Restless Night and Alzheimer’s: Concrete Solutions to Regain Sleep

Table of contents

1. Understanding sleep disorders in Alzheimer’s

2. Strategies to promote falling asleep

3. Adapting the room and the environment

4. Managing nighttime awakenings and wandering

5. Solutions for the exhausted caregiver

6. When to consult and possible treatments

Understanding sleep disorders in Alzheimer’s {#comprendre}

Why do they sleep so poorly?

1. Brain degeneration

The hypothalamus (area regulating the sleep-wake cycle) is damaged.

Consequence: Disruption of the circadian rhythm (biological clock).

The person no longer knows when it is day, when it is night.

2. Day-night reversal

Sleeps a lot during the day (multiple, long naps).

Result: Not tired at night, becomes restless.

3. Anxiety, nighttime confusion

The night amplifies confusion (darkness = disorientation).

Fear: "Where am I?", "Who are you?"

Anxiety → Agitation, screams, attempts to flee.

4. Pain

Osteoarthritis, cramps, gastric reflux: Nighttime pains disturb sleep.

5. Medications

Side effects: Some medications disturb sleep (diuretics = awakenings to urinate, corticosteroids = insomnia).

6. Sleep apnea

Common in elderly people (snoring, breathing pauses).

Disrupt deep sleep, daytime fatigue.

7. Restless legs syndrome

Irresistible urge to move the legs (discomfort).

Prevents falling asleep.

8. Unmet physiological needs

Need to urinate, hunger, thirst, too hot/cold.

Consequences of sleep disorders

For the sick person:

• Worsening cognitive decline (the brain does not "cleanse" itself at night)
• Daytime fatigue, drowsiness
• Irritability, aggressiveness
• Falls (nighttime wandering)
• Worsening health condition (hypertension, diabetes...)

For the caregiver:

• Physical and mental exhaustion (fragmented nights = no recovery)
• Depression, burnout
• Risk of accidents (fatigue = inattention)
• Institutional placement (often decided due to nighttime exhaustion)

Sleep disorders = urgent to treat.

Strategies to promote falling asleep {#endormissement}

1. Strict bedtime routine

Same time every evening (example: 9 PM).

Routine = signal for the brain: "It’s time to sleep."

Soothing sequence (30-45 min before bedtime):

1. Hygiene (warm water = relaxes)

2. Put on pajamas

3. Herbal tea (chamomile, linden - without sugar)

4. Soft music (5-10 min)

5. In bed (same time)

Repeat EVERY night (even weekends).

2. Limit naps

Major problem = naps too long during the day.

Rule:

Goal: Tired in the evening = easier to fall asleep.

3. Daily physical activity

Exercise = the best natural sleeping pill.

Recommended activities:

Timing: NOT in the evening (exciting), rather morning/afternoon.

Effect: Physical fatigue → Better sleep.

4. Appropriate cognitive stimulation

EDITH in late morning or early afternoon (15-20 min).

Stimulates the brain (avoids apathy).

But NOT in the evening (cognitive excitement).

Effect: Maintains daytime alertness, promotes nighttime sleep.

5. Exposure to natural light

In the morning (crucial):

Open shutters, curtains as soon as you get up.

Go outside (even 10 min): Natural light resets the biological clock.

In the evening:

Dim lights gradually (starting at 6 PM).

Soft light (no harsh fluorescents).

Principle: Light = alertness, darkness = sleep (signals for the brain).

6. Appropriate diet

In the evening:

Light meal (avoid heavy digestion).

No coffee, tea, alcohol (disturb sleep).

Soothing herbal tea (chamomile, verbena).

If hungry at night: Light snack planned (biscuit, applesauce) to avoid awakening.

7. Room temperature

18-20°C = ideal for sleep.

Too hot = awakenings.

8. Soothing ritual

Soft music (baroque, classical, music from youth).

Reading (if able to listen): Short, soothing story.

Massage of hands, feet (5 min): Very soothing.

