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

www.LightBridgeHealthcare.com

Click here to open Certificate of Completion

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