2.3. Outline how staff can support a person with dementia who has difficulty sleeping

This. guide will help you answer 2.3. Outline how staff can support a person with dementia who has difficulty sleeping.

Many people living with dementia struggle with sleep. Their sleep patterns can change. They might find it difficult to fall asleep, stay asleep or wake very early. Some may wander at night. Others might feel restless or distressed in bed.

Staff must recognise these struggles as part of the condition. Dementia affects the brain’s ability to control the sleep-wake cycle. This makes normal patterns harder to maintain. People with dementia may mix up day and night, nap during the day, or feel anxious when it is dark.

Sleep problems can make dementia symptoms worse. Tiredness can increase confusion, agitation and memory loss during the day. Unsettled nights can add to the strain for families and carers too.

Observation and Monitoring

Understanding the individual’s sleep issues begins with careful observation. Staff should watch for patterns in the person’s sleep. Write down what time they go to bed, how often they wake, how long they stay awake, and what they do during those times.

Use a sleep chart or diary. Keep it simple. Note down:

• Bedtime and waking time
• Night waking episodes
• Duration of sleep
• Any naps during the day
• Behaviours seen during the night, such as wandering or calling out

Share these details with the care team and healthcare professionals. This helps everyone work together and identifies any triggers such as pain, thirst, hunger or environmental changes.

Creating a Calm and Comfortable Environment

The bedroom should feel safe and relaxing. Small changes may make a big difference to sleep. Check that:

• The bed and bedding are comfortable and familiar
• The room is not too hot or cold
• There is enough ventilation and fresh air
• Noise is minimal
• Light is low but there is a soft night light, if needed, to reduce confusion or fear if the person wakes up

Remove any clutter or hazardous objects from the bedroom floor. Use blackout blinds if daylight or street lights disturb the person. Make sure the route to the toilet is clear and well lit, using motion sensor lights if the person gets up at night.

Keep a clock in the bedroom that shows whether it is day or night. This helps reduce confusion.

Supporting a Good Bedtime Routine

People with dementia benefit from simple routines. Routines give a sense of familiarity and comfort. Help the person wind down before bed, using the same steps each evening if possible.

Good routines include:

• A warm bath or shower before bed
• Brushing teeth and toileting
• Changing into comfortable night clothes
• Soft, calming music or gentle reading
• Light snacks (avoid caffeine or sugar in the evening)
• Closing curtains and dimming lights to signal bedtime

Spend a little time talking or sitting quietly with the person to help them relax. Use gentle reassurance if they express worry or confusion.

Encouraging Daytime Activities

People with dementia often rest or nap too much during the day, which affects night-time sleep. Staff should help the person stay active and engaged.

Support daytime activity by:

• Helping the person to get up at a regular, suitable time each morning
• Encouraging time outdoors in natural light during the day
• Suggesting light exercise such as walking, gardening, or simple chair exercises
• Involving the person in household tasks if they wish, like folding laundry or laying the table
• Providing stimulating activities adapted to the person’s skills, such as crafts, puzzles, or music

Discourage naps, especially in the late afternoon or evening. If a nap is needed, keep it short and before 3pm. Exposure to daylight helps maintain natural sleep-wake patterns.

Managing Food and Drink

What a person eats and drinks can affect their sleep. Staff should monitor intake, especially in the hours before bed.

Promote better sleep by:

• Offering a light snack (such as warm milk, banana or wholemeal toast) before bedtime if the person is hungry
• Avoiding caffeine (tea, coffee, cola, chocolate) in the afternoon or evening
• Avoiding large meals late in the evening
• Discouraging alcohol or sugary drinks before bed – they can disrupt sleep or increase the need to wake up and urinate at night
• Checking whether the person needs a drink of water before bed, to avoid waking up thirsty

If the person gets up for the toilet at night, keep the route safe and well lit. Assess for signs of urinary tract infection or prostate problems if night waking is frequent.

