Sleep: a two-week plan for both of you
- First, find which kind of night-waker this is. The table.
- Then run a two-week plan with a log, not a tip sheet. (With a tip sheet, carers walked on 7% of days. Coached: 86%.) The plan.
- At 3am: needs first, one calm line, low warm light, water not food. The 3am steps.
- Sudden change, fever or new confusion? Call the doctor today. (It may be delirium.) The signs.
Kinds of night-waker
Watch three nights, then find the closest match.
| Pattern | Likely cause | First fix |
|---|---|---|
| Asleep by 7 or 8pm, up and bright at 3 or 4 | An early body clock, often too long in bed | A later bedtime, late-afternoon light: time in bed, light |
| Wired in the evening, groggy till noon | A late body clock | Light right after a fixed wake time: light |
| Up and down all night | A body cause. Waking every 15 to 30 minutes points to apnea. | Why they are awake |
| Sleeping in bits around the clock | No set pattern. Common in later stages. | Bright days, dark nights, set times for meals and the walk |
| Punching, kicking or shouting while asleep | Acting out dreams, a treatable sleep disorder | Pad the bed area tonight; tell the doctor: acting out dreams |
The two-week plan
Coaching plus a log is what worked in the trials. (Expect about 30 to 40 fewer minutes awake a night, while it is kept up.)
- Day 1: set the wake time and start the log. (Bedtime, each waking and what happened, wake time, naps, time outdoors, the walk.) On paper or in the behavior log.
- Days 1 to 14: the daily steps, at least 4 days a week. (In the home trial, that is what predicted the gains.)
- Day 7: add up hours in bed and hours asleep. Far more in bed? Move bedtime later. Same waking hour most nights? Find the cause.
- Day 14: compare week 2 with week 1. Better? Keep going. (In one trial the gains were gone 6 months later, once families stopped.) No change? Take the log to the doctor: Fragmented sleep, for both of us. Here are two weeks of notes.
Daytime steps that help night sleep
Wake time and time in bed
Get them up at the same time every day, within half an hour, and open the curtains. (The wake time sets the whole clock.)
- Far more in bed than asleep? Move bedtime 15 minutes later every 3 or 4 nights. Stop when time in bed is about real sleep plus 30 to 60 minutes. (Sleep compression, an evidence-based insomnia treatment in older adults. Step sizes: our reasoning.)
- Keep at least about 7 hours in bed, and go slowly. (Early daytime sleepiness usually fades, but in dementia it means more dozing and falls: our reasoning.)
- Seizures, a history of mania, or dozing all day already? Ask the doctor first.
Light at the right hour
Outdoors 30 to 60 minutes most days, even in shade or cloud. (Indoors is usually at least ten times dimmer, and older eyes let in less light.) Can't get out? A light box.
| Night-waker | Bright light | Dim or dark |
|---|---|---|
| Early sleeper, up at 3 | Late afternoon; lamps bright until an hour before bed | Curtains shut at dawn until the wake time |
| Wired at night, groggy mornings | Right after the wake time | Lamps dim from an hour before bed |
Why we say this: evening light moved early wakers' clocks later, adding sleep; morning light pulls late clocks earlier.
Naps
- One nap, up to 30 minutes, after lunch. (NIA: no naps late in the afternoon or evening. A nap habit of many years can stay.)
- Dozing in the chair? Give them something to do, not a ban: an hour or two a day of what they used to love, like folding, songs, the garden, old photos. (Activity, daylight and routine cut daytime sleep from 32% to 21% of staff checks.)
The walk
Walk together, building up to 30 minutes, at least 4 days a week. (In the home trial, walkers were awake 33 fewer minutes a night at 2 months. Frail people started shorter.)
Caffeine and alcohol
- No coffee, tea, cola or chocolate after lunch. (In older men, about half of a 3pm cup is still there at 8pm.)
- Check pain pills for "caffeine" on the box. (One Excedrin Extra Strength caplet has 65 mg.)
- No nightcap. (Alcohol breaks up the second half of the night. Older people feel more from the same drink, with more falls.)
