Dementia-related Sleep Disturbances and Sundowning
Published: 11 October 2023
Published: 11 October 2023
Sleep issues are among the most challenging dementia symptoms to manage (Dementia Australia 2017a).
Up to 25% of people with mild or moderate dementia and 50% of people with severe dementia are affected by sleep disturbances, with these issues worsening as the condition progresses (Mayo Clinic 2021).
With more than 50% of aged care residents in Australia living with dementia (AIHW 2023), how can you support those who are having difficulty sleeping?
Some people with dementia may experience a disturbed sleep pattern, causing them to sleep during the day and feel awake and restless at night. They may have difficulty falling asleep at night and will wake up frequently, then struggle to go back to sleep (Alzheimer’s Society 2022).
In some cases, a client may wake up prematurely, become disoriented and attempt to get dressed or leave the premises. Some clients may struggle to differentiate between day and night altogether (NHS 2021; Dementia Australia 2017a).
As dementia progresses, many people will begin to sleep for longer and may eventually spend a significant portion of their time asleep. Sleep disruptions can also contribute to feelings of tiredness during the day, and may consequently lead to long periods of sleep. The client will not necessarily be aware that they are experiencing sleep issues (Alzheimer’s Society 2021a, 2022).
It is estimated that people with late stages of Alzheimer’s spend most of the day sleeping, but are awake for about 40% of the night (Alzheimer's Association n.d.).
It is estimated that up to 20% of people with dementia experience a phenomenon known as sundowning, wherein symptoms worsen around the time of sunset (Canevelli et al. 2016).
People experiencing sundowning might become restless, confused, anxious or insecure, leading to aggressive, demanding and suspicious behaviour. In some cases, they may hallucinate (particularly when it is dark) or engage in potentially harmful behaviour. Sundowning seems to be exacerbated by changes to routine (Healthdirect 2020).
Disturbed or insufficient sleep might play a role in the occurrence of sundowning. Furthermore. people experiencing sundowning may feel too restless to sleep properly (Healthdirect 2020; Alzheimer's Association 2012).
Factors that may cause people with dementia to experience sleep disturbances and sundowning include:
(Mayo Clinic 2021; Dementia Australia 2017a; Alzheimer’s Society 2022)
Other factors that are not necessarily related to dementia but may contribute to sleep disturbances include:
(Dementia Australia 2017a)
Some people with dementia may sleep for up to 14 or 15 hours per day. However, this is not necessarily good quality sleep (Alzheimer’s Society 2022).
The consequences of sleep disturbance in people with dementia include decreased emotional and physical health, worsened cognitive symptoms and an overall decrease in quality of life (Kinnunen et al. 2017).
Wandering caused by disorientation or restlessness can be potentially dangerous if the client manages to leave the facility or goes missing. This can be quite a worrying event that raises concerns for the client’s safety (Dementia Australia 2017b).
The following strategies may help clients with dementia sleep more comfortably:
(Dementia Australia 2017a; Alzheimer’s Society 2021b; Alzheimer's Association n.d)
(Alzheimer's Association 2012)
As an aged care worker, you are likely to interact with many clients who have dementia. In order to appropriately care for these clients and ensure they are comfortable and safe, it is important to understand how dementia can affect sleep and how these disturbances can be managed.
Sleep issues in those with dementia can be challenging to navigate. As well as ensuring that your clients are able to have regular periods of rest, it is important for you to get adequate sleep as well (Dementia Australia 2017a).
Question 1 of 3
Finish the sentence. In the later stages of dementia, people tend to…