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Adults over 65 need around 7-8 hours of good quality sleep each night, but there is a sleep and dementia link. People who live with dementia can experience a variety of problems with their sleep, particularly with maintaining a pattern of good quality, deep sleep each night. This article will explore the sleep and dementia link.
How can dementia affect sleep?
Sleep issues associated with dementia can include:
- Excessive sleeping, particularly in people in later stages of dementia
- Getting mostly light, broken sleep
- Waking up frequently during the night
- Being unable to wake up in time to go to the toilet
- Talking or shouting in their sleep
- Sleep walking or acting out their dreams
- Sleep apnoea, when they stop breathing in their sleep
Why does dementia affect sleep?
Disruption to the natural body clock
One reason that dementia affects normal sleeping patterns is that it disturbs the circadian rhythm, or the ‘body clock’. Usually your body knows that day is the time to be awake and night is the time to sleep. If you keep to a routine, it can become easy to naturally wake up at the same time every day.
For people with dementia, this innate function often doesn’t work properly, so their sleep routine can be all over the place. This can leave them feeling groggy and confused, much like people do after a nap or getting up much earlier than usual. It also means they don’t always get full REM cycles and miss out on important, deep sleep. They can also become agitated and confused in the evening. This is called sundowning.
Mental fatigue
Damage to the brain can cause mental and physical fatigue. You may notice your loved one sleeps a lot more when they have been socialising or had a busy day that’s required more cognitive function than usual.
For example, on a day out, your loved one might have to plan their time in order to make it to the bus or an event on time, remember their route, recall or take in new information far more than a relaxed day at home. This brain work can tire them out as much as the physical demands of the day.
Signs of mental fatigue can include looking spaced out, getting easily confused or distressed, and difficulty finding the right word or words coming out in the wrong order. If these come on very suddenly though, it can be a sign of delirium.
Does lack of sleep cause dementia?
Good quality sleep is integral to mental and physical wellbeing. Lack of sleep can worsen cognitive function, including memory, concentration, problem-solving and mood. For someone who lives with dementia, this can see their symptoms worsen.
Several studies have suggested a link between lack of good quality sleep and the risk of developing dementia. A 2021 study found that people over 50 who persistently get less than six hours’ sleep a night have a 30% increased risk of developing late-onset dementia than those of the same age who are getting at least seven hours a night.
How to help someone with dementia to sleep at night
Older people tend to be lighter sleepers anyway, which isn’t ideal for a restful and revitalising night. It is optimal for people to have one good sleep at night rather than naps or broken sleep.
Here are some ways you can support your loved one with dementia to sleep well.
Make sure their bedroom is comfortable
A busy environment can cause stress and confusion that make sleeping properly more difficult.
You can support good sleep by keeping your loved one’s bedroom clean and tidy, and as dark and quiet as possible. Night lights or a rug (that they won’t trip over, you can buy rug adhesive in DIY shops) can guide them to their commode or the bathroom if they wake up disorientated.
Familiar items and scents can also help a person with dementia to sleep. When washing their bedding, leave one pillowcase each time or having an item of clothing or a loved one nearby can help soothe them.
Be active during the day
Spending too much time without fresh air or exercise can make falling asleep at night more difficult. It can also cause Restless Leg Syndrome, when excess unused energy causes legs to feel twitchy and uncomfortable in bed, unless you move them very fast, which doesn’t help you to fall asleep.
If your loved one is able to, you, a friend or a carer could support them to go for walks, or any other exercise or activity that gets them moving or outside.
Get into a routine
A good bedtime routine is useful to anyone and for people with dementia it can help their brain and body to understand that it’s time for sleep.
You could help your loved one to establish a night time routine, or be consistent with one they already have. Include activities that help them to wind down, like reading or having a bath, and try to stick to doing the routine at roughly the same time each day.
Reducing anxiety
People living with dementia can experience anxiety. One way this can manifest is needing to obsessively check doors and switches repeatedly (both due to anxiety and poor memory) before they go to bed, a ritual that can take quite a while and which they may procrastinate.
You could support them by doing the checking for them and reassuring them that they are safe and everything is locked up for the night.
They may be anxious about other things that keep their brain whirring, rather than settling down for sleep, due to their memory loss. If they sit up worrying that they didn’t do these tasks, or upset this person, you can reassuringly reflect on their day with them as part of their bedtime routine.
Lifestyle changes
Lifestyle factors can affect sleep quality. While lack of sleep can cause people to be drawn to junk food, eating a diet high in processed foods can disrupt sleep further.
Stimulants like caffeine, sugar and alcohol can directly disturb sleep. You could help your loved one to avoiding these substances in the evening by switching to decaffeinated or non-alcoholic alternatives and swapping sweet snacks for something better for sleep, like nuts.
Music to help dementia patients sleep
Music is known to help cognitive function in people with dementia but there are also suggestions that it can help them to sleep. One study suggests that playing slow, soothing music to a person with dementia in the half an hour before they go to bed can improve their quality of sleep.
There are playlists and even a radio station specifically for people with dementia. For signposting these, check out music and dementia.
Medication to help people with dementia to sleep
Medication may help but only if it’s prescribed by their doctor. People with dementia can have difficulty with swallowing tablets so if their doctor thinks medication would be helpful, they may prescribe a liquid medicine.
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