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Dementia - behavior and sleep problems

Sundowning - care

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

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 or hears 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. Call 911 or the local emergency number if you or the person with dementia is in danger.

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.

National Institute on Aging website. Managing personality and behavior changes in Alzheimer's. www.nia.nih.gov/health/managing-personality-and-behavior-changes-alzheimers. Updated May 17, 2017. Accessed April 25, 2020.

National Institute on Aging website. 6 tips for managing sleep problems in Alzheimer's. www.nia.nih.gov/health/6-tips-managing-sleep-problems-alzheimers. Updated May 17, 2017. Accessed April 25, 2020.

  • Alzheimer disease

    Animation

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    Alzheimer disease - Animation

    Imagine waking up this morning, and not being able to remember your own name, or recognize your spouse? While Alzheimer disease is a more gradual process, over time it can destroy memory to the point where people can't even remember the simplest and most important details of their lives. Let's talk more about Alzheimer disease. Alzheimer disease is a type of dementia, a loss of brain function that makes it harder and harder to think and speak. To understand what causes Alzheimer, we need to look inside the brain. In a normal brain, nerves send messages to one another. In people with Alzheimer disease, abnormal proteins clump in the brain, damaging nerve cells so they can no longer send the messages needed to think clearly. So, why do some people get Alzheimer, and others do not? Getting older itself doesn't cause Alzheimer disease. It's not a part of the normal aging process. Alzheimer does seem to run in families, though. So if you have a close relative, like a sister or parent, with Alzheimer, you may be more likely to get the disease. Usually when Alzheimer disease starts, people have trouble remembering simple things, like their phone number, or where they put their car keys. But, as the disease progresses, memory loss gets worse. People with Alzheimer find it hard to have conversations or complete simple tasks, like getting dressed. They can also become angry or depressed. Those in the later stages of the disease can no longer care for themselves. They lose the ability to recognize even close family members. To diagnose Alzheimer disease, doctors prescribe tests of mental ability. They also prescribe medical tests to rule out diseases that can make it harder to think clearly, such as a brain tumor or stroke. As far as treatments for Alzheimer disease, right now, there isn't a cure. A few drugs can slow memory loss and control depression and aggressiveness from the disease. Despite what you may have read, there isn't any proof that vitamins or other supplements can prevent or treat Alzheimer. However, eating a low-fat diet that's high in vitamin E and C, and rich in omega-3 fatty acids may keep your brain healthier. Alzheimer disease is different in each person. Some people decline quickly and die within just a few years, while others can live for two decades with the disease. If you have a family member with Alzheimer, talk to your doctor about ways to protect your own memory. And, call right away if you have any significant memory loss. Though it may be normal forgetfulness that comes with getting older, the sooner you get it checked out, the earlier you can start treatment if you need it.

  • Alzheimer disease

    Alzheimer disease - illustration

    Aged nervous tissue is less able to rapidly communicate with other neural tissues.

    Alzheimer disease

    illustration

  • Alzheimer disease

    Animation

  •  

    Alzheimer disease - Animation

    Imagine waking up this morning, and not being able to remember your own name, or recognize your spouse? While Alzheimer disease is a more gradual process, over time it can destroy memory to the point where people can't even remember the simplest and most important details of their lives. Let's talk more about Alzheimer disease. Alzheimer disease is a type of dementia, a loss of brain function that makes it harder and harder to think and speak. To understand what causes Alzheimer, we need to look inside the brain. In a normal brain, nerves send messages to one another. In people with Alzheimer disease, abnormal proteins clump in the brain, damaging nerve cells so they can no longer send the messages needed to think clearly. So, why do some people get Alzheimer, and others do not? Getting older itself doesn't cause Alzheimer disease. It's not a part of the normal aging process. Alzheimer does seem to run in families, though. So if you have a close relative, like a sister or parent, with Alzheimer, you may be more likely to get the disease. Usually when Alzheimer disease starts, people have trouble remembering simple things, like their phone number, or where they put their car keys. But, as the disease progresses, memory loss gets worse. People with Alzheimer find it hard to have conversations or complete simple tasks, like getting dressed. They can also become angry or depressed. Those in the later stages of the disease can no longer care for themselves. They lose the ability to recognize even close family members. To diagnose Alzheimer disease, doctors prescribe tests of mental ability. They also prescribe medical tests to rule out diseases that can make it harder to think clearly, such as a brain tumor or stroke. As far as treatments for Alzheimer disease, right now, there isn't a cure. A few drugs can slow memory loss and control depression and aggressiveness from the disease. Despite what you may have read, there isn't any proof that vitamins or other supplements can prevent or treat Alzheimer. However, eating a low-fat diet that's high in vitamin E and C, and rich in omega-3 fatty acids may keep your brain healthier. Alzheimer disease is different in each person. Some people decline quickly and die within just a few years, while others can live for two decades with the disease. If you have a family member with Alzheimer, talk to your doctor about ways to protect your own memory. And, call right away if you have any significant memory loss. Though it may be normal forgetfulness that comes with getting older, the sooner you get it checked out, the earlier you can start treatment if you need it.

  • Alzheimer disease

    Alzheimer disease - illustration

    Aged nervous tissue is less able to rapidly communicate with other neural tissues.

    Alzheimer disease

    illustration

A Closer Look

 

Self Care

 

Tests for Dementia - behavior and sleep problems

 
 

Review Date: 4/25/2020

Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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