Sleep and night-time disturbance

People with dementia often have sleep disturbances, such as repeatedly waking up through the night or ‘sundowning’.

Some people living with dementia often experience problems with sleep. They might:

• sleep during the day
• be unable to get to sleep at night
• wake up often throughout the night. They may feel disorientated, or try to get dressed and walk around.

What effect can sleep disturbance have?

Sleep disturbance can affect the quality of life of a person with dementia and anyone caring for them. It can have impact on a person’s wellbeing, and can lead both the person with dementia and those caring for them to become more tired.

Sleep problems are linked to disruption to a person’s body-clock due to dementia. This is often associated with ‘sundowning’.

Different types of dementia

Disturbed sleep patterns can affect someone with any type of dementia. They tend to get worse as dementia progresses.

People with dementia with Lewy bodies tend to have a particular kind of sleep problem. They’ll often experience rapid eye movement sleep behaviour disorder. It may be one of the first signs of the condition.

Dealing with sleep problems

It is always best to try promoting better sleep without using drug, before considering any medication.

A doctor should assess the person to rule out any other conditions that may be causing disturbed sleep. These include:

• untreated pain
• depression
• sleep apnoea (where breathing stops for a few seconds or minutes during sleep).

It is also important to be realistic about how much sleep a person will get. Older people don’t often sleep for more than five to six hours at night. In people with dementia, this will often be spread out over a full 24 hours.

Non-drug approaches

If a person with dementia does have sleep problems, the following tips may help them:

• limit daytime napping
• set the alarm for the same time every morning and get up when it goes off
• avoid tea and coffee from lunchtime onwards as they contain caffeine. (Try caffeine-free alternatives instead, such as herbal teas)
• avoid nicotine and alcohol at night
• make sure the bedroom is comfortable and not too bright at night
• use the bedroom just for sleeping or sex.

Drugs and sleep medication

If non-drug approaches haven’t worked, medication may be given to help someone sleep. This can reduce the risks involved in getting up at night, and the strain this puts on carers.

Two types of drugs that can help with sleep problems are benzodiazepines and non-benzodiazepines, known as ‘Z-drugs’. Doctors usually prefer to prescribe one of the ‘Z’ drugs rather than a benzodiazepine.

However, drugs should only be used for a short period. Sleep medication (hypnotics) does not generally work very well in people with dementia and most drugs have significant side effects. Often, the risks associated with taking sleep medication are bigger than any possible benefits.

If, however, the person with dementia and their carer feel that medication would be an option, the tablets taken should meet their specific needs – whether they are having trouble with falling asleep or staying asleep.

Talk to the doctor if the person is taking or considering any over-the-counter (non-prescription) medication for help with sleep.