Dementia - behavior and sleep problems

Alternate Names

Sundowning - care

Definition

People with dementia often have certain problems when it gets dark at the end of the day and into the night. This problem is called "sundowning." The problems that get worse include increased confusion, anxiety, agitation, confusion, and not being able to get to sleep and stay asleep.

See also: Dementia - daily care

Tips for Behavior and Sleep Problems

Having a daily routine may help. Calmly reassuring and giving cues to orient the person who has dementia is also helpful in the evening and closer to bedtime. Try to keep them going to bed at the same time every night.

Doing calm activities at the end of the day and before bedtime may help the person with dementia sleep better at night. If they are active during the day, these calm activities can make them tired and more able to sleep.

Avoid loud noises and activity in the home at night, so the person does not wake up once they are asleep.

Do NOT restrain a person with dementia when they are in bed. If you are using a hospital bed that has guard rails in the home, putting the rails up may help keep the person from wandering at night.

Always talk with the health care provider before giving the patient store-bought sleep medicines. Many sleep aids can make confusion worse.

If the person with dementia has hallucinations (sees things that are not there):

• Try to decrease the stimulation around them. Avoid things with bright colors or bold patterns.
• Make sure there is enough light so that there are no shadows in the room. But do not make rooms so bright that there is a glare.
• Avoid movies or television shows that are violent or action-packed.

Take the person to places where they can move around and exercise during the day, such as shopping malls.

If the person who has dementia has an angry outburst, try not to touch or restrain them. Touch or restrain them only if you need to for safety. Instead, try to stay calm and distract them during outbursts. Do not take their behavior personally.

Try to prevent the person with dementia from getting hurt if they start wandering. See also: Dementia - safety in the home

Try to keep your home stress-free. These things can help:

• Keep lighting low, but not so low that there are shadows.
• Take down mirrors, or cover them.
• Do not use bare light bulbs.

When to Call the Doctor

Call your health care provider if:

• You think medicines may be the cause of changes in the behavior of someone who has dementia.
• You think the person may not be safe at home.

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References

Moniz Cook ED, Swift K, James I, Malouf R, De Vugt M, Verhey F. Functional analysis-based interventions for challenging behaviour in dementia. Cochrane Database Syst Rev. 2012;2:CD006929. DOI: 10.1002/14651858.CD006929.pub2.

Woods B, Aguirre E, Spector AE, Orrell M. Cognitive stimulation to improve cognitive functioning in people with dementia.  Cochrane Database Syst Rev. 2012;2:CD005562. DOI: 10.1002/14651858.CD005562.pub2.

Knopman DS. Alzheimer's disease and other dementias.In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 409.

Smith DA, Brechtelsbauer DA. Delirium and dementia. In: Rakel RE, ed. Textbook of Family Medicine. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 48.

Dave J, Hecht M. Dementia. In: Frontera, WR, Silver JK, Rizzo TD Jr, eds. Essentials of Physical Medicine and Rehabilitation. 2nd ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 119.

Petersen RC. Mild cognitive impairment. N Engl J Med. 2011;364:2227-2234.