10: Sleep: Managing Hallucinations, Illusions, Delusions, Nightmares, Sundowning, Anxiety and Depression

This program will:

  • Discuss how these issues can affect sleep
  • Present some strategies for managing them
  • There are no easy answer when its comes to the care of another
  • Our hope is to offer you useful information and guidelines for caring 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
  • HALLUCINATIONS: false sensory perceptions of objects or events
  • ILLUSIONS: misinterpretations or incorrect perceptions
  • DELUSIONS: firmly held incorrect or inaccurate beliefs

How did Mary try to calm and reassure Robert?

  • A. Mary offered to look around the room to see if anyone was there.
  • B. Mary used a calm voice and reassuring touch.
  • C. Mary tried to distract Robert from the topic of his misperception.
  • D. Mary did not try to convince Robert that what he saw was not real.
  • E. All of the above.

Choice E: All of the above, is the best answer. Choice A: Mary offered to look around the room to see if anyone was there, is a good choice.

  • Acknowledge the person’s concern and provide reassurance

Choice B: Mary used a calm voice and reassuring touch, is also a good answer.

  • Stay calm and show empathy
  • Avoid pointing out errors, arguing, scolding, or embarrassing the person
  • Be careful about touching someone

Choice C: Mary tried to distract Robert from the topic of his misperception, is another good answer.

  • Use distraction to redirect the person’s attention onto something pleasant

Choice D: Mary did not try to convince Robert that what he saw was not real, is a good answer.

  • Trying to convince people that hallucinations are not real will make them more upset and make it harder to get them back to sleep
  • Do not argue or try to reason with the person
  • Ignore the hallucination, illusion, or delusion if there is no harm caused
  • Use reassuring words with a calm voice and comforting touch
  • Find a solution to reassure the person
  • Try distraction
  • Consider asking about the false perception
  • Investigate for things that may have caused the hallucination or illusion
  • Listen
  • Offer reassure
  • Remove triggers or sources of stress

Sundowning refers to a worsening of behavioral symptoms that occurs near sunset or nightfall Factors that can increase the risk of sundowning:

  • Being in a dimly lit room
  • Disturbances in the person’s biological clock
  • Fatigue at the end of the day
  • Pain
  • Over-stimulation
  • Restlessness
  • Keep regular waking and sleeping times as much as possible
  • Follow a bedtime routine
  • Limit daytime idleness with activities
  • Encourage regular exercise
  • Make afternoon and evening hours calming
  • Control the diet
  • Address any stressful environmental factors
  • Provide good lighting
  • Check for and treat pain
  • Consult a healthcare professional

Anxiety is a state of worry, nervousness, uncertainty, or fear resulting from the anticipation of an event or situation that is real or imaginary Anxiety may appear in the following ways:

  • Fear
  • Excessive worry or nervousness
  • Restlessness
  • Heart palpitations
  • Sleep disturbances
  • Acknowledge concerns and offer reassurance and comfort
  • Distract or redirect
  • Use relaxation techniques and spiritual activities
  • Anxiety can be a sign that activities are becoming difficult
  • Simplify activities and instructions
  • Be flexible and adaptive
  • Seek support groups
  • Consider a combination of drug and non-drug therapies

Depression is an illness that involves the body, mood and thoughts, and affects the way a person acts, feels about oneself, and thinks about things Common symptoms of depression:

  • Poor sleep patterns
  • Loss of energy, initiative and interest
  • Increased confusion or forgetfulness
  • Change in appetite
  • Feelings of hopelessness, sadness and guilt
  • Crying spells, irritability and moodiness
  • Increase in pain symptoms, shortness of breath, or stomach problems
  • Talk to a healthcare professional
  • Involve a therapist or counselor
  • Join a support group
  • Sunlight and bright light therapy
  • Hallucinations, delusions, illusions, sundowning, anxiety, and depression can disrupt sleep


  • Offer reassurance, empathy and comfort
  • Use distraction
  • Find out its meaning or cause
  • Remove any environmental triggers


  • Keep regular schedules and routines
  • Provide activities and encourage regular exercise
  • Make afternoon and evening hours calming
  • Treat pain
  • Control the diet
  • Address any stressful environmental factors


  • Offer reassurance, empathy and comfort
  • Redirect
  • Simplify activities and instructions
  • Relaxation techniques and spirituality
  • Exercise, sunlight and bright light therapy
  • Support group, therapist, or counselor
  • Consult a healthcare professional if non-drug therapies are not successful

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

Edited by:
Sasha Asdourian


09: Sleep: Managing Nighttime Awakenings & Wandering

Select the best answers from the list of choices following each question.

Click here to open Certificate of Completion
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