Sleeping
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Research into sleep issues is ongoing, and there's no magic cure - however we mention below some things worth noting.
Sleeping pills
Before discussing particular sleep issues below, we feel we ought to note that sleeping pills are not a cure for the long-term sleep issues that arise from dementia. They might be tried (under a doctor's prescription) short-term to see if they can reset the person's body clock, but long-term use is neither encouraged nor helpful given that the body soon develops resistance. There's a serious risk of falls when under the influence of sleeping pills. We must, however, stress that there can be severe withdrawal symptoms (which can take up to 3 weeks to appear) so you absolutely must consult your doctor before reducing or stopping these medications.
For more information see our section on sleeping pills and sedatives.
Medication that also causes sleepiness
In addition to sleeping pills and sedatives, several other medications may also contribute to sleepiness or dizziness as a side effect, and this in turn may contribute to disruption of sleeping patterns. If you think this may be an issue then consult your GP for a medication review, which can look at which medications are prescribed and the time of day they're given.
Disruption of sleeping patterns
A common symptom of dementia is waking in the night and getting up as if it were day (not simply to go to the toilet). This is obviously very disruptive for them and for their carer. (It's also common to see changes in behaviour in late afternoon or early evening - something known as 'sundowning', although this is likely to have different causes.)
Someone with dementia may not recognise the cues that govern a normal wake-sleep cycle, including lack of daylight at night - and of course given that the sun comes up and goes down at very different times of day between summer and winter we also rely heavily on clocks and the things we do in our normal daily routine.
Comfort
Perhaps the first thing to consider is whether the bedroom is too cold, or too hot, taking account of the bedclothes and how easily the person can adjust their warmth for themselves by rolling layers up or down.
Also check that the mattress and pillow are comfortable - an old mattress may have a spring sticking up. It might be possible to turn a mattress over, and/or rotate it top to bottom - but note that some modern mattresses will be marked with instructions that one side must be up, or it may be apparent from different surfaces on each side. Be extremely careful if you do turn or rotate a mattress as they're very big and very heavy - get help, and before you start move everything else (including pictures on the wall) away so they don't get damaged. Check that the pillow is the right thickness for the person.
See our section on preventing pressure sores, for information about air mattresses that can avoid discomfort and serious health problems.
Having a routine
Try to keep mealtimes, activities and bedtime regular from day to day. It may help to have daytime activities that keep the person engaged and awake, but that doesn't mean there can't be any naps. Avoid making the daytime environment too noisy or confusing, as that's likely to overburden and fatigue them, making them sleepy during the day instead.
Lighting
Good lighting during the day may help, noting that old folks are only a third as sensitive to light as younger people - but don't make rooms unpleasantly bright or dazzling to them. It may also help to have the new whiter 'daylight' bulbs in the day rooms and slightly orange 'warm white' bulbs in the bedroom - see our subsection on bulbs.
'Blackout' curtains
If the person gets up early in the summer when it becomes light outside, consider whether too much light is leaking around or through the curtains. 'Blackout' linings prevent light getting through the curtain - it may be possible to hang new linings inside existing curtains to avoid changing things they're familiar with, but equally consider whether the curtains may in any case have a pattern that is confusing, too 'busy' or may be unsettling in the half-light and would benefit from being replaced anyway. If you replace the curtains keep the old ones just in case the change proves to be unsettling, and let your loved one help choose the new ones. Choose ones that are easily distinguishable from the walls without being so distracting that they become a focus of attention. If too much light is getting round the top of the curtain you could consider a valence or pelmet.
Day/night clocks and talking clocks
There are clocks that have an additional display for whether it's day (and morning, afternoon or evening) or night, and for those unable to read a clock there are talking clocks. Talking clocks can be as simple as a large button that speaks the time when pressed - you may need to label it so they know that's what it does. Devices such as this can have mixed results with different people - but if you find it useful then we'd strongly recommend having one by the bedside as well as one in the day room, otherwise your loved one may get up in the night just to consult the day room clock.
For more information see our more detailed section on day/night clocks, talking clocks and watches.
Sleepiness during the day
Obviously, sleep disruption in the night is likely to lead to sleepiness in the day, but equally someone getting into a pattern of sleeping during the day may lead to them getting up early in the night.
Often people with dementia do sleep more overall, and this is likely to increase gradually as the disease progresses. A sudden increase in apparent sleepiness may be a sign of an infection, or be a side effect of a new medication, and should be referred to your GP.
General sleepiness may also be caused by some of your loved one's longstanding medications. If you feel that daytime sleepiness is causing a problem, such as missed meals or sitting in one position too long for comfort (also see preventing pressure sores), you could ask your GP to review the medications and the time of day they're given.
Good lighting during the day, especially with LED 'daylight'/'cool white' bulbs, may help.
Also consider their activities and entertainments.