Responding to Night-time Waking

If the person wakes during the night, remain calm and gentle. Respond with patience. Avoid arguing or correcting the person if they are confused.

Support could involve:

• Speaking softly and reassuringly
• Checking if they are in pain or discomfort
• Offering the toilet
• Providing a drink of water if thirsty
• Assisting the person back to bed and suggesting relaxation, such as slow breathing or humming quietly

Sometimes, the person will not be able to return to sleep. If so, stay with them quietly or offer a calm, non-stimulating activity such as looking at a photo book or listening to gentle music. Try again to encourage rest after a while.

Personalised Care and Knowing the Individual

Each person with dementia is different. What works for one person may not work for another. Staff should get to know the individual’s preferences, habits and life history.

Consider:

• What time did they usually go to bed and get up before dementia?
• Did they work shifts, which might affect sleep patterns?
• Are there cultural or religious practices linked to bedtime?
• Does the person have fears about the dark?
• Do certain songs, scents or bedtime routines bring comfort?

Family members can help by sharing the person’s usual habits. These personal details help staff to offer meaningful support.

Working with Healthcare Professionals

Some sleep problems have medical causes. Pain, infections, constipation or side effects from medication can disrupt sleep. Staff should look out for signs such as:

• Complaining of pain
• New confusion or agitation
• Changes in appetite or toilet habits
• Itching or skin discomfort
• Restless limbs or cramps

Report concerns to the nurse, GP or pharmacist. Medication reviews are important. Some medicines can make sleep harder. Others can cause drowsiness in the day. Healthcare professionals can advise if medication changes are needed.

Reducing Distress and Night-time Anxiety

People with dementia may become anxious at night. They may see shadows, misunderstand reflections or get frightened by noises.

Staff can reduce distress by:

• Using blackout blinds or curtains to remove confusing shadows
• Covering mirrors in the bedroom if they cause distress
• Making sure the person’s favourite objects or photos are nearby for reassurance
• Using a soft, familiar blanket or teddy for comfort
• Offering gentle touch, such as holding hands, if the person finds this soothing
• Providing company and reassurance until the person is calm

Avoid using restraint, raising your voice, or forcing someone to stay in bed. Respond to feelings, not just behaviour.

Safe Use of Medicines

Sometimes, a doctor may prescribe medication to help sleep. Sleeping tablets are not usually recommended for people with dementia unless other approaches do not help. These medicines can cause falls, drowsiness, or problems with memory.

If sleeping tablets are prescribed, monitor their effects. Observe any changes in behaviour, balance or confusion. Follow care plans and store medicines safely to prevent overdosing.

If there are any negative reactions, seek medical advice.

Communicating with Families and Other Professionals

Families may worry about the person’s sleep. Share information with them and involve them in care planning. Invite their input about routines or past habits.

Document sleep patterns and changes so that all care staff are aware. Share this information at handover.

If external professionals such as district nurses, occupational therapists or continence nurses are involved, work together as a team to address problems. Use their ideas and recommendations.

Adapting Approaches When Things Change

Sleep patterns can change as dementia progresses. Review and update care plans as needed. If current approaches do not work, try a different routine or environment. Staff should stay flexible and open-minded.

Discuss persistent sleep issues with the wider care team. Use team meetings to share ideas and experiences. Ongoing training about dementia care helps staff keep their skills and knowledge up to date.

Importance of Staff Wellbeing

Supporting someone with dementia who has sleep difficulties can be stressful, especially during night shifts. Staff should look after their own wellbeing. Seek help and advice if finding the situation difficult. Use debriefs and supervision to share feelings and find solutions.

Support from managers and a positive team approach makes the work less stressful and improves care for people living with dementia.

Final Thoughts

Understanding and patience are needed to help people with dementia sleep better. Small changes and a person-centred approach often have the biggest effect. Every action should respect the person’s dignity, safety and comfort at every stage.