Tips for Getting the Patient Ready for Bed
Remind the person to use the bathroom before bedtime
Encourage people with dementia to empty their bladders as close to their bedtime as possible. Toileting should be standard procedure at bedtime as well as first thing in the morning and after meals. Because people with Alzheimer's may forget to use the bathroom, keep in mind that you may need to remind them by encouraging them and asking them if they have to go.
Try soft music to reduce anxiety and promote relaxation at bedtime
In addition to playing mellow musical favorites, you could try relaxing your loved one with a back rub or even a warm bath. If the person likes watching TV in the evening, make sure the subject matter is light so as not to be frightening or upsetting. Be aware that nighttime confusion makes it increasingly difficult to distinguish between real life and fictional violence or televised news events.
Do not insist that the person wear pajamas
Following the maxim about never going to bed mad, it's even more important not to upset or anger people with dementia right before bedtime. If forcing the issue by insisting that they wear pajamas or nightgowns could start an argument or cause agitation, let them sleep in their clothes. After all, it is far more important that they get sleep, no matter what they're wearing to bed.
Let the person sleep where it's most comfortable
Sometimes people with Alzheimer's disease will not sleep in their beds, but will readily fall asleep in a favorite chair or on a couch. If necessary, allow them to sleep there, as it's better than having them not sleep at all. Moreover, consider how waking someone with dementia at night just to get into bed is likely to confuse and agitate the person. However, be sure to wake them for toileting or changing as necessary.
Tips for Preparing the Patient's Bedroom for Sleep
Eliminate or reduce any noise that might disrupt sleep
Be sensitive to environmental conditions that could make it difficult for the person to fall asleep or stay asleep. Limit noise that might disturb the person with dementia. For example, you might want to disconnect the ringer on the bedroom telephone at night.
Leave a light on in the bedroom to help orient the person upon awakening
Place a nightlight in the bedroom so that people confused by dementia can more readily identify their surroundings if they wake up in the middle of the night. Keeping the bedroom partially lit will reduce agitation that occurs when surroundings are dark and unfamiliar, and help diminish the chance of confused patients misinterpreting what they see as hallucinations in a darkened room. Moreover, this will lessen the chance of a fall on the way to the bathroom.
Leave the bathroom light on and maintain a clear, visible pathway
Make sure the bathroom is easily accessible. Clear the pathway of any obstacles, such as furniture, walkers, shoes, throw rugs. Light the pathway as well as the bathroom. To help locate the bathroom, consider using reflective tape on the floor leading to it and around the bathroom door or painting the door a bright color. To help identify it in the early stages of the disease, consider hanging a large sign on the door with a picture of a toilet or block letters saying "BATHROOM." Avoid having items nearby that could be mistaken for a toilet, such as a trashcan.
Place a commode beside the bed if the person often wakes up to urinate
Older people may awaken many times at night to urinate and find themselves unable to get back to sleep. Placing a portable commode or urinal bottle by the bed is less dangerous and sometimes less upsetting than a nighttime walk to the bathroom. With less emotional upset, the person with dementia may fall back asleep more easily. As Alzheimer's disease erodes short-term memory, be sure to point out the commode, urinal or bedpan to the person every night as many times as necessary. Avoid having items nearby that could be mistaken for a commode, such as a wastebasket.
Be sure the room and the bed are comfortable
Make sure the climate in the bedroom is neither too cool nor too warm. Also make sure that the mattress and the bedding are comfortable. For example, quilts are less likely to tangle than blankets and sheets.
Draw shades to limit shadows in the room
Make sure to limit shadows or other environmental distractions that could be misinterpreted and frighten the person. Be sensitive to how "sundowning" can cause confused patients to misinterpret what they see and hallucinate at night.
Tips for Managing Sleep Interruptions
Assume that the person with dementia is disoriented upon awakening
Everyone has experienced the jarring sensation of awakening and momentarily not knowing where you are or what time it is. People with Alzheimer's are often that much more disoriented when they awake, especially at night, and thus need to be reoriented and reassured after sleep is disrupted. Keep this tip in mind when they doze off on a couch or in a chair: consider how disoriented or agitated they might become when they are awakened at night.
Remind the person that it's time for sleeping
Upon awakening in the middle of the night, some confused persons forget that they were even sleeping. Try gently reminding them to turn over and go back to sleep.
Once the person is awake and upset, experts suggest that caregivers:
- Approach the person in a calm manner.
- Find out if there is something the person needs.
- Gently remind the person that it's nighttime.
- Avoid arguing or asking for explanations.
- Offer reassurance that everything is all right and everyone is safe.
- Try soothing music if needed to allay anxiety and restlessness.
- Speak softly and quietly, using a relaxed tone of tone.
- Never betray your own exasperation over being awakened.
Make sure that incontinent patients are comfortable
If incontinence is a problem, check to see whether the person needs help toileting or changing. Never let the person remain in wet or soiled diapers. Change the person's diapers as many times as necessary. Get the person up once at night if toileting is necessary. If there is a problem with confused Alzheimer's patients trying to remove diapers at night, consider getting them in a one-piece outfit for sleeping or cutting the legs off a pair of pantyhose and place the panty portion over the diaper. Click here to see our caregiving tips on Incontinence and Toileting.
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