09: Sleep: Managing Nighttime Awakenings & Wandering

This program will:

  • Discuss reasons for nighttime awakenings
  • Present strategies for managing nighttime awakenings
  • Provide strategies for preventing and managing wandering
  • Strategies for improving home safety for wandering
  • There are no easy answer when its comes to the care of another
  • Our hope is to offer you useful information and guidelines for careing for someone with dementia
  • These guidelines will need to be adjusted to suit your own individual needs

Sleep issues associated with Alzheimer’s Disease

  • Spend more time awake at night and sleeping during the day
  • Wake up during the night to wander
  • Wake up confused, disoriented, frightened, or feeling alone
  • Delusions and hallucinations disrupt sleep patterns

Why was Robert unable to get to the bathroom?

  • A. He forgot where the bathroom was.
  • B. He got hungry and wanted to go to the store to buy some food.
  • C. He couldn’t remember why he got up.
  • D. He wasn’t sleepy and got bored.
  • E. He was distracted by the shoes.

Choice A: He forgot where the bathroom was, is a good answer.

  • Leave a clear, well-lit path from the bed to the toilet
  • Practice walking the path with the person before going to bed
  • Put up bathroom signs with arrows that point the way

Choice B: He got hungry and wanted to go to the store to buy some food, is a possibility.

  • Try giving the person a light snack sleep-promoting food before bedtime

Choice C: He couldn’t remember why he got up, is a possibility.

  • Reorient the person to the time of day
  • Check for toileting needs, discomfort, and pain
  • Post bathroom signs with arrows that point the way

Choice D: He wasn’t sleepy and got bored, is a possibility.

  • If someone won’t go back to sleep, try redirecting
  • Allow the person to wander in a dedicated, safe area

Choice E:

  • He hurt himself when he bumped into the furniture and got distracted , is a good answer.
  • Create a safe environment by removing clutter
  • Keep hallways and pathways as clear as possible
  • Provide enough light to prevent injuries

Mary’s Approach to Managing Robert’s Wandering

  • Changes in the environment
  • Sets out favorite comfort items
  • Installs nightlights to light the path
  • Moves bed away from windows
  • Removes unnecessary furniture
  • Dedicates the bedroom for sleeping and napping
      • Assess for confusion or discomfort
      • Use a calm tone of voice and body language to orient and reassure
      • Address any need or source of discomfort
      • If the person becomes combative, remain calm
      • Do not argue or try to reason with the person
      • Offer reassurance
      • If the person is frightened, offer to look around
      • Once the person has relaxed, approach the topic of going back to bed
      • Consult a physician if sleep patterns do not improve

Managing nighttime incontinence and toileting

        • Plan scheduled trips to the bathroom during the day
        • Reduce the intake of liquids just before bed
        • Use the bathroom before going to bed
        • Practice walking to the bathroom
        • Well-lit and unobstructed path to the bathroom
        • Nightlight in the bathroom
        • Label the bathroom door
        • Consider a bedside urinal or commode
        • Provide clothing that is easy to take off
        • Never leave someone in wet or soiled
        • clothing or diaper

Increasing Nighttime Home Safety

          • Keep areas free of clutter
          • Provide enough light
          • Make sure the path to the toilet is clear
          • Install hand railings and remove area rugs
          • Dedicate a space safe for wandering
          • Lock away hazardous chemicals
          • Use door locks, latches, bolts, and covers
          • Install window locks
          • Use door alarms, motion sensors, or bells
          • Do not leave shoes, keys, briefcases, or umbrellas by the door
          • Post door signs
          • Try to determine the reason for wandering
          • Make frequent checks for unmet needs before wandering starts
          • Identify sources of stress that may be triggers
          • Change daily routines that may be triggering the wandering
          • Consult a physician about medications
  • Dedicate safe areas free of clutter and other hazards
  • Provide a rummage drawer or chest
  • Comfortable, secure shoes
  • Watch closely and use cues
  • Have security measures in place on all exits
  • Provide medical bracelet or necklace
  • Make sure important information and numbers are always on the person
  • Consider placing a locator on the person
  • GPS (Global Positioning System) locator
  • RFID (Radio Frequency Identification) locator
  • Cellular locator
  • Consider a wanderer alert system
  • Consider enrolling person in the Safe Return® Program

