People with dementia don’t tend to get the much needed uninterrupted deep sleep. In this article we look at ways to help the person with dementia sleep better with dementia.
Sleep hygiene is a variety of different practices and habits that contribute to quality sleep during the night and staying alert and active during the day.
(1) Maintain a regular routine
Establishing a routine with regular bedtimes and rising times, eating, and doing meaningful activities can help someone with dementia sleep well. Some helpful tips for creating and sticking to a daily routine:
- Morning: Follow a morning ritual that the person has always had. Try to provide compensatory support so they can keep to this schedule as much as possible. Mark the end of nighttime and start of the day by changing clothes and keeping night-time clothes out of sight.
- Afternoon: Early afternoon can be a good time to schedule a nap. Try to avoid naps past lunchtime. It can be good to include social and physical activities.
- Evening: Start focusing on relaxation. Plan activities that help the person become relaxed. Some ideas include a warm glass of milk, a bath/shower, soothing music or a massage. Focus on good memories and positive conversations, avoiding anything that could be upsetting.
- Night time: Changing into night-time clothing can signal that it’s time to sleep. You can accompany this with their other bedtime rituals they might have done before they were diagnosed with dementia. Before getting into bed, make sure they have gone to the bathroom. A gentle reminder that it’s time to sleep and a soothing back rub can help. If that doesn’t work, try an alternative place in the house that is comfortable to sleep.
- Middle of the night: A back rub also helps when the person wakes up in the middle of the night. Approach them in a calm manner, provide reassurance that everything is okay and gently remind them it’s nighttime. See if they need anything. Avoid arguing or using physical restraint. If they wander at night, it might be worth letting them do this if the house is safe.
(2) Stay physically and socially active
Exercising doesn’t have to be a high intensity workout. Staying active can include gentle exercises and meaningful activities. The person can take a walk, do chair yoga, or gardening. You can do some of these activities together, attend a community class, or dementia-friendly meetups to add in the social element. By doing such activities and staying engaged, it can reduce daytime naps and promote restful sleep.
- Exercise in the afternoon or early evening (not close to bedtime)
- Ideally plan for around 30-60 minute sessions 3-5 times a week
- The type and intensity of the exercises should depend on the person’s physical and mental capabilities
- Get exposure to natural light during your walk
(3) Create a comfortable sleeping environment
- Maintain a temperature that is comfortable for the individual (usually 16 – 20℃) with good ventilation
- Minimise the noise
- Create a dark room with a sensor-based night light for safety
- Pick a comfy mattress and pillows
- Keep mirrors covered or away because seeing themselves or others in the mirror can cause confusion
- Remove any trip hazards like loose rugs or furniture in the way to the bathroom or areas they might wander at night
- Keep away from TV and smartphones closer to bedtime
(4) Eat and drink right
- Providing a light night snack can help as the person might find it difficult to sleep if they are hungry. A light, healthy meal like cheese with whole grain crackers, hummus with pita bread, and tart cherries with oatmeal can help. Check out 4 Nighttime Snacks to Help You Sleep for more information.
- Avoid heavy, rich or fatty and fried foods for dinner. Additionally, spicy dishes, citrus fruits and carbonated drinks can trigger indigestion for some people.
- Make sure the person stays hydrated throughout the day. For techniques to stay hydrated, read Keeping hydrated with dementia
- Limit alcohol and caffeine consumption, especially after 5pm. Alternatives include caffeine-free tea and alcohol free-drinks if they ask for one in the evening.
Light plays a key role in regulating core body temperature, melatonin secretion and the sleep-wake cycle. A small study found that bright light therapy can help decrease sleep during the day and increase sleep during the night in people with dementia. Ideally a person should have exposure to natural sunlight. However, if this is not possible like during winter months, you can use light therapy (e.g. A light box).
