By Meredith Kimple
Many older people find it difficult to get an adequate amount of sleep at night. In a previous post, we explored some of the reasons for this change; an older person’s circadian rhythm (sleep-wake cycle) may be disrupted, they may wake frequently to urinate, or they may not receive enough exposure to sunlight during the day. While elderly insomnia is certainly not an uncommon occurrence, we should never dismiss this condition as “normal” or “inevitable.” Sleep impacts our overall health, and there are steps we can and should take to ensure our older loved ones are getting enough rest during the night.
But what about our older loved ones who live with Alzheimer’s disease?
Alzheimer’s can have a significant impact on a person’s ability to sleep well, due in part to a condition known as “sundowning.” Sundowning often occurs in the late afternoon and early evening, when the sun begins to set; when sundowning, a person with middle or moderately advanced stage Alzheimer’s tends to become more restless, agitated, aggressive, and confused. They may experience intense mood swings, pace aimlessly around the house, accuse family members and friends of being “imposters,” or convey a general sense of suspicion towards their surroundings.
Caring for a loved one who is exhibiting sundowning behaviors can prove challenging in and of itself, but when their agitated state prevents them from sleeping at night, it can take a considerable toll on our own health and peace of mind as their caregivers. Not only does sundowning exacerbate restlessness and disturb a person’s sleep-wake cycles, but sleep troubles can also, in turn, lead to and worsen sundowning behaviors. You might say that, to an extent, sleep issues and sundowning are two interconnected problems; though it goes without saying that there is no all-in-one solution to these complications, there is the possibility that in minimizing our loved ones’ discomfort and helping them sleep better, we might at least improve their quality of life.
The following are just a few ways we can combat sundowning restlessness and other factors that inhibit sleep.
- Create a Schedule
Frequently, sundowning is a reaction to new or unexpected stimuli, like unfamiliar places, activities, or things. For our older loved ones who have Alzheimer’s disease, there is a great deal of comfort in what is familiar; making a schedule and helping them stick to it will establish a sense of order and routine in their ever-changing lives. Having a set time for sleeping and rising may help them grow accustomed to sleeping at night and gradually recalibrate their shifted sleep cycles.
- Shorter Naps
Many people with Alzheimer’s will sleep for a considerable portion of their daytime hours, in the form of long, unplanned naps. While naps are not bad, they can interfere with our loved ones’ sleep cycles; the more they sleep during the day, the more trouble they may have sleeping at night. If they are tired from exercising or the physical strain of moving, they can still take naps, but these should be limited to about 30 minutes at most.
- Let There Be Light
Light is a very important component in our sleep cycles; the presence or absence of light signals to our biological clock that we should be awake during the day and asleep at night. Keeping the house light and bright from the moment they wake up and dimming the lights closer to their bed time can help to gradually adjust our loved ones’ circadian rhythm (their sleep-wake cycle). Light also helps when our loved ones are displaying sundowning behaviors; darkness and shadows can sometimes agitate, scare, or disorient them, so keeping the house bright in the early evening may somewhat alleviate their symptoms. At night, keep their bedroom partially lit, either with a dimmer, a lamp, or a few nightlights; this will keep them from panicking if they wake in the middle of the night and become disoriented in the darkness.
- Make Healthy Choices
As with many of the topics we discuss on this blog, exercise and a nutritious diet are a great place to start when we want to improve our older loved ones’ health. Light exercise, like a short walk down the street, dancing to music, or swimming early in the day can help keep them active and awake; because it will tire them out, they may find falling and staying asleep at night an easier task. Sugar, caffeine, alcohol, and large meals should be limited, particularly before our older loved ones go to bed, as they can lead to nighttime restlessness and agitation.
- A Comfortable Environment
Make sure your loved one’s sleeping environment is cool, quiet, and comfortable. If you keep the temperature too warm or too cold, they might find it difficult to fall asleep. If they like to fall asleep to the sounds from the television, quietly enter their room and turn it off before you go to bed; the bright lights and loud noises may make it difficult for them to stay asleep. Keep precious and sentimental items close by, and surround them with their favorite things to put them at ease.
These are simply a few suggestions, but the solution to your older loved one’s sleep difficulties and sundowning may not be so straightforward. Sometimes, restlessness and poor sleep at night are caused by other medical conditions, such as sleep apnea or a urinary tract infection. Do not hesitate to speak with your loved one’s doctor about their sleep troubles, because there may be something else going on for which an effective treatment option might be available.
While coping with the stress of caring for our loved ones who have Alzheimer’s, it may feel as though we as their caregivers are helpless. Not only in watching them struggle, exhausted, through day after day of disheartening losses, but in our own fatigue and anxiety as we try to give them the very best care. Helping our loved ones sleep will also help us sleep, and this will enable us to better provide them with the attention and love they need.