Getting a good night’s sleep

Not getting a good night’s sleep can make everything feel more difficult. Carers report disturbed sleep to be one of the most difficult and distressing things to deal with. Identifying and treating sleep issues is an important part of dementia care. This can alleviate stress for the person and carer, and could potentially slow cognitive decline.

As carers, we feel stressed when we believe we don’t have the energy or resources to cope with whatever demands are being placed on us. Not getting a good night’s sleep can have a big impact on our ability to manage.

The 2016 Great British Sleep Survey found that 63.1% of people feel they don’t get enough sleep. Poor sleepers are seven times more likely to feel hopeless and five times more likely to feel alone. As family carers, our need for good quality sleep is a vital component of reducing stress and increasing our resilience. 

Our sleep tends to be affected by four things:

• our environment
• our routine (or lack of it)
• our behaviour
• our thoughts/emotions

When we are aware that we’re not sleeping, that can make us anxious as we feel we should be asleep. Our stress levels rise, making it even harder to get to sleep.

One approach that can help with this is Acceptance and Commitment Therapy (ACT). ACT teaches people that trying to resist worry is unhelpful. Instead, we should just accept that this how things are right now and stop fighting.

Some people find it helpful to keep a notebook and pen by the bed to write things down in the night that they want to remember to do, or worries that they want to address the next day. Then there is the option to deal with it tomorrow.

An ACT approach also suggests that if you’re struggling to sleep, you can comfort yourself with the knowledge that your body is still resting while you’re lying in bed.

We tend to have poorer sleep as we get older. For example, many peri-menopausal and menopausal women find it really difficult to sleep at night. Also, conditions such as sleep apnoea, chronic pain and restless legs can interrupt sleep. If there are physical health problems that are affecting your sleep it is definitely worth seeking advice from your GP.

As a carer of a person with dementia you may be under a great deal of strain and looking after yourself, which includes getting enough sleep, is vital.

How much sleep you get as a carer can be impacted by how well the person you are caring for is sleeping.

Sleep difficulties can affect some people with dementia. We are not yet clear as to why this occurs for some and not for others.

Being active during the night time hours can be a common occurrence for a person with dementia. Research shows that it may affect up to 25% of people with mild to moderate dementia and 50% of people with severe dementia. 

It is thought it may be related to the dementia affecting the person’s internal biological clock which helps us to define the time of day, therefore the person starts to feel sleepy at the wrong time of day. The type of dementia you have can affect your sleep, such as Lewy Body Dementia, or Parkinson’s Disease Dementia which can cause the person to be sleepy during the day with very disturbed nights.

Causes of poor sleep may include:

• Changes to our internal clock
• Exhaustion
• Inactivity/cat napping
• Anxiety
• Poor lighting
• Medication – Side effects, inappropriate dosage or timing of medication
• Depression
• Changes to metabolism
• Misinterpreting cues in the environment – visitors leaving and the person thinking they need to go with them
• Other underlying health related problems -infections, pain, or sleep apnoea
• Continence issues

Not getting enough sleep can lead to:

• Increased confusion
• Disorientation for time, place and person
• Hallucinations/illusions/paranoia
• Restlessness, pacing, need to go somewhere
• Mood swings/low mood
• Insomnia
• Resistant to care
• Physical/verbal aggression

There are risks and problems associated with disturbed sleep. For example, concerns about someone leaving home in the middle of the night or hurting themselves. Disturbed sleep can impact on the sleep patterns of carers, often leaving them fatigued and exhausted.

People with dementia, especially those in the later stages, can often spend a lot of time sleeping both during the day and night. This can sometimes worry carers, friends and family. Excessive sleep is often due to the disease progressing. As the damage to a person’s brain becomes more extensive, they gradually become weaker and frailer over time.

Here we have some suggestions about what might help ensure a better night’s sleep for both of you.