Home

Why is my loved one with dementia sleeping a lot?

What can cause excessive sleep for someone with dementia?

If a family member lives with dementia, you may notice they sleep a lot more than they used to, or more than you think would be considered healthy. There are many reasons this might occur, so here, we are helping you understand why people with dementia might experience excessive sleep, the most common causes, the behavioural and environmental factors that could influence their fatigue, and the potential risks involved. We will also indicate when you should seek medical advice for this, and how home carers can help to support people with dementia. 

At Home Instead, our aim is to help people age positively and in place by bringing expert care to their home. For nearly 20 years, we have been providing the highest standard of care, and creating industry-leading training programmes for our Care Professionals that are accredited by nursing and medical professionals. Today, we are the world’s largest global domiciliary care network, supporting over 100,000 older adults with personalised, tailored care at home. So whatever questions you have about your loved one’s dementia symptoms and sleep habits, we can help.

Why might a person with dementia sleep excessively?

There are several reasons why a person with dementia might be sleeping a lot, but mostly, this happens when the condition disrupts the brain’s circadian rhythms which regulate sleep cycles. This means it is more difficult for people with dementia to establish day or night, leading to them potentially waking at night when they should be sleeping, and sleeping during the day when they should be active. 

Notably, fatigue should be expected in older people and people with dementia, but too much sleep could look like:

  • Taking long naps during the day
  • Having trouble staying awake, particularly during conversations or stimulating tasks 
  • Sleeping for most of the day
  • Finding simple, everyday tasks exhausting 

It is not fully known why dementia affects sleep, but there is a strong connection between the two that could even indicate that inadequate sleep is linked to possible dementia later in life; research suggests that adequate sleep helps to clear a protein called beta-amyloid from the brain which is associated with dementia, and a lack of sleep could allow this to build up over time.

What are the most common causes of excessive sleep in dementia? 

If someone with dementia is experiencing excessive daytime sleepiness and needs to take many naps during the day, there could be several reasons for this. The most common include: 

Overnight Sleep Disturbances 

Dementia can cause a person to struggle with sleep at night, either as an isolated issue, or due to other symptoms like depression or pain. For example, people with Lewy Body dementia tend to experience nightmares or restless leg syndrome as a result of their condition, which could interrupt sleep. 

When this happens, the person may intentionally or involuntarily begin sleeping more during the day to compensate for their lack of nighttime sleep. 

Cognitive Changes 

As dementia progresses, cognitive changes occur that can cause disruption to the brain and its functions, such as its internal body clock. This helps to regulate the body’s circadian rhythms so the person knows when they should feel alert (daytime) and when they should feel sleepy (nighttime). According to the Sleep Foundation, the suprachiasmatic nucleus (SCN) is the region of the brain that operates this body clock and responds to external cues, like when the sun goes down or when they get into bed and turn the lights out. People with Alzheimer’s disease are known to have damaged SCN cells. 

In addition, regulated circadian rhythms are important to clear out brain interstitial fluid tau, which is linked to dementia. A 2019 study found that the sleep-wake cycle helps to regulate this, but brain interstitial fluid tau increases when the person is awake.

In either case, the result is that those with dementia might feel more tired and mentally fatigued during the day, and choose to sleep a lot during this time period, but feel more awake and restless at night. This can cause disrupted sleep overall, and is usually the cause of a phenomenon called “sundowning”, where people with dementia may become more irritated, anxious or erratic as night falls. 

You can learn more about this in our article: What is “Sundowning” In Dementia?

Medications Side Effects 

Many people with dementia will be prescribed some sort of medication (or multiple) by their doctor to help manage some of the associated symptoms of the condition. Medications such as sedatives, antipsychotics, antidepressants, and certain pain medications can all affect the brain, and while difficulty sleeping can be a common side effect of many dementia-related medications (such as donepezil, rivastigmine or galantamine), fatigue, tiredness or excessive sleep can also occur. This may be intensified when multiple medications are taken together. 

Stage and Type of Dementia

It is widely known that excessive sleeping occurs most often in the later stages of dementia, but this is also more common in specific types of dementia due to the different ways the brain can be impacted. For example: 

  • Lewy Body dementia might cause fluctuations in alertness. According to the Lewy Body Dementia Association, daytime sleepiness is often a symptom of the condition, and researchers find this to be the case regardless of the stage of dementia.
  • Vascular dementia might affect energy levels and require more rest. A 2010 study of UK males (the study did not include females) acknowledged that intense sleepiness during the day could be a predictor of vascular dementia. 
  • Frontotemporal dementia might change the person’s behaviours and lead to excessive sleep. A 2019 study found that excessive daytime sleepiness was significantly more frequent in those with frontotemporal dementia.

You can learn more in our articles: The Different Types Of Dementia and Managing The Stages Of Dementia

Other Medical Conditions 

More than 1 in 4 adultsin England live with two or more long-term health conditions, and this multimorbidity is more common in older people. As a result, they may be suffering with more symptoms, and taking more medications to address them. Conditions like neurological disorders, mental health issues, and of course, nighttime sleep issues, could all cause excessive daytime sleepiness in older people with dementia, as could their associated medications.

