Sleeplessness and Sundowning

Sleeping problems experienced by individuals with Alzheimer’s and caregiver exhaustion are two of the most common reasons people with Alzheimer’s are eventually placed in nursing homes. Some studies indicate that as many as 20 percent of persons with Alzheimer’s will, at some point, experience periods of increased confusion, anxiety, agitation, and disorientation beginning at dusk and continuing throughout the night.

While experts are not certain how or why these behaviors occur, many attribute them to late-day confusion, or “sundowning,” caused by the following factors:

  • end-of-day exhaustion (mental and physical)
  • an upset in the “internal body clock,” causing a biological mix-up between day and night
  • reduced lighting and increased shadows
  • disorientation due to the inability to separate dreams from reality when sleeping
  • less need for sleep, which is common among older adults

Tips for reducing evening agitation and nighttime sleeplessness

  • Plan more active days. A person who rests most of the day is likely to be awake at night. Discourage afternoon napping and plan activities, such as taking a walk, throughout the day.
  • Monitor diet. Restrict sweets and caffeine consumption to the morning hours. Serve dinner early, and offer only a light meal before bedtime.
  • Seek medical advice. Physical ailments, such as bladder or incontinence problems, could be making it difficult to sleep. Your doctor may also be able to prescribe medication to help the person relax at night.
  • Change sleeping arrangements. Allow the person to sleep in a different bedroom, in a favorite chair, or wherever it’s most comfortable. Also, keep the room partially lit to reduce agitation that occurs when surroundings are dark or unfamiliar.

Nighttime restlessness doesn’t last forever. It typically peaks in the middle stages, and then diminishes as the disease progresses. In the meantime, caregivers should make sure their home is safe and secure, especially if the person with Alzheimer’s wanders. Restrict access to certain rooms or levels by closing and locking doors, and install tall safety gates between rooms. Door sensors and motion detectors can be used to alert family members when a person is wandering.

Once the person is awake and upset, experts suggest that caregivers:

  • approach their loved one in a calm manner
  • find out if there is something he or she needs
  • gently remind him or her of the time
  • avoid arguing or asking for explanations
  • offer reassurance that everything is all right and everyone is safe
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