mattress. They are not full length but can be placed towards the head of the bed that will allow the person to still sit up in bed, use the railings as support for getting in and out of bed. Another safety measure is to place one side of the bed against a wall. A hospital bed with guard rails in the mid and later stages of Alzheimer’s may then be called for.
This article was submitted by Tor Eckert with permission from www.alz.org. Eckert has been involved all facets of Alzheimer’s disease since the 2005 including owning a Alzheimer’s Care Home. His public speaking forums — The Many Faces of Dementia have provided health care professionals, adult children, caregivers and families with a better of understanding of Alzheimer’s and the other dementias. For more information, please call Eckert at (530) 432-8308 or email firstname.lastname@example.org.