Insomnia is common among elderly adults. Of adults aged 65 and older, 42 percent report difficulty with falling asleep and staying asleep. Chronic insomnia can lead to impaired cognition, confusion, increased risk for injury, and other impairments for elderly adults. Nursing home residents with untreated insomnia are at a greater risk of falls and fractures.

Adults with dementia or Alzheimer’s are particularly at risk of developing sleep problems. The neuronal degeneration of Alzheimer’s damages parts of the brain that regulate sleep patterns. Often, dementia patients have sleep-wake rhythm disturbances, in which they wake up during the night and fall asleep during the day. Dementia patients may suffer from circadian rhythm decline due to difficulty understanding environmental cues. They may feel disoriented and unable to separate dreams from reality or have difficulty seeing, especially at night.

Developing a Bedtime Routine
Bedtime routines can be helpful in improving sleep latency and quality, making it easier for dementia patients to transition into bedtime each night. With a bedtime routine, going to sleep becomes more soothing and predictable. Although dementia patients may not pick up on all environmental cues, a bedtime routine can reinforce healthy sleep habits and a regular sleep schedule.

• Encourage daytime exercise. Although a bedtime routine typically starts just before bed, they are not entirely effective in preventing sleep disturbances. Set the stage for healthy sleep by encouraging activity throughout the day. Walk whenever possible, run errands, and schedule mentally stimulating activities such as reading, talking, or sitting in common areas.

• Avoid common sleep pitfalls. Another major element of a healthy bedtime routine is knowing what not to do. Dementia patients should avoid afternoon naps, as they may be too well rested to go to sleep later in the evening. Caffeine, alcohol, and heavy meals should be avoided before bed. Although exercise is helpful in the daytime, it should be avoided late at night. And screen time, including loud TVs, should be stopped at least an hour before bed, as it’s too stimulating to support healthy rest.

• Be consistent. Bedtime routine activity choices are not as important as simply going through the routine each night. Going through the same few steps each night before bed reinforces the cues that it’s bedtime and therefore time to slow down, relax, and sleep.

• Choose calming activities. Reading aloud, listening to music, or taking a warm bath can be reassuring and calming for dementia patients just before bed.

• Maintain a healthy sleep environment. A dementia patient’s bedroom should be kept cool, dark, and quiet. Make sure they’re sleeping in a comfortable bed that meets their needs for firmness and support. Consider using nightlights for visibility, and keep doors and windows locked at night.