The number one reason for institutional placement of someone with Alzheimer’s disease is nighttime wakefulness. If you’re living with a loved one that has Alzheimer’s disease sleep may be a distant memory. Here’s a familiar scenario: it’s 2am and your loved one is awake, ready for the day, and no amount of talking on your part is going to get her back to bed.

For your loved one with Alzheimer’s Disease time has no meaning. Yesterday is the same as today and 2am is the same as 2pm. Now add that to normal changes occurring with age and you have a double whammy! Even though your loved one has dementia she will still experience normal changes that effect quality of sleep just like you and me.

The need for an average7 to 8 hours of sleep a night doesn’t change, as we get older. But sleep becomes more fragmented, time spent in deep sleep is shorter, and it’s not uncommon for older adults to nap during the day to make up for nighttime depravation. For someone with Alzheimer’s disease sleep is even more elusive due to confusion and disorientation and caregiver concerns about daytime napping. However, there are some things you can do to help promote better sleep.

  1. Provide structured activities during the day that are both physically and mentally stimulating. A short nap (about an hour) right after lunch can also be helpful. Contrary to popular opinion an early nap will not cause your loved one to be more wakeful at night. Exhaustion from sleep depravation is more problematic and may contribute to ‘sundowning’, the evening agitation so commonly seen in Alzheimer’s disease.
  2. Avoid chocolate, spicy or gas producing foods, caffeinated beverages, and stimulating activities in the late afternoon and evening. Maintain a sleep routine for your loved one and be consistent about the time to go to bed. Put a large faced-clock in the bedroom along with a note about what time to wake up.
  3. Be sure there is adequate lighting and a clear path to the bathroom. Decreased bladder capacity is normal with aging and many times wakefulness is caused by the need to urinate and agitation from the inability to relieve the urge. When your loved one wakens, don’t make a big deal about it. Assist her to the bathroom and calmly orient her to time. Encourage her to go back to bed but don’t force the issue, it may only cause more problems. If she rummages in her room, and it’s not harmful, allow the behavior to be.
  4. Nap when your loved one naps. It’s easy to fall into the routine of doing chores while she sleeps, but your sleep needs must also be met. The chores will still be there when you wake up and with both of you refreshed they can be done together.
  5. If she’s taking a cognitive enhancer like Aricept, Exelon, or Reminyl you’re most likely giving it in the evening. In some people these medications can have a stimulating effect. So, if your loved one has trouble sleeping, try giving it in the morning.
  6. Medication is also available for nighttime wakefulness that is out of control or becoming detrimental to your health. Don’t be afraid to talk to the doctor about it. Just be aware that sleep inducing medicines have side effects so additional safety measures, like preventing injury from falling, should be applied. Always start with the lowest dose and increase as recommended by the prescribing practitioner.

If nothing works, it may be time to consider alternative placement. Assisted living facilities and nursing homes are equipped to manage this behavior and most do a good job. Research the facilities through your local Area Agency on Aging, by talking to family members of residents, and unannounced visits to get as much information as you can before making a decision. Don’t think of placement as a personal failure instead think of it as another caregiving experience on the journey through Alzheimer’s disease.

God Bless.

Mary C. Fridley