Sleep issues for those diagnosed with dementia


By Micha Shalev, MHA

Sleep disorders are commonly underdiagnosed and a significant source of concern in the geriatric population.

Age alone does not cause sleep problems. Disturbed sleep, waking up tired every day, and other symptoms of insomnia are not a normal part of aging. Instead, poor sleep habits, untreated sleep disorders, medications, or medical problems can contribute to sleeplessness. This article will help you understand the causes of sleep problems and provide tips to help you sleep well.

In addition to affecting quality of life (including excessive daytime sedation and physical, psychological, or cognitive problems affecting overall health of the resident), sleep disorders have been implicated with an increased mortality rate. Unfortunately, the number of medications increases with age, which in itself can lead to more morbidity, mortality, side effects such as falls, cognitive impairment, financial stressors, and even sleep disturbances. Treating insomnia in the elderly with dementia can improve the overall health of the resident, but care must be taken when medications are used in this particular population.
Resident education about age-related changes in sleep can alter residents’ expectations. An example is when residents realize that an occasional sleepless night does not indicate a health problem.

Residents should be encouraged to improve sleep hygiene and use behavioral interventions. For example, to improve sleep hygiene, residents are reminded not to consume stimulants (eg, caffeine) for several hours before bedtime.

Behavioral interventions include sleep restriction therapy (limiting the time spent in bed and minimizing daytime napping). This therapy increases sleep efficiency; it may deprive residents of some sleep, but usually only at first.

Residents are instructed to awaken at the same time each morning; they determine when to go to bed based on their usual total nightly sleep time, estimated using a sleep diary. The time spent in bed is gradually increased as sleep efficiency increases.

Bright light therapy may help residents with an advanced or a delayed sleep phase. In sunny climates, outdoor bright light exposure may work just as well. A clinician should review all drugs that residents are taking to check whether any may induce photosensitivity and should determine whether residents have other disorders that may be exacerbated by this therapy.

Until recently, poor sleep in people with dementia was taken as an irreversible aspect of the disease. Today, however, studies are increasingly showing that sleep quality in people with dementia can indeed be improved, and, consequently, symptoms of poor sleep, such as sundowning, insomnia, and excessive daytime sleepiness, can be diminished.

Improved sleep means an improved quality of life for a person with dementia through increased alertness, decreased sleepiness, and reduction in behavioral problems. These beneficial consequences have a positive impact on a caregiver’s quality of life and the quality of care the caregiver is able to give. Normally, a caregiver’s own sleep quality begins to suffer as the caregiver deals with a wandering or belligerent person. A moment of inattentiveness on a tired caregiver’s part can potentially allow the person with dementia to get into dangerous situations. Persistent poor sleep quality can cause the caregiver to suffer negative mood changes, such as depression, anger, hopelessness, etc., which in turn can negatively affect the quality of care the person is able to give someone with dementia. Poor sleep quality and its impact on the caregiver may be the most common factor leading caretakers to institutionalize a person with dementia. However, improving sleep quality in a person with dementia may delay having to place the person in an institutional setting and improve quality of life of not only the person with dementia but also that of the caregivers.

Micha Shalev, MHA CDP CDCM CADDCT, is the co-owner of The Oasis at Dodge Park, Dodge Park Rest Home and The Adult Day Club at Dodge Park located at 101 and 102 Randolph Road in Worcester. He holds a master’s degree in health care management, is a graduate of the National Council of Certified Dementia Practitioners program, and is a well-known speaker covering Alzheimer’s and dementia training topics. He can be reached at 508-853-8180 or