Editor’s Note: This article was originally published in 2023 and has been completely updated in September 2026 to provide clearer, more practical guidance for dementia caregivers.

When someone with dementia sleeps all day, stays awake at night, or gets up over and over, the whole household feels it.

You may spend the night listening for footsteps, guiding your loved one back to bed, or trying to keep them safe. Then morning comes, and caregiving begins again—even though you barely slept.

Sleep problems are common in dementia, but that does not mean you should ignore them or assume nothing can help. A restless night may be connected to changes in the brain, but it may also be a clue that something else is wrong.

The first question is not only, “How can I get them to sleep?”

It is also, “Why are they having trouble sleeping?”

How Dementia Can Change Sleep

Our bodies have an internal clock that helps us know when to be awake and when to sleep. This is called the sleep-wake cycle, or circadian rhythm.

Dementia can damage the parts of the brain that help control this clock. The brain may have more trouble using light, darkness, routines, and other signals to tell day from night.

A person with dementia may:

• Have trouble falling asleep
• Wake several times during the night
• Stay awake for long periods
• Call out or become restless at night
• Wander or believe it is time to start the day
• Sleep for long periods during the day
• Become more confused as evening approaches
• Reverse their sleep schedule and stay awake at night

Normal aging can also change sleep. Older adults may fall asleep earlier, wake earlier, or sleep more lightly. Dementia can make these changes more frequent and much harder to manage.

Watch: Why Is My Loved One Up at Night?

When your loved one with dementia sleeps during the day but stays awake at night, the entire household feels it.

In this video, I explain how dementia can change the sleep-wake cycle, possible reasons for nighttime restlessness, and practical steps caregivers can try.

We will also use the Dementia Detective process to look for the reason behind difficult nights:

NOTICE → LOOK → ASK → TRACK → CONNECT

You will learn what clues to watch for, what details to track, how to make nighttime safer, and when a sudden sleep change should be reported to the healthcare provider.

A restless night does not mean you failed. It means something made sleep difficult—and you are looking for the reason.

Why Is My Loved One With Dementia Awake at Night?

Changes in the brain are only one possible cause. Before blaming dementia, look for physical, emotional, medication-related, and environmental clues.

Pain or discomfort

Arthritis, an injury, constipation, reflux, an uncomfortable mattress, tight clothing, or another source of pain may make it difficult to rest. A person with dementia may not be able to explain what hurts. Pacing, moaning, guarding part of the body, grimacing, or repeatedly getting out of bed may be their way of showing discomfort.

Learn more about how pain may appear in dementia.

The need to use the bathroom

The person may need to urinate, feel constipated, have an accident, or be unable to find the bathroom. Urinary urgency, an enlarged prostate, diabetes, some medications, and other health problems can also cause frequent nighttime trips.

Hunger or thirst

Someone who did not eat or drink enough during the day may wake because they are hungry or thirsty. Dehydration can also increase weakness and confusion.

Learn why dehydration can look like a dementia change.

Illness or another health change

A urinary tract infection, breathing problem, fever, depression, restless legs syndrome, or sleep apnea may interfere with sleep. A sudden change in sleep or nighttime behavior deserves special attention because it may be the first sign of a new health problem.

Medication effects

Some medicines can make a person sleepy during the day, restless at night, or more confused. The time a medicine is given can matter too. Ask the doctor or pharmacist to review all prescription medicines, over-the-counter products, vitamins, and supplements.

Do not stop or change a medicine without guidance from the prescribing healthcare provider.

Too much daytime sleep

A person who sleeps for long periods during the day may not feel tired at bedtime. However, suddenly sleeping much more than usual can also be a clue to illness, medication side effects, depression, or a change in their condition.

The environment

Noise, shadows, glare, a television left on, an uncomfortable temperature, or an unfamiliar room can make it harder to settle. Complete darkness may also feel frightening if the person wakes and does not recognize where they are.

A change in routine

Travel, visitors, a hospital stay, a new caregiver, a move, or even a different evening routine can disrupt sleep. A tired brain often depends on familiar patterns to know what is happening next.

Is It a Sleep Problem or Sundowning?

Sleep problems and sundowning can overlap, but they are not exactly the same.

Sundowning describes increased confusion, worry, pacing, restlessness, agitation, or other behavior changes that tend to happen in the late afternoon or evening. These changes may continue into the night and make sleep more difficult.

Not every person with dementia experiences sundowning, and not every nighttime sleep problem is sundowning.

If difficult behaviors appear around the same time each day, write down what happens before, during, and after them. The pattern may point to fatigue, hunger, pain, shadows, noise, a busy environment, or another trigger.

Learn more about preventing and managing dementia sundowning.

Become a Dementia Detective: Look for the Reason Behind the Restless Night

Instead of treating each difficult night as a separate problem, pause and look for clues. Use the Dementia Detective process:

NOTICE → LOOK → ASK → TRACK → CONNECT

Notice what is happening, look for possible causes, ask what your loved one may need, track the details, and connect the clues to find patterns.

The behavior is the clue. The pattern may help you uncover the reason behind the restless night.

Learn how to become a Dementia Detective →

NOTICE what is happening

Pay attention to the details:

• What time does the restlessness begin?
• Is the person unable to fall asleep, or do they wake later?
• Are they pacing, calling out, frightened, or trying to leave?
• Are they sleeping for long periods during the day?
• Is this a new change or a familiar pattern?

LOOK for possible causes

Check for pain, hunger, thirst, constipation, the need to urinate, wet clothing, breathing trouble, fever, medication changes, noise, shadows, or a room that is too hot or cold.

Think about what happened during the day. Was there enough activity and daylight? Was the day unusually busy? Did they nap late? Did they have caffeine? Did the normal routine change?

ASK simple questions

Someone with dementia may have trouble answering a broad question such as, “What is wrong?” Try one short question at a time:

• “Are you hurting?”
• “Do you need the bathroom?”
• “Are you cold?”
• “Would you like a small snack?”
• “Do you want me to sit with you?”

Watch their face and body language as well as their words.

TRACK the pattern

Write down bedtime, wake time, naps, nighttime waking, meals, fluids, bathroom trips, activities, behavior changes, and what you tried. A few days of notes may reveal a pattern that is hard to see when you are exhausted.

CONNECT what you found

Use the pattern to make one small change at a time. Share your notes with the healthcare provider when a problem continues, becomes unsafe, or changes suddenly.

Look for the clue. Write it down. Watch for the pattern.

What Can Help Someone With Dementia Sleep Better?

There is no single sleep routine that works for everyone. Start with small changes and give them time. Changing several things at once can make it difficult to know what helped.

Start with a consistent morning

A better night often begins in the morning.

• Help the person get up at about the same time each day.
• Open the curtains and turn on lights.
• Offer morning sunlight when possible, such as sitting near a bright window or going outside.
• Encourage washing, dressing, breakfast, and other familiar morning activities.

Regular morning light and activity give the brain stronger clues that the day has started.

Encourage safe daytime activity

Gentle movement can help the person stay awake during the day and feel more ready for sleep at night. Try walking, folding towels, watering plants, setting the table, chair exercises, or another activity that matches their abilities.

Avoid pushing them to the point of exhaustion. Being overly tired may increase late-day confusion and agitation.

Be thoughtful about naps

Some people need a nap, especially as dementia progresses or after a poor night of sleep. You do not have to eliminate every nap.

If naps seem to interfere with nighttime sleep, try making them shorter and earlier in the day. Watch the person’s response. The goal is not to keep an exhausted person awake at all costs.

Offer food and fluids throughout the day

Encourage regular meals and plenty of fluids earlier in the day. If hunger seems to wake the person, offer a light bedtime snack that fits their diet and swallowing needs.

If nighttime bathroom trips are a problem, offer smaller drinks close to bedtime rather than sharply limiting fluids all evening. People with heart, kidney, swallowing, or fluid-restriction concerns should follow their healthcare provider’s instructions.

Watch caffeine and alcohol

Coffee, tea, cola, chocolate, energy drinks