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Dementia - behavior and sleep problems

  • Description
    • 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 and agitation
      • Not being able to get to sleep and stay asleep
  • Alternative Names
    • Sundowning - 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 the person going to bed at the same time every night.

      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 better 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 person's health care provider before giving them 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. Help 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.
      • Help them 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 -- only do so if you need to for safety. If possible, try to stay calm and distract the person during outbursts. DO NOT take their behavior personally.

      Try to prevent them from getting hurt if they start wandering.

      Also, try to keep the person's home stress-free.

      • 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 the person's provider if:

      • You think medicines may be the cause of changes in the behavior of the person who has dementia.
      • You think the person may not be safe at home.
  • References
    • Budson AE, Solomon PR. Evaluating the behavioral and psychological symptoms of dementia. In: Budson AE, Solomon PR, eds. Memory Loss, Alzheimer's Disease, and Dementia: A Practical Guide for Clinicians. 2nd ed. Philadelphia, PA: Elsevier; 2016:chap 21.

      Khachiyants N, Trinkle D, Son SJ, Kim KY. Sundown syndrome in persons with dementia: an update. Psychiatry Investig. 2011;8(4):275-287. PMID: 22216036