According to the NHS, some medical conditions that could cause excessive daytime sleepiness include:

  • Narcolepsy
  • Sleep apnea
  • Restless Leg Syndrome
  • Depression 
  • Bipolar Disorder
  • Myalgic Encephalomyelitis or Chronic Fatigue Syndrome (ME/CFS)

What behavioural or environmental factors could influence more regular sleep patterns?

While it is not always possible to change excessive sleep, people with dementia can start by shaping healthy sleep patterns for themselves by making some behavioural and environmental changes. With help from their loved ones and caregivers, people with dementia may find it helpful to:

  • Create more daytime stimulation and physical activity to encourage fatigue and tiredness by the end of the day 
  • Get regular social interaction and take part in mentally stimulating activities to stay engaged during the day
  • Avoid daytime naps if possible, as they can disrupt nighttime sleep schedules
  • Minimise confusion, anxiety, or pain to address frequent waking and encourage a better sleep at night 
  • Improve lighting to better signify day and night, such as dimming the lights in the evening before bed
  • Avoid anything that causes excessive noise or interruptions before bed, as this can be stimulating and disturb sleep
  • Go outside during the day to increase light exposure and regulate circadian rhythms 
  • Create a more comfortable sleeping experience with things like softer bedding or a cooler room temperature
  • Go to sleep in familiar surroundings for a more restful night

Are there any risks associated with too much sleep? 

Too much sleep can be an indicator of an underlying health issue, or in someone with dementia, it could signal further cognitive decline. It is even thought to be a potential indicator of cognitive decline in someone who does not have a dementia diagnosis – a 2016 study found that excessive daytime sleepiness in those without dementia often displayed increased rates of cortical thinning. 

“Unusual sleep patterns are common for people with dementia, but research suggests that sleep changes could be apparent long before any symptoms like memory loss start to show.” 

– Dr Susan Mitchell, Head of Policy from Alzheimer’s Research UK

If a person with dementia does not seem to be uncomfortable or distressed by their increase in sleep, then a little more rest during the day is usually not a problem. However, excessive daytime sleep could lead to:

  • Disorientation upon waking
  • Periods of inactivity which can weaken muscles and affect balance
  • An increased risk of falls 
  • Social isolation due to sleeping throughout the day, which can lead to loneliness 
  • Feelings of sadness from reduced daylight exposure, social interaction, and enjoyable activities 
  • Stiffness and poor circulation as a result of not walking around as regularly 
  • Bed sores from prolonged time lying in the same spot

When should you seek professional advice for a loved one’s excessive sleep? 

Excessive sleep can be brought up at a regular dementia check-up appointment, but if the person is sleeping to the point of concern, it is important to speak to a professional as soon as possible to get their advice on what the underlying issue could be. It may be that they determine the person’s dementia has progressed further and they should sleep as much as they feel they need to, or a doctor may be able to identify a fixable issue. For example, adjusting any medications causing this side effect. If someone is spending a lot of time in bed asleep, they may also need to be evaluated for other issues like bed sores or muscle deterioration. 

Speak to the person’s GP as early as possible if your loved one is showing any sudden, unusual or significant increases in their fatigue, particularly if this is accompanied by other signs of illness, such as pain or an infection. Noting any behavioural changes could also help their doctor determine the reason, as things like increased confusion, withdrawal, or agitation could be signs of more advanced dementia.

What resources are available for older adults with dementia?

Managing a loved one’s excessive sleeping alongside other dementia symptoms can feel worrying and overwhelming, so if you have any further questions about the issue, the following organisations may have advice to help:  

How can home care support older people with dementia who sleep excessively? 

Home care can be a help and a comfort to a person living with dementia who struggles with many of the common symptoms, like memory loss or communication issues. Caregivers can also support families who are looking after a loved one with dementia, particularly if excessive sleep is becoming a concern for their wellbeing.  

Home care can help by:

  • Promoting more of a routine for sleep habits
  • Taking over housekeeping and other tasks that become more challenging with extreme fatigue 
  • Encouraging more daytime activity to promote tiredness at night, such as regular movement
  • Encouraging social activity to keep them engaged during daylight hours
  • Getting them exposure to natural light to help regulate their circadian rhythms
  • Maintaining a consistent daily routine for things like mealtimes and other activities, to help create a healthier bedtime habit 
  • Reducing long daytime naps where possible 
  • Creating a calm, comfortable bedroom environment to support rest
  • Assisting with evening routines
  • Providing night time dementia care in case they need help or reassurance at night 
  • Monitor medications, watch for potential side effects, and communicate concerns to family or doctors

At Home Instead, our Care Professionals can provide person-centred, specialist dementia care using a programme that is City & Guilds Assured, and are trained to create a care routine that focuses on their needs and addresses their most pressing symptoms to improve their quality of life. We always take the time to match clients with a caregiver who will complement their personality and interests, who has experience with dementia, and who can respect their vision for home care.   

We’re an award-winning home care provider and part of a worldwide organisation devoted to providing the highest-quality relationship-led care for older people in their own homes. Arranging care for yourself or your loved one shouldn’t be stressful, so whatever questions you would like answered, feel free to reach out to the Home Instead team to discuss your needs.