Try: Possible causes physiological or medical causes; illnesses such as angina congestive heart failure diabetes ulcers alcoholism; pain caused by illnesses such as arthritis; urinary tract infections which cause constant pressure to urinate; "restless legs" twitching or leg cramps often caused y metabolic problems; depression; side effect of medications such as diuretics; sleep apnea breathing difficulties; need for less sleep with increased age; disrupted sleep patterns due to progressive dementia the ability to sleep appears to deteriorate as cognitive abilities decline environmental causes ; too hot or too cold; lighting poor – darkness disorienting; can’t find bathroom; change in environment hospitalization often results in changes in sleep patterns other causes ; too much time spent in bed at night; too much daytime napping; too fatigued to calm down and sleep; not enough exercise; too much caffeine or alcohol; hunger; agitated from upsetting situation such as bath or an argument with caregiver; disturbing dreams coping strategies ; have a good medical work-up to identify and treat any medical problems; treat pain with an analgesic at bedtime if approved by physician; try vitamin e for ‘restless legs’ also discuss with doctor stopping or changing diuretic medications that may be contributing to this problem; for sleep apnea breathing difficulties characterized by heavy snoring help person lose weight if obese see doctor and discuss eliminating sedatives that may be contributing to this problem; have an evaluation for depression done if early morning awakening e g waking regularly at 4 00am is a problem antidepressants given at bedtime may help sleep; have all medications carefully evaluated for side-effects; check whether person appears to be too hot or cold on awakening internal thermostat may change with dementia; provide adequate lighting during evening hours shadows glares or poor lighting may contribute to agitation and hallucinations; provide nightlights or soft lighting while sleeping to cut down on confusion during night and to aid in finding bathroom; make sure there is a clear well lit pathway to the bathroom practice the route during the day; place a commode or hand held urinal next to bed if finding the bathroom is a problem; make sure older adult goes to bathroom before going to bed; try to change environment as little as possible; have the older adult spend less time in bed try getting the older adult out of bed at an earlier hour of keep him her up later until they are tired many people require only six to eight hours of sleep per night; make sure that the bed and bedroom are comfortable and familiar to the older adult a favorite blanket or pillow or bed clothes may be helpful; maintain a set bedtime and waking routine once a good routine is established continue bedtime rituals from the past e g a glass of milk before bed or music on radio at bedtime; try bedrails they may help to remind some people that they are in bed for others however bedrails may be confusing and may lead to falls if the older adult tries to climb out of bed; try to prevent daytime napping unless person seems very fatigued in evening hours then try a short rest or nap after lunch; make sure the person is getting adequate exercise try to take one or two vigorous walks a day; cut down on caffeine coffee tea or soft drinks during day and eliminate any after 5 00pm; cut down on alcohol intake discuss the effects of alcohol and medications being taken with physician; make sure the older adult is not hungry at bedtime try a light snack before bed some herbal teas may have a calming effect warm milk often helps promote sleep; avoid bathing or other upsetting activities in late afternoon or evening unless warm baths relax the older adult; avoid laying clothes out for the next day or talking about the next day’s activities this may be confusing and give a ‘wake up’ signal; allow the older adult to sleep on couch or in armchair if refusing to get into bed; make the house or an area of the house safe for the older adult to wander in alone at night safety proofing a house for a safe night of wandering may include ; gating off stairs; special locks or alarms on doors to outside; blocking off kitchen or locking up dangerous items; making sure windows are locked; give the older adult a backrub or massage legs at bedtime or during night wakefulness; try a softly playing radio beside the bed; hire a companion at night or work out shifts so that primary caregiver can get sleep; gently remind the older adult that it is dark out and time for sleeping; consider allowing the older adult to be up at night if this can be accomplished safely and without destroying the caregiver’s routine; for sundowning agitation and wandering in the late afternoon evening; try to distract put on music give the older adult something to hold feel or fiddle with; go for a walk; try a craft activity; turn on the television; try closing blinds or curtains to shut out darkness; turn lots of lights on to brighten atmosphere and combat shadows; try to be rested for better coping at the most agitated time of day; try to minimize noise confusion and the number of people around during the most agitated time of day; try a rocking chair in nursing homes or adult foster care homes; increase staffing volunteers or family visits at that time of day to permit more one-to-one attention; try a breathing chair – they are soft comfortable and easily cleaned however older people may need assistance getting up; be aware that shift changes are often noisy confusing times of day which can contribute to agitation; use psychotropic medications to take the edge off agitation use only under the supervision of a physician in some older adults with dementia these medications can have the opposite effect by making people more agitated; use otc sleeping medications only as a last resort be aware that their effectiveness is only short term but may be helpful in establishing a more regular sleep cycle however sleeping medications may add to confusion on waking other considerations ; be very cautious with the use of any kinds of medications for inducing sleep sometimes they may make symptoms of confusion and disorientation worse psychotropic or sleeping medications must be very carefully monitored by a physician familiar with dementia; problems with sleeping or late evening agitation are often a stage in dementia that eventually passes many older adults with alzheimer’s disease begin sleeping more during the later stages of disease; it is important to try to recognize elements in the environment the medical situation or problems of communication that might be contributing to sleep problems before deciding on particular strategies to try keep a log to help pinpoint possible cause of the sleeping problem; sleep problems are one of the symptoms that are least tolerated by family caregivers when the caregivers are unable to get adequate sleep themselves night after night they become high risk candidates for accidents or illness and their relatives become likely candidates for nursing homes; it may be helpful for the caregiver to try meditation or relaxation techniques to help him herself fall back asleep quickly references 1 alzheimer’s association 2 mace nancy & rabins peter 1999 the 36-hour day baltimore the john’s hopkins university press 3 robinson anne spencer beth & white laurie 1992 understanding difficult behaviors ypsilanti mi eastern michigan university
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Categories: Cognitive Intellectual, Emotional Psychological, Medical Physical
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*This information is listed as a Fact Sheet and is not explicitly medically licensed