Reassuring words: "You are safe, everything is fine, sleep peacefully."

Adapting the room and environment {#chambre}

1. Darkness (but not total)

Blackout curtains (block outside light - streetlights, cars).

But nightlight (discreet): Avoids disorientation if nighttime awakening occurs.

Avoid total darkness = can cause anxiety (does not recognize anything).

2. Relative silence

Avoid outside noises (noisy street): Double glazing if possible.

But white noise (fan, white noise machine) can mask disturbing noises.

3. Comfortable bed

Appropriate mattress (not too soft, not too hard).

Comfortable pillows (slightly elevate if gastric reflux).

Appropriate blanket (not too warm, not too cold).

4. Safety

If there is a risk of nighttime falls:

Medical bed with barriers (prevents falls).

Or mattress on the floor (if gets out of bed alone).

Clear path from bed → toilet (remove obstacles, rugs).

Nightlights along the path (guide to the bathroom).

5. Reassuring markers

Visible family photos (near the bed).

Familiar objects (stuffed animal, favorite blanket).

Clock with large numbers (knows what time it is = still night).

6. Eliminate stimuli

Turn off the television (noise, light = disruptors).

Turn off the phone (if it rings at night).

Cover mirrors (may not recognize themselves, think there’s an intruder).

Managing nighttime awakenings and wandering {#reveils}

If awakened at night: What to do?

1. Stay calm

Your stress = their stress.

Breathe, calm down before intervening.

2. Soft light

Turn on nightlight (not bright light = too stimulating).

3. Soothing voice

"It’s night, everything is fine, you need to sleep."

Soft, reassuring tone.

4. Check physiological needs

Need to go to the bathroom? (frequent)

Accompany, then return to bed.

Thirsty? Small glass of water.

Too cold/hot? Adjust blanket.

5. Stay in the room

Do not turn on all the lights, do not take to the living room (= signal "day begins").

Goal: Get back to bed quickly.

6. Soothing techniques

Soft music (2-3 min).

Massage hands, shoulders.

Reassuring words repeated: "Sleep, everything is fine."

7. Patience

It may take 10-30 min to fall back asleep.

Do not get upset (worsens the situation).

Nighttime wandering: Management

The person gets up, wanders around the house, opens cupboards, fridge...

Risks:

Safety solutions:

1. Alarms

Motion detector (discreet sound when they get up).

Alerts the caregiver (even in a distant room).

2. Stair barriers

If there are stairs: Safety gate (prevents falls).

3. Locking the front door

High lock (cannot reach).

Alarm on the door (sounds if opened).

4. Kitchen safety

Block access (closed door) if possible.

Or stove unplugged at night.

5. Room near the caregiver

If possible, adjacent room (hears more easily).

6. Bed on the floor

If gets up often: Mattress on the floor (prevents falling out of bed).

7. Gentle redirection

If found wandering:

Do not scold ("What are you doing standing up!").

Calmly accompany: "Come, let’s go back to bed."

Arm under arm, soft tone.

8. Let wander (under supervision)

If insists on walking:

Let walk (prior safety measures): Gets tired → Easier to return to bed.

Solutions for the exhausted caregiver {#aidant}

You cannot hold on for long without sleep

Chronic sleep deprivation = danger (physical, mental health).

Solutions for the caregiver:

1. Alternate with a relative

If family: Alternate nights (one night each).

Allows recovery every 2 days.

2. Night caregiver

Home aide who stays overnight (watches the person).

Cost: 100-150€/night (depending on region).

Possible funding: APA (Personalized Autonomy Allowance).

Even 1-2 nights/week = essential respite.

3. Temporary accommodation

Night care (rare) or temporary accommodation (1 week) in a nursing home.

Allows the caregiver to recover.

4. Separate room

If possible, sleep in a separate room (with alarm/baby monitor to hear if there’s a problem).

Allows for less interrupted sleep.

5. Caregiver nap

Sleep when they sleep (nap at the same time).

Compensates for lack of nighttime sleep.

