Sleep Struggles with Dementia: Tips That Help

Written by Nguyenjessica

Published on June 27 2025

Is your loved one wide awake at night, napping all day, or restless as the sun goes down? You’re not alone—and it’s not just aging. Sleep issues are deeply tied to changes in the brain caused by dementia. Poor sleep can speed up memory loss, cause more confusion, and make caregiving even harder. But here’s the hopeful part: with the right

understanding and simple strategies, you can improve sleep for your loved one—and yourself. From daily routines and calming nighttime habits to the pros and cons of sleep medications, this article breaks it all down in plain language. Read on for real answers and practical tips to make nights more peaceful.

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Key Points

1. Sleep issues are common in dementia and deeply disruptive
People with dementia often struggle with falling or staying asleep due to brain rhythm changes, lower melatonin, and health conditions. Too much daytime napping and low activity make nights worse. Sundowning—late-day anxiety and confusion—adds to the problem.

2. Poor sleep speeds up brain decline and worsens symptoms
Deep sleep helps clear toxic proteins like beta-amyloid and tau. Poor sleep causes buildup, brain shrinkage, and worsens memory. It also affects focus, mood, and daily function.

3. Good daytime habits help sleep; medications should be used cautiously
A steady daily routine, sunlight, and activity help reset the body clock. Calm nighttime routines reduce stress. Sleep meds should be a last resort—many increase confusion or dementia risk and must be used under medical guidance.

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Table of content

Why do people with dementia have trouble sleeping?

What are the most common sleep issues in dementia?

How does poor sleep affect dementia symptoms and brain health?

What can caregivers do during the day to promote better sleep at night?

Are there nighttime routines that can help calm someone with dementia?

Should you consider sleep medications for dementia? What are the risks?

Why do people with dementia have trouble sleeping?

People with dementia often struggle to sleep, and it’s not just because of aging—it’s tied to how the brain changes and how other health issues pile on.

One key issue is the reduced production of melatonin, the hormone that tells your body it’s time to rest when it gets dark. As dementia progresses, the internal clock gets thrown off. This means someone might feel tired during the day and wide awake at night.

Parts of the brain that manage sleep—like the suprachiasmatic nucleus—also weaken. This leads to broken sleep, frequent wake-ups, and less deep or REM sleep. As a result, the quality of rest gets much worse.

Many also experience sundowning. As evening approaches, they may become agitated, anxious, or confused. Some might even see things that aren’t there. All of this makes it harder to wind down and fall asleep. Others wake up in the middle of the night thinking it’s morning, which totally breaks the sleep cycle.

Health issues like pain, frequent urination, depression, or sleep apnea also play a role. Plus, medications taken for dementia or other problems can interfere with sleep too.

Because nights are so restless, people with dementia often nap during the day. If those naps are too long or too frequent, it makes it harder to fall asleep at night. Add in a lack of physical or mental activity, and sleep becomes even more disrupted.

Dementia also brings along several sleep disorders—like insomnia, excessive sleepiness, circadian rhythm issues, REM behavior disorder, and sleep apnea. These all mess with normal sleep and can make memory and mood problems worse.

In the end, trouble sleeping in dementia comes from a mix of brain changes, behavior issues, and other medical or medication-related factors. It creates a tough cycle that affects both the person living with dementia and those who care for them.

What are the most common sleep issues in dementia?

People with dementia often face a wide range of sleep problems that affect both their nights and their days.

One of the most common issues is sleep-disordered breathing, especially obstructive sleep apnea (OSA). This happens when the airway collapses during sleep, cutting off oxygen. It’s very common in Alzheimer’s disease and leads to broken sleep and faster cognitive decline.

Excessive daytime sleepiness is another big concern—about half of people with dementia feel sleepy during the day. This usually happens because they don’t sleep well at night and may have undiagnosed sleep issues. Constant napping makes it even harder to sleep at night.

Insomnia is also common. People have trouble falling asleep, wake up often, or wake too early. This tends to get worse as dementia progresses, especially in Alzheimer’s and Lewy body dementia.

REM sleep behavior disorder (RBD) is when someone acts out their dreams—kicking, punching, or shouting in their sleep. It’s more common in Lewy body and Parkinson’s-related dementia and can even show up before dementia is officially diagnosed.

Restless legs syndrome (RLS) and periodic limb movement disorder (PLMD) also affect sleep. RLS creates an overwhelming urge to move the legs, usually at night. PLMD involves jerky limb movements during sleep that interrupt rest.

Circadian rhythm disruptions are very common. The body’s internal clock gets thrown off, causing sleep at odd times and wakefulness at night. This often leads to sundowning, where people get more agitated and confused in the evening, making sleep even harder.

Other things like pain, depression, medication side effects, noise, and not getting enough sunlight can all make sleep worse.

These issues often overlap, creating a complicated web that worsens dementia symptoms and makes care more challenging. That’s why a full, careful assessment is so important.

What are the most common sleep issues in dementia?

How does poor sleep affect dementia symptoms and brain health?

Bad sleep does more than just make us tired—it seriously affects brain health, especially for people with dementia.

When we don’t get enough good sleep, especially deep sleep, levels of beta-amyloid and tau proteins build up in the brain. These toxic proteins are linked to Alzheimer’s. Sleep helps clear them out, so poor sleep means the brain can’t clean itself properly, speeding up damage.

Chronic poor sleep also leads to brain shrinkage, especially in areas like the hippocampus and amygdala—key regions for memory and emotions. These parts are already vulnerable in dementia. Even older adults without dementia can show reduced brain volume if they consistently sleep poorly, suggesting sleep issues might harm the brain before symptoms even begin.