Click here to learn about the Safe Return® program

  • Dementia can cause nighttime awakenings
  • Strategies for managing nighttime awakenings
  • Orient and reassure
  • Do not argue
  • Address any reasons
  • Prevent possible triggers
  • Distract or redirect
  • Consult a physician

Strategies for managing wandering

  • Address possible reasons and sources of stress
  • Change routines that may be triggering wandering
  • Dedicate safe areas for wandering
  • Home safety modifications
  • Remove hazards
  • Doorknob covers, locks, and door alarms
  • Medical bracelet/necklace
  • Wanderer alert system
  • Locator system
  • Alzheimer’s Safe Return ® program

Written by:
Catherine M. Harris, PhD, RNCS.
Mindy J. Kim-Miller, MD, PhD

Edited by:
Sasha Asdourian


08: Sleep: Promoting Healthy Sleep Patterns

Select the best answers from the list of choices following each question.
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Click here to open Certificate of Completion

  • Aggarwal, N., et al., People with dementia and their relatives: personal experiences of Alzheimer’s and of the provision of care. Journal of Psychiatric andMental Health Nursing, 2003. 10: p. 187-197.
  • Allen, R., Should we aggressively evaluate and treat sleepiness in the elderly? Sleep Medicine, 2003. 4: p. 477-478.
  • Asada, T., et al., Associations between retrospectively recalled napping behavior and later development of Alzheimer’s disa. Sleep, 2000. 23(5): p. 1-6.
  • Coste Koenig, J., Learning to speak Alzheimer’s: a groundbreaking approach for everyone dealing with the disease. 2003, Boston, New York: HoughtonMifflin Company. 240.
  • Ellgring, J., Depression, psychosis, and dementia: Impact on the family. Neurology, 1999. 52(7): p. S17-S20.
  • Farlow, M., Pharmacokinetic profiles of current therapies for Alzheimer’s disease: Implications for Switching to Galantamine. Clinical Therapeutics, 2001.23(Suppl A): p. A13-A24.
  • Fatigue: When to rest, when to worry. (2006 August 16). Mayoclinic.Com. Retrieved on March 30, 2008 from
  • Ficca, G. and P. Salzarulo, What in sleep is for memory? Sleep Medicine, 2004. 5: p. 225-230.
  • Gais, S. and J. Born, Low acetylcholine during slow-wave sleep is critical for declarative memory consolidation. PNAS, 2004. 101(7): p. 2140-2144.
  • Gordon, A., Insight into auditory hallucinations and psychosis. International Journal of Geriatric Psychiatry, 1997. 12: p. 410-411.
  • Gruetzner, H., Alzheimer’s: A Caregiver’s Guide and Sourcebook. Vol. Updated and Revised. 1992, New York, Chichester, Brisbane, Toronto, Singapore:John Wiley and Sons, Inc. 308.
  • Hallucinations. 2004, Alzheimer’s Association. Retrieved on March 30, 2009 from http://www.alz.org/national/documents/topicsheet_hallucinations.pdf.
  • Harding, A., G. Broe, and G. Halliday, Visual hallucinations in lewy body disease relate to lewy bodies in the temporal lobe. Brain, 2002. 125: p. 391-403.
  • Haythornthwaite, J., M. Hegel, and R. Kerns, Development of a sleep diary for chronic pain patients. Journal of Pain and Symptom Management, 1991. 6(2):p. 65-72.
  • Hyyppa, M. and E. Kronholm, Quality of sleep and chronic illnesses. Journal of Clinical Epidemiology, 1989. 42(7): p. 633-638.
  • Lamberg, L., Illness, not age itself, most often the trigger of sleep problems in older adults. JAMA, 2003. 290(3): p. 319-323.
  • Lewis, S., Stress Relief for Caregivers. 2003, University of Texas Health Science Center at San Antonio.
  • Luboshitzky, R., et al., Actigraphic sleep-wake patterns and urinary 6-sulfatoxymelatonin excertion in patients with Alzheimer’s disease. ChronobiologyInternational, 2001. 18(3): p. 513-524.
  • Luxenberg, J., Clinical Issues in the Behavioural and Psychological Symptoms of Dementia. International Journal of Geriatric Psychiatry, 2000. 15: p. S5-S8.
