Sleep disturbances are common for people with dementia, and often lead to the people who care for them also having problems with their sleep.
A person with dementia may get up repeatedly during the night and may become disorientated when they wake. They may get dressed or try to leave the house. All this night-time activity can make them tired during the day and they may sleep for long periods.
All of this can be very stressful and tiring for carers, but the person with dementia may not be aware they are having any problems during the night.
What to try:
- Make sure the person sees plenty of daylight and does lots of activity during the day.
- Think about improving the sleeping environment. Make sure the room is a comfortable temperature, quiet and appropriately lit. If it’s too light, consider blackout blinds.
- Cut down on caffeine and alcohol in the evening.
- Consider putting a clock next to the bed that shows whether it’s day or night.
- If they like to have something to cuddle, consider a soft toy.
- Going for a walk, having a warm milky drink, or having a relaxing bath or shower before bed may help the person relax and sleep better.
Afternoon restlessness (sundown syndrome)
Sometimes people with dementia might become more confused, agitated, restless or insecure late in the afternoon or early evening, which is why this condition is called the ‘sundown syndrome’ or ‘sundowning’.
This pattern may continue for several months and often happens in the middle to later stages of dementia. It can be particularly hard for those caring for them if they are trying to relax or enjoy some quiet at that time.
What to try:
- Give the person something meaningful to do at this time of day, using past activities as a guide.
- Plan quiet and relaxing activities for late afternoon/evening for the person with dementia, and also for anyone else around them.
- Think about what’s happened during the day. Could the person’s behaviour be about them needing the toilet, feeling hungry or being in pain?
- Try giving the person something to eat and drink about half an hour before they usually get restless.
Walking around
Many people with dementia feel a strong need to walk around. They might walk repeatedly around the house, or get up and leave the house at any time of the day or night.
The walking isn’t a problem in itself as it can help to relieve stress and boredom and give the person exercise. But people with dementia can become disoriented and might have difficulty finding their way home. This can be very worrying for those who care for them and may put the person in danger, so it’s important to find a solution that preserves the person’s independence and dignity but still keeps them safe.
This type of behaviour is often referred to as ‘wandering’. However, this term is unhelpful because it suggests it does not have purpose, that it is aimless, whereas the walking around often does have a purpose – perhaps they think it’s time to go to work, or to pick up the children from school.
Why might people walk around?
There could be a number of reasons why a person with dementia walks around. It may help to keep a journal for a couple of weeks to record when they walk around, and what they say when they are walking, as that could help you identify any triggers or reasons.
Once you identify what they are trying to achieve, you can start to find ways to meet their needs. That should reduce your frustration and help them to keep their independence. Possible reasons to walk around include:
- Continuing a habit
- Relieving boredom
- Using up energy
- Relieving pain and discomfort
- Responding to anxiety
- Feeling lost
- Searching for the past
- Getting confused about the time
Retaining independence
It’s very important that people with dementia are encouraged to remain independent for as long as possible. There will always be some degree of risk, whatever choices are made. Those caring for the person need to decide what level of risk is acceptable in order to maintain their quality of life and protect their independence and dignity.
The steps you need to take to keep the person safe will depend on how well they are able to cope, and what could be causing their behaviour. You will also need to take the safety of the person’s environment into account – while there’s no such thing as a risk-free environment, some places are safer than others.
Does the person live on a busy main road or in an urban area where people don’t know their neighbours? Or do they live in a peaceful rural area where they are well known within the local community?
Should I stop the person from leaving the house?
If a person with dementia wants to walk then you should try to find a solution that lets them do so safely. You may be able to get help and advice from your local Alzheimers organisation.
Some family members in caring roles decide to lock or bolt doors to prevent the person with dementia leaving the house. But remember you should never lock a person with dementia in the home if they are alone.
Less restrictive options include distracting them, deterring them from leaving by fixing a bead curtain across the front door, or painting the door the same colour as the surrounding walls. If there are outside lights it may be helpful to switch them off at night.
However, these approaches don’t suit everyone and could be confusing or distressing for the person.
Limiting the risks from walking around
To limit the risks you could try the following:
- Don’t confront the person with dementia – If they’re determined to leave confronting them could be upsetting. Instead try getting them to put on appropriate clothing (such as outdoor shoes and a coat) and going with them a little way before you divert their attention so you can both go home.
- Make sure they carry some form of identification – They should also have the name and phone number of someone who can be contacted if they get lost. You could sew this into a jacket or a handbag so it’s not easily removed. Consider an identification bracelet, like a MedicAlert.
- Walking route – if you can, encourage them to walk along the same roads so that they have a regular route.
- Put contact numbers in their mobile phone if they use one – Make sure the phone number of the primary carer is stored in it and is easy to find. If the mobile phone is switched on it may be possible to trace the person if they go missing. Specialist locator/tracking devices are also available.
- Let others know – Tell local shopkeepers and neighbours about the person’s dementia and give them your contact details as they may help keep a look out.
This type of behaviour may be a phase, and if you can take the time to understand what the person's needs are it could often resolve the problem.