6. Accept help

Family, friends: Ask them to come a few nights/month.

Associations (France Alzheimer): Respite care (professional replaces caregiver for a few days).

7. Consider placement if total exhaustion

If nights are unmanageable despite everything:

Nursing home: Trained teams, 24/7 supervision.

Not a failure, but a necessity to preserve everyone’s health.

When to consult and possible treatments {#traitements}

Consult if:

Who to consult?

General practitioner (assessment, search for causes).

Geriatrician (specialist in elderly people).

Neurologist (adjustment of Alzheimer’s treatment).

Sleep center (if suspected apnea).

Possible examinations

1. Complete medical assessment

Search for organic causes:

2. Polysomnography

Sleep recording (specialized center).

Detects sleep apnea, restless legs.

3. Review of medications

Some medications disturb sleep: The doctor can adjust.

Medications (last resort)

After trying everything (sleep hygiene, adaptations).

Options:

1. Melatonin

Sleep hormone (natural).

Helps reset circadian rhythm.

Few side effects.

Medical prescription.

2. Anxiolytics (benzodiazepines)

Example: Lorazepam, oxazepam.

Effect: Falling asleep, reduced anxiety.

Risks: Falls (residual drowsiness), dependence.

Short duration only.

3. Antipsychotics (if severe agitation)

Example: Risperidone (low doses).

Reserved for severe cases (nocturnal aggression).

Significant side effects (sedation, falls).

4. Sedative antidepressants

Example: Mirtazapine.

If underlying depression.

Promotes sleep.

⚠️ All these medications = under strict medical control.

Prefer non-drug solutions first.

7-step action plan

Step 1: Analyze the situation

Keep a sleep diary (2 weeks):

Identify patterns (e.g., long nap = bad night).

Step 2: Consult a doctor

Health assessment (eliminate organic causes).

Step 3: Adapt the environment

Room: Darkness, temperature, safety.

Step 4: Establish a routine

Strict bedtime routine (same time, same sequence).

Limit naps (30 min max).

Daily physical activity (morning/afternoon).

Step 5: Cognitive stimulation EDITH

15-20 min/day (morning or early afternoon).

Maintains daytime alertness → Better nighttime sleep.

Step 6: Manage nighttime awakenings

Calm protocol: Soft light, soothing voice, get back to bed quickly.

Step 7: Take care of the caregiver

Alternate, ask for help, sleep when they sleep.

If exhausted: Temporary accommodation.

Testimonials

Marie, caregiver for her mother

"My mother used to wake up 5-6 times a night. I was exhausted. I implemented a strict routine: bedtime at 9 PM, limit naps to 30 min, walk every morning. In 3 weeks, improvement! She still wakes up 1-2 times, but falls back asleep quickly. My life has changed."

Jean, son of a father with Alzheimer’s

"My father wandered at night, opened the fridge, went outside. I secured things: alarm on the door, nightlights everywhere, high lock. And I asked for help: my sister comes 2 nights/week. I can finally sleep."

Conclusion: More peaceful nights are possible

Sleep disorders in Alzheimer’s are not a fatality. With an adapted routine, a secure environment, management of awakenings, cognitive stimulation (EDITH), and support for the caregiver, calmer nights are possible. It requires patience, adjustments, and sometimes external help, but the result is worth it: better health for everyone.

The keys to regained sleep:

1. ✅ Strict routine (bedtime, wake-up time, limited naps)

2. ✅ Daily physical activity

3. ✅ Cognitive stimulation (EDITH)

4. ✅ Exposure to natural light (morning)

5. ✅ Adapted room (darkness, temperature, safety)

6. ✅ Calm management of awakenings

7. ✅ Help for the caregiver (alternating, aide, accommodation)

Sleep is vital. For your loved one. For you. Act now. Solutions exist.

DYNSEO resources to improve sleep:

The night is made for sleeping. Everyone. Your loved one and you. Reclaim this fundamental right. The solutions are here. Seize them.