Sleep problems also mess with memory and thinking. Less time in deep and REM sleep affects our ability to learn, focus, and remember. For people with dementia, this means worse symptoms and faster decline.

Poor sleep affects daily function too—slower reaction times, poor decision-making, and reduced motor skills. Conditions like sleep apnea, which cause brief moments of low oxygen in the brain, only make things worse.

It’s not just too little sleep that’s harmful. Both short and long sleep durations raise the risk of dementia and silent brain injuries. Sleeping less than seven hours in midlife increases the chance of getting dementia later on by about 30%.

On top of that, poor sleep fuels anxiety and depression, which also speed up cognitive decline. Emotional and behavioral symptoms like confusion or agitation in dementia often get worse after a bad night’s sleep.

In short, sleep isn’t just rest—it’s how the brain heals and resets. When sleep suffers, brain health suffers. That’s why improving sleep is so important for slowing dementia and protecting mental function.

What can caregivers do during the day to promote better sleep at night?

Helping someone with dementia sleep better at night often starts with what happens during the day. Caregivers can build simple, steady routines that gently guide the body into a healthy sleep rhythm.

Physical activity and time outdoors are key. Light exercise like walking or gardening, plus natural sunlight, helps reset the internal clock and boosts daytime alertness—making it easier to wind down at night.

Try to limit long or late naps. Too much daytime sleeping, especially in the afternoon, can take away the sleep drive needed to fall asleep at night.

In the evening, cut back on screen time. TVs, phones, and tablets give off blue light that confuses the brain’s clock, making it harder to relax and fall asleep.

Keep a consistent daily schedule. Having set times for waking up, meals, activities, and bedtime creates structure and predictability. This reduces anxiety and helps the body know when it’s time to rest.

Fill the day with pleasant and meaningful activities. Things like chatting, light chores, hobbies, or music keep the person engaged, which helps burn energy and ease evening restlessness.

Build a calm bedtime routine. Gentle music, a warm bath, or a short book can signal that the day is ending. It’s a soothing way to help the mind and body slow down.

Finally, make sure the sleep environment feels safe and cozy. Keep the room quiet, dark, and at a comfortable temperature. Use soft nightlights or familiar objects to ease any nighttime confusion.

With the right mix of daytime movement, calming evenings, and a sleep-friendly setting, caregivers can improve sleep, reduce sundowning symptoms, and make nights easier for both themselves and their loved ones.

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Are there nighttime routines that can help calm someone with dementia?

Evenings can be difficult for people with dementia, but a gentle and consistent bedtime routine can help ease anxiety and support better sleep.

Start with a warm bath about an hour or two before bed. Soft lighting, gentle massages, or calming music can also help the body and mind slow down. These cues tell the brain it’s time to rest.

Avoid screens like TVs, phones, or tablets at night. The blue light from these devices can interfere with the body’s sleep-wake rhythm and make falling asleep harder.

Stick to a consistent bedtime and wake-up time. A steady routine helps reduce confusion. Adding simple activities like reading aloud or soft music before bed can create a peaceful mood.

Try using soothing sounds like soft music, white noise, or nature sounds. These can block out sudden noises and make the room feel more relaxing.

Make sure the sleep environment feels safe and cozy. The room should be quiet, dim (or use a soft nightlight if total darkness causes anxiety), and kept at a comfortable temperature. Soft bedding and safety features like non-slip rugs or bed rails can also help.

Light massage—on the hands, shoulders, or back—can ease tension. Guided breathing or relaxation exercises may help calm the mind before sleep.

Consider using aromatherapy. Essential oils like lavender in a diffuser can have a calming effect and help set the mood for sleep.

Choose familiar, low-stimulation activities like reading a favorite book, listening to audiobooks, or doing gentle stretches to help distract from worries and settle the mind.

Offer reassurance and familiar items. A caregiver’s presence, soothing voice, and comforting objects—like family photos or favorite blankets—can reduce nighttime confusion and bring emotional comfort.

When these routines are applied consistently and tailored to the individual, they can ease anxiety, lessen sundowning behaviors, and make bedtime a calmer experience for everyone.

Should you consider sleep medications for dementia? What are the risks?

Sleep medications for people with dementia should be used very cautiously, as they can bring risks and their long-term benefits are still uncertain.

Many over-the-counter sleep aids (like Benadryl®) contain anticholinergic ingredients such as diphenhydramine. When taken for years, these drugs have been linked to a higher risk of dementia. That’s because they block brain chemicals involved in memory and thinking, potentially speeding up cognitive decline.

Prescription sleep drugs, including benzodiazepines and “Z-drugs” like Ambien, have also been tied to a greater dementia risk. In one study, older white adults who used these medications often had a 79% higher chance of developing dementia than those who rarely used them.

Side effects can include daytime sleepiness, confusion, increased risk of falls, and worsening of behavioral issues—all serious concerns for people with dementia.

That said, it’s still unclear whether these medications cause dementia, or if people start using them because they already have early symptoms. This makes the link tricky to interpret.

Some newer medications, like suvorexant, are showing promise. It targets the brain’s wakefulness system and has helped improve sleep in small studies, without hurting cognition. One study even showed it might reduce Alzheimer’s-related proteins, though more research is needed.

Low-dose trazodone has also been found helpful for sleep in dementia patients, with relatively few side effects.

Current medical advice is:

Start with non-drug methods, like increasing activity, setting sleep routines, and treating other health issues;
If medication is needed, use the lowest effective dose for the shortest time, and always with medical supervision;
Patients and caregivers should have open conversations with healthcare providers to weigh pros and cons together.
In short, most traditional sleep medications carry real risks for people with dementia. While some new options may be safer, they’re not yet proven. Focusing on natural, behavioral approaches remains the safest and smartest first step.