Behaviour Change Ahead ? – Night Time

People living with Dementia may have problems sleeping or increases in emotional responses that begin at dusk and last into the night that is generally known known as Sundowning.

Susan Macaulay’s article talks about 10 reasons people living with dementia get up in the night, and what often happens when they do


The Alzheimer’s Society states:

For example, people may become more agitated, aggressive or confused. This is often referred to as ‘sundowning’. This pattern may continue for several months and often happens in the middle and later stages of dementia.

Sundowning may be caused by:

  • disturbance to the 24-hour ‘body clock’ that tells our bodies when to sleep, caused by the physical changes to the brain
  • loss of routine at a previously busy time of day
  • too little or disturbed sleep
  • too little or too much light
  • Reduced lighting and increased shadows causing people with Alzheimer’s to misinterpret what they see, and become confused and afraid
  • Reactions to nonverbal cues of frustration from caregivers who are exhausted from their day
  • Disorientation due to the inability to separate dreams from reality when sleeping
  • Less need for sleep, which is common among older adults
  • prescribed medication wearing off
  • medications that worsen confusion and agitation
  • lots of noise
  • other conditions such as sight or hearing loss.

Sometimes you might think of the person’s behaviour as ‘sundowning’ and not realise that they’re actually trying to meet a need. For example, the person may be trying to communicate rather than behaving a certain way just because it’s late afternoon. Always consider what other reasons there may be for a person’s behaviour.

“A person with dementia may keep getting up during the night and may become disorientated when they wake up. They may get dressed or try to leave the house. This might make the person tired during the day and they may sleep for long periods, which might be very stressful for you. The person may have problems during the night but not realise they’ve had them.

Dementia can affect a person’s sleep patterns. This is separate and different from normal sleep difficulties that come with getting older. It can cause problems with the sleep-wake cycle and also interfere with the person’s ‘body clock’. Disturbed sleep can have a negative impact on a person’s wellbeing (and those living with them). The tips below may help.


Better sleep strategies from Dementia UK

  • Firstly try to establish the cause of sleep disturbances.
  • Consider the environment and try to minimise noise levels and use of bright lighting.
  • Check if the temperature is uncomfortable i.e. too hot or too cold and adjust the persons bedding as required.
  • Night/day clocks can be used which help clearly indicate that is night time,  make sure they can be easily seen from the person’s bed.
  • Low level light or night lights can help the person find the bathroom and promote orientation.
  • If the person is away from home and in an unfamiliar environment, try to put familiar things in sight such as photos or prized possessions. This will make them feel more secure.
  •  Think about  food and drink; some people like to have a small snack before bed but heavy meals and caffeine based drinks should be avoided prior to sleeping.
  • Find out about toilet habits; ensure someone has been able to use the toilet prior to getting into bed.
  • If the person with dementia uses continence aids ensure they are appropriate for night time and are fitted comfortably.
  • Soft music and relaxation tapes can help the person get to sleep but always consider their own individual tastes, did they have a favourite album they found relaxing beforehand?

Other things to consider

Sleep disturbances may be a stage that the person with dementia goes through which will subside and settle over time. As dementia progresses people tend to sleep more. If problems persist then medical advice should be sought. Most importantly please discuss concerns with the GP so that any preventable or treatable reason for the sleep disturbance is identified and treated.


 

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