People living with dementia, like my mom, often get confused between day and night. Sleep issues when you have dementia can show up in many ways—frequent waking, daytime drowsiness, restlessness, and confusion after dark.

Why people with dementia don’t sleep well isn’t entirely clear, but it’s one of the more difficult and heartbreaking parts of the condition. In my mom’s case, she now needs a nighttime caregiver because she often wakes up five or six times throughout the night—and many times, she doesn’t fall back asleep.

Many people wonder at what stage of dementia does not sleeping become a major issue. This is common for people in mid-to-late stages, like my mom. 

It’s a constant challenge. Most nights, she wakes because she needs to use the bathroom. But afterward, her mind won’t settle. Five or six disruptions each night leave her exhausted, and by morning, she’s overtired, confused, and at a much higher risk of falling—especially because her balance and mobility are already fragile.

One night, the nurse gave her her usual melatonin and added an extra one, hoping it would help. When I arrived the next morning around 10:00 a.m., I found her extremely lethargic. She was too sleepy to engage with anything and ended up napping through most of the day. Of course, that only fueled the cycle—she slept all day and was wide awake again at night.

What is the Best Sleep Aid for Dementia Patients?

For anyone wondering, “What is the best sleep aid for dementia patients?” the truth is—it depends. Sometimes, even natural sleep aids for dementia patients can backfire.

I started asking myself: Why is this happening? Maybe it’s because she’s always been a light sleeper. Maybe it’s old routines—she used to wake in the night with thoughts or dreams, and my dad would talk her gently back to sleep. Now that he’s gone, and her memory is slipping, maybe those nighttime awakenings feel scarier and more disorienting.

Medication doesn’t seem to be the long-term answer. We’ve tried melatonin, but it either doesn’t help—or it helps too much, and then she’s groggy all day. We have experimented with essential oils, calming routines, soft lighting, and even a little energy work, and while we sometimes are able to get her to fall asleep more quickly, she still wakes up multiple times a night, and we never know whether she will be able to fall back asleep.

Tips for Managing Sleep Struggles with Dementia

If you’re walking a similar road with a loved one, here are a few gentle suggestions that have helped us (and may help you):

1. Establish a consistent routine. Regular sleep and wake times, meals, and activities help the body find a rhythm—even if memory is fading.
2. Limit naps during the day. Too much daytime sleep can disrupt nighttime rest. Short naps (30 minutes or less) are okay, but try to keep your loved one active during daylight hours.
3. Use light to cue the body clock. Open the curtains in the morning. Use soft, warm lighting at night. Light can help signal when it’s time to wake or wind down.
4. Try natural sleep aids carefully. Melatonin works for some, but not everyone. Start small. Aromatherapy, calming music, and massage can also support relaxation.
5. Reduce stimulation before bed. Quiet the environment. Avoid screens, loud noises, or upsetting news in the evening.
6. Offer reassurance. Sometimes confusion at night comes from fear. Gentle words like, “You’re safe. Everything’s okay,” can do more than you might think.
7. Consider night visits. If possible, go see your loved one at night to better understand what they’re experiencing. It might shift your perspective—and your approach.

Why Some People with Dementia Have Difficulty Sleeping at Night

1. Disruption of the Brain’s Internal Clock

The human body runs on a 24-hour cycle known as the circadian rhythm, which controls when we feel awake and when we feel sleepy. This rhythm is regulated by a part of the brain called the suprachiasmatic nucleus (SCN), located in the hypothalamus.

In people with dementia—particularly those with Alzheimer’s disease—the brain undergoes physical and chemical changes that can damage the SCN. When this internal clock is disrupted, it becomes difficult for the person to maintain a normal pattern of sleeping at night and staying awake during the day.

In addition to disruption in the circadian rhythm, as people age, the pineal gland—the small gland in the brain that produces melatonin—naturally produces less melatonin. This decline typically begins in middle age and continues into older adulthood, and results in less pronounced sleepiness at night, more fragmented sleep, earlier wake times (early morning awakenings), difficulty falling or staying asleep

2. Reduced Exposure to Natural Light

Light is a major cue for the brain to distinguish between day and night. Many people with dementia spend most of their time indoors, sometimes in poorly lit environments. Without enough exposure to natural daylight, the brain may struggle to register the correct time of day, further disrupting the sleep-wake cycle.

3. Sundowning Syndrome

“Sundowning” refers to a state of increased confusion, agitation, or restlessness that typically occurs in the late afternoon or evening. While the exact cause of sundowning is unclear, it is thought to be related to changes in the brain, fatigue, and low light levels at the end of the day.

During sundowning, people with dementia may become more active or anxious, leading them to stay awake at night or misinterpret the time altogether. Some may even get up in the middle of the night, believing it is morning.

4. Memory Loss and Time Perception

Dementia often impairs a person’s ability to track time. They may forget recent events, lose their sense of sequence (what comes before or after), or have difficulty interpreting clocks or calendars. As a result, they might believe it is morning when it’s actually evening, or feel that they’ve just woken up even after sleeping for hours.

5. Sleep Disorders and Physical Health Issues

Sleep problems are common in dementia, including insomnia, restless leg syndrome, and sleep apnea. These conditions can fragment sleep, making it harder for people to stay asleep at night. Additionally, other health issues—like chronic pain, urinary tract infections, or side effects of medications—can lead to frequent nighttime awakenings and daytime drowsiness.

Day-night confusion in dementia is not just frustrating—it’s a sign of how profoundly the brain is affected by the disease. Understanding the biological and environmental causes can help caregivers respond with compassion and develop strategies that support better rest and a higher quality of life for their loved ones.

Source: https://www.alzheimers.org.uk/about-dementia/symptoms-and-diagnosis/sleep 

This journey is never easy. But sometimes, just being there—especially when things don’t make sense—can offer a kind of comfort that words can’t. Love, even in the quietest hours, still speaks loudly.

If you’re caring for someone with dementia and struggling with sleep issues, don’t hesitate to seek guidance from a healthcare provider or a dementia support specialist.