The sundowning plan
Start by 2pm, not 4. (In 85 nursing-home residents, agitation peaked on average at 2:38pm. Only 2 were true evening "sundowners".)
| When | Do |
|---|---|
| Morning | Visitors, outings and baths, not late in the day |
| Midday | The main meal, then a light supper. Hunger can pass for sundowning. |
| The usual restless time | One simple job, like setting the table |
| Before dusk | Lamps on, curtains closed, TV off. Shadows and dark windows get misread as people. |
| The hour before bed | Warm, low lamps. The same short routine: quiet music, warm drink, hand lotion |
The day after a bad night
It may be delirium, not tiredness. (A sudden brain problem, often from illness.)
- Confusion that came on over hours or a day or two, or that swings up and down.
- Much sleepier than usual, or much more agitated. (Families miss the quiet, sleepy kind most.)
- New hallucinations, or they cannot manage what they did yesterday.
- A sudden flip of days and nights.
- Fever, peeing often, a cough with fever, or signs of pain (grimacing, moaning, guarding one spot).
- A new medicine or dose, or a fall in the night.
Any of these: call the doctor today. Say: This is a sudden change from their normal.
Give no sleep pills or tranquilizers meanwhile. (They can make delirium worse.)
A blow to the head, an injury, or a sudden, severe change: go to the emergency page.
Otherwise, plan a smaller, quieter day. As a card: After a bad night.
- Put off the bath and anything that can wait. Keep urgent medical visits.
- Keep the house quiet: fewer people, less noise, no big outings.
- Wake them within half an hour of the usual time. (The after-lunch nap stands in for a lie-in.)
- Get them into daylight, outdoors if you can.
- Offer drinks and snacks early and often. (Too little fluid raises the risk of delirium.)
- One nap, up to 30 minutes, after lunch. (Sleepy later? Rest without sleep: a quiet sit, soft music.)
- Walk beside them on stairs and outside. Shoes on, lights on, floors clear. (Short, broken sleep is linked to more falls.)
- Tonight, no "PM" pill or leftover sleeping pill to catch up. (They raise falls and confusion. What to try instead.)
- Then the usual evening: the 2pm plan, and bed at the usual time.
You lost sleep too? Nap 15 to 20 minutes while someone watches them, or while they rest, with the door chime on. Do not drive drowsy. (Let grogginess clear, about half an hour. Most who fell asleep driving were on short trips.)
What to do at 3am
Leave them with a calm feeling, even if the words are forgotten. (People with Alzheimer's stayed sad for over 30 minutes after a sad film they could no longer recall.)
- Check needs first: toilet, pain, thirst, too hot or cold, a bad dream.
- Say one calm line, then stop talking. It's still night. I'm right here. Let's rest till it's light.
- Keep the light low and warm: amber nightlights aimed at the floor, no overhead light, TV or phone screen. (Bright light at 3am tells the body clock it is morning.)
- Water, not food or TV. (What happens at 3am, the body comes to expect: our reasoning.)
- Not settled in about 20 minutes? Move to a dim chair with a blanket and quiet music. (Adapted from a sleep-doctor method: leave the bed when sleep won't come.)
- In the morning, log it: the time, what came before, what worked.
When they think it's morning
- A day clock readable from the pillow that says "Thursday night" in words: dementia day clocks.
- Your recorded voice by the bedroom door: a motion-sensor alert (about $20 to $40) plays it when they get up. It's still nighttime, love. Come back to bed. I'm right here. (Families report it helps; the research is very thin.)
- Hide the morning cues: clothes in the closet, blackout curtains, a cover over any mirror facing the bed. (At night, a mirror can show a stranger.)
- Want to go to work, or home? Answer the worry, not the clock. You worked so hard for us. It's night now. Rest, and I'll wake you when it's time.
Melatonin, a "PM" pill, a sleep medicine? The options, in order. On a prescribed one? Do not stop it suddenly; ask for a plan.
Snoring and side sleeping
Side sleeping can quiet snoring and some apnea. Body pillows, a bumper belt, a raised bed head: side sleeping, step by step.
Snoring, gasps or pauses, theirs or yours, still need a sleep study. Sleep apnea.
Your own sleep
- Set the house to wake you only when it matters: a bed-exit pad that chimes a pager, door chimes, stair gates. Home safety.
- Trade nights with any second adult. Ask: "Can you take Friday nights?"
- Alone, and they're up nightly? Tell the doctor about your sleep, and ask about overnight respite. (The Eldercare Locator, 1-800-677-1116, can point to programs.)
- Two duvets, and two rooms if you need them. (It says nothing about the marriage: the spouse's chapter.)
A pad, watch, or ring sold to track sleep is a separate page: what they can keep on, and what only records.