Dementia often affects the brain and body’s internal body clock, making it harder to distinguish between night and day. Having disrupted sleep is one of the most distressing parts of dementia, not just for the person living with the condition but also for the people supporting them.
Because disrupted sleep in dementia cases is so common, like Dementia UK highlights, and sleeping patterns change as the condition progresses, it’s important to understand how to prepare and adapt to any restless nights when caring for someone with dementia.
We’ll explain why dementia symptoms often worsen at night, 7 ways to calm someone with dementia before and during the night, and how seeking support helps create a better nighttime environment.
Why is sleep so important in dementia?
A healthy adult typically needs between 7 and 9 hours of sleep, although this varies depending on individual sleep patterns, according to the NHS. Quality sleep supports your memory, mood regulation, immune health and overall brain function. For someone living with dementia, poor sleep can worsen symptoms such as:
- Increased confusion the next day
- Heightened anxiety or low mood
- Feeling agitated or aggressive
- Increased risk of falls and moments of poor balance
- Added strain to family and caregivers
While people without dementia may recover from a few nights of poor sleep fairly easily. However, people with dementia struggle to reset their routine, affecting their safety and wellbeing.
What causes dementia agitation at night?
Night-time agitation in dementia is often caused by disrupted circadian rhythms, pain, medication side effects, dehydration, confusion, or a condition called sundowning.
Every person with dementia is different, but common causes include:
- Side effects from medication, like steroids, antidepressants or certain dementia medications
- Too much light or noise stimulation in the evening
- Nightmares or difficulty separating dreams from real life
- Too much sleep during the day
- Reduced melatonin production
- Damage to the brain’s internal body clock due to the degenerative condition
- Medical conditions such as restless leg syndrome
- Physical pain or discomfort
- Mood disorders such as anxiety or depression
- Strong emotions or feelings that arise when distractions fade
At Sova Healthcare, we often see increased restlessness linked to changes in routine and dehydration, particularly during seasonal temperature differences when too much or too little is drunk.
What is sundowning?
‘Sundowning’ refers to increased distress and restlessness a person with dementia experiences towards the late afternoon or evening. It may be triggered by unmet needs, pain or confusion.
Alzheimer’s Society mentions that sundowning isn’t explicitly linked to the sun setting and can happen at any stage of dementia, but that it can affect their sleep.
Symptoms of sundowning may include pacing or wandering, increased irritability, suspicion or fear, and difficulty settling down for bed.
It’s important to note that sundowning isn’t inevitable, and small changes to a person’s environment can make a difference to their sleep quality.
7 Ways to help people with dementia stay calm at night
Preventing agitation at night isn’t always possible, but creating a comfortable environment and routine can reduce confusion and distress. Here are 7 practical ways that focus on familiarity and safety.
1. Reduce harsh or bright lights
Gradually dim lights in the evening and switch to warm-toned lamps to signal that it’s nearly bedtime. Limiting screen glare and strong shadows can also reduce overstimulation and confusion.
2. Decorate with soft colours and be mindful of materials
Use soft colours, like neutrals, greens and blues, to provide a sense of comfort and safety. Reduce clutter in the bedroom by placing things in boxes under the bed, keeping familiar items nearby. Removing shiny items like mirrors or things with busy patterns may help prevent distractions or misinterpretations in low light.
3. Building a nighttime routine
Having a wind-down transition with repetitive activities in the evening can help them recognise that it’s nearly time to go to sleep. This could include having a warm bath, reading together, or playing gentle music in the background. Consistency can help reduce anxiety through familiarity.
4. Be a reassuring presence
If they wake distressed, speak calmly and use simple language. Gentle reassurance is more effective than correcting confusion or arguing and getting frustrated.
5. Minimise evening stimulation
Reducing caffeine and alcohol in the afternoon, lowering noise levels in the rest of the house, and introducing slower activities can help the person with dementia adjust to the transition to nighttime. A clear day-and-night clock, as suggested by the NHS, may also help reduce confusion.
6. Make night-time toileting easier
Soft hallway lighting, like small plug-ins, can guide them to the bathroom, and door labels or floor mats can prevent frustration if they wake needing the toilet and you’re not around. Keeping the route tidy and clear of obstructions ensures safety and boosts their feeling of independence.
7. Ensure physical needs are met before bedtime
Offer meals earlier in the evening to help with digestion, and ask if they need the toilet before they get into bed. Placing a jug of water close by can also be useful if they wake in the night needing a drink. It may also be useful to have a routine set up where you can check for pain or discomfort, such as massages, in case they’re unable to communicate their pain properly.
When to seek medical and professional help
Occasional restlessness is common, but you should seek medical help if their behaviour suddenly changes and sleepless nights become persistent. It’s best to speak with their GP or nurse to help identify if there are any underlying reasons why they’re struggling to stay calm at night.
There is also no shame in protecting you and your family if your safety is at risk. This may look like hiding car keys or locking away items that could cause harm to you or the person with dementia. For escalating issues or behaviour that feels unmanageable, speak with their GP or dementia care team promptly.
Looking for help at home during the night?
Nighttime care can be physically exhausting and emotionally draining at times for the person with dementia and for the people caring for them. If you’re a carer and are feeling overwhelmed, we’re here to remind you that you’re not alone.
At Sova Healthcare, we specialise in home care for people with complex needs and supporting their families, including overnight support so you can rest knowing your loved one is safe during the night.
Speak to your local team today to discuss how we can support your nights.