  • Martin, J., et al., Circadian rhythms of agitation in institutionalized patients with alzheimer’s disease. Chronobiology International, 2000. 17(3): p. 405-418.
  • Mayo, W., et al., Individual differences in cognitive aging: implication of pregnenolone sulfate. Progress in Neurobiology, 2003. 71: p. 43-48.
  • McCurry, S., et al., Training Caregivers to Change the Sleep Hygiene Practices of Patients with Dementia: The NITE-AD Project. JAGS, 2003. 51(10): p.1455-1460.
  • McCurry, S., et al., Treatment of sleep and nighttime disturbances in Alzheimer’s disease: a behavior management approach. Sleep Medicine, 2004. 5: p.373-377.
  • Menefee, L., et al., Self-reported sleep quality and quality of life for individuals with chronic pain conditions. Clinical Journal of Pain, 2000. 16(4): p. 290-297.
  • Mittelman, M.S., C. Epstein, and A. Pierzchala, Counseling the Alzheimer’s Caregiver: A Resource for Health Care Professionals. 2003: American Medical Association – AMA Press. 346.
  • Morin, C., D. Gibson, and J. Wade, Self-Reported Sleep and Mood Disturbances in Chronic Pain Patients. Clinical Journal of Pain, 1998. 14(4): p. 311-314.
  • Murgatroyd, C. and R. Prettyman, An Investigation of visual hallucinosis and visual sensory status in dementia. International Journal of Geriatric Psychiatry,2001. 16: p. 709-713.
  • Neubauer DN. Sleep problems in the elderly. Amer Acad Family Phys. 1999. 59(9): 2551.
  • Philips, B. and S. Ancoli-Israel, Sleep disorders in the elderly. Sleep Medicine, 2001. 2: p. 99-114.
  • Rabow, M.W., J.M. Hauser, and J. Adams, Supporting family caregivers at the end of life. JAMA, 2004. 294(4): p. 483-491.
  • Roth, T., J. Costa e Silva, and M. Chase, Sleep and cognitive (memory) function: research and clinical prespectives. Sleep Medicine, 2001. 2: p. 379-387.
  • Roth, T., et al., The Art of Good Sleep. Sleep Medicine, 2004. 5(Suppl 1): p. S1.
  • Sleep and seniors: Insomnia isn’t inevitable. 2004 July 6, Mayo Clinic Staff.
  • Sleep Changes in Alzheimer’s Disease Fact Sheet. 2004, Alzheimer’s Association. p. 1-3.
  • Sleep: Your body’s means of rejuvenation. 2004, Mayo Clinic.
  • Soeda, S., et al., Aging and visual halluncinations in elderly psychiartic outpatients. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 2004.28: p. 401-404.
  • Strine, T. and D. Chapman, Associations of frequent sleep insufficiency with health-related quality of life and health behaviors. Sleep Medicine, 2005. 6: p.23-27.
  • Stroke, O.O.C.A.P.L.N.I.O.N.D.A., Brain Basics: Understanding Sleep. October 8, 2004, National Institutes of Health: Bethesda, MD.
  • Tappen, R.M., Interventions for Alzheimer’s Disease: A Caregiver’s Complete Reference. 1997, Baltimore: Health Professions Press, Inc. 239.
  • Tariot, P., Medical management of advanced dementia. JAGS, 2003. 51(5, Supplement): p. S305-S313.
  • Teri, L., R. Logsdon, and S. McCurry, Nonpharmacologic treatment of behavioral disturbances in dementia. Med Clin N AM, 2002. 86: p. 641-656.
  • Tractenberg, R., et al., The sleep disorders inventory: an instrument for studies of sleep disturbances in persons with Alzheimer’s disease. Journal of Sleep Research, 2003. 12: p. 331-337.
  • Tsuno, N., et al., Fluctuations of source locations of eeg activity during transition from alertness to sleep in Alzheimer’s disease and vascular dementia.Neuropsychobiology, 2004. 50: p. 267-272.
  • Van Someren, E., Circadian rhythms and sleep in human aging. Chronobiology International, 2000. 17(3): p. 233-243.
  • Vgontzas, A. and A. Kales, Sleep and its disorders. Annu Rev Med, 1999. 50: p. 387-400.
  • Volicer, L., et al., Sundowning and circadian rhythms in Alzheimer’s disease. Am J Psychiatry, 2001. 158(5): p. 704-711.
  • Yehuda, S., S. Rabinovitz, and D. Mostofsky, Essential fatty acids and sleep: mini-review and hypothesis. Medical Hypotheses, 1998. 50: p. 139-145.