Sleep Issues in Alzheimer’s

Reviewed by: HU Medical Review Board | Last reviewed: May 2023

Alzheimer’s can impact sleep. Sleep issues can happen at any stage of Alzheimer’s disease. Changes in how much and how well you sleep are common as you age. But Alzheimer’s sleep issues tend to be more severe than normal sleep disruption. And some Alzheimer's symptoms can get worse if sleep is disrupted.1,2

In early Alzheimer’s, people may sleep more than expected. They may wake up disoriented. Later stages may cause a sleep cycle to flip or cause sundowning, which is restlessness, irritability, or confusion in the evening hours. A person with advanced Alzheimer’s may doze throughout the day as opposed to having a consistent nightly sleep schedule.1,2

Learning how to manage sleep issues can improve quality of life for the person with Alzheimer’s as well as their caregivers.

What causes sleep issues in Alzheimer’s?

There are many possible reasons for sleep disruptions in people with Alzheimer’s disease. People naturally need less sleep as they age. But Alzheimer’s can also cause issues with the body’s internal clock. For a person with Alzheimer's, this means the part of their brain that keeps them awake during the day and asleep at night may not work properly.1

People with Alzheimer’s could also be mentally or physically exhausted from the day. Alzheimer’s causes confusion and a lack of familiarity even in familiar environments. This can be stressful and tiring.1

Sleep loss can also worsen symptoms of Alzheimer’s. It can contribute to delusions, restlessness, and wandering. These can also all make sleeping more difficult. Getting enough sleep is needed for long-term memory. This is especially true of deep sleep (also called REM sleep). People who are not getting enough good-quality sleep may have worsening memory issues.1,2

Nondrug treatments for sleep issues

Many experts encourage nondrug treatments for sleep issues. These types of treatment focus on creating a consistent schedule and a relaxing environment. Examples include:1-4

  • Creating a consistent routine of waking up, eating meals, and going to bed
  • Scheduling doctors appointments, trips, or other activities earlier in the day or when the person with Alzheimer’s is most alert
  • Engaging in light physical exercise during the day, like going for a walk
  • Limiting daytime naps, alcohol, caffeine, and nicotine, which can all affect ability to sleep
  • Taking medicine at an appropriate time of day, as prescribed by your doctor
  • Using light therapy, which involves using a bright light for at least 30 minutes during the day
  • Arranging the home in a way that covers mirrors, does not create shadows, and avoids loud noises to limit hallucinations and agitation

It may be worth combining these treatment strategies. One study found that using sleep hygiene practices, light therapy, and daily walks resulted in lower rates of depression and nighttime wakefulness in people with Alzheimer’s. Try a few techniques to see what works best for you.4

Medicine for sleep issues

Nondrug options are usually the first line of treatment for sleep issues in people with Alzheimer's. But if they do not help, it may be necessary to speak to a doctor about drugs to aid with sleep. Before making a decision about a medicine, talk to your doctor about the risks and side effects to determine if it is right for you.1

Sleep drugs can be riskier for people with Alzheimer's. Many can cause falls and injury, confusion or memory loss, and sedation. Sleep aids are usually used only in cases where other options have been exhausted. Talk to your doctor about the risk and benefits of sleep aids, and if they may be right for you.2

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