Consider the following:
- The impact of bright light treatment depends on severity of dementia, the season of the year, and any sedating medications they may be using
- Morning light exposure is beneficial for those who sleep late and wake up late or those with seasonal depressive disorder
- Evening bright light treatment is beneficial for those who fall asleep in the early evening, struggle to maintain sleep and wake up very early in the morning
- Wall- or ceiling-mounted illumination systems may work better than standing light box if the person tends to wander or falls asleep when they are in one place
- Combined light therapy and melatonin supplementation seems to enhance sleep outcomes (Speak to your doctor about Melatonin and dosage)
- Some side effects of light therapy include irritability, dizziness and headache
Aromatherapy is an ancient practice in which essential oils from plants, herbs, flowers and trees are used to promote wellbeing. You can warm the oil in oil burners and then add it to baths or add a few droplets onto pillows, tissues, or clothing. You can also use it as a massaging oil. The oils will come with a set of instructions as to how to handle that particular oil.
A study has found that essential oils, particularly lavender, bergamot and lemon balm, can help bring a sense of calmness. Lavender and lemon balm in particular helped increase the duration of sleep for people with dementia.
Tips for using essential oils:
- The manner in which the essential oils are used should be personalised to the person with dementia – is the person comfortable being touched? Do they have delicate skin, bruises, eczema, or allergies?
- When starting out, try out a drop or two of the oil on a tissue to see how the person feels and reacts to that scent
- Use a well-ventilated area when practicing aromatherapy
- It’s advised not to experiment with different oils together, stick to the ones linked to positive outcomes.
It is important to note the following:
- Aromatherapy is not a replacement for medical treatment and should only be used if the therapy makes the person feel calm and relaxed
- Undiluted essential oils can cause skin irritations so please read the label to make sure the oil is suitable
- The oils can be potent and cause a headache
- The smells of the oils can trigger unwanted memories
- The person can become agitated by some oils like thyme oil as it has a stimulating effect
If the above non-medical approaches don’t help, your doctor might recommend medication to induce sleep. When starting out, it’s recommended that treatments “begin low and go slow.” It should be seen as a short-term solution where once the sleeping pattern returns to normal, your doctor will likely discontinue the medication.
The types of medications prescribed to induce sleep include some antidepressants, sleeping pills, antipsychotics and benzodiazepines.
Risks to consider:
- The prescription may not work
- Increased likelihood of falls and fractures
- Impact on behaviour such as confusion
- Daytime sleepiness
- Weight gain
Cannabidiol (CBD) is another option that you can discuss with your doctor. CBD is a compound derived from cannabis plants and has been used for medicinal purposes without the “high” of marijuana. Researchers have seen that cannabis or CBD oils could help some manage behavioural changes that interfere with sleep like agitation and aggression.
Questions to ask your doctor:
- How well does this medication work?
- What are the side effects and risks associated with the medication?
- What are other treatment options?
There are a variety of other health issues and medications that can interfere with sleep as mentioned in detail in the article causes of sleep disturbances in dementia. It is important that these are assessed and treated by your doctor.
Sleeping Aids that can help
- Devices based on mediation and slowing breathing to help induce sleep i.e. Dodow sleeping aid
- White noise machines, soft music, double-paned windows and ear plugs can help block out external noise
- Weighted blankets are duvet-like creations that may relieve anxiety, stress and insomnia
- Humidifiers and fans can help create a comfortable environment
- Night light system to help avoid falls
- Blackout curtains and eye shades can help achieve a dark room
- Visual alarms that are easy to read and indicate what time of the day it is
- Gradual wake up alarms like a personal sunrise, a gradually brightening light that gently rouses the person from sleep
Remeber you need sleep too. If you aren’t getting the sleep you need, it’ll make the next day a lot more difficult. The person can sense when you are on edge and agitated. If possible, ask a family member or friend to help take alternative nights. Speak with your doctor or social worker to find professional support that can help you overnight.
If you have found other techniques and ways that have helped your loved one fall asleep, do let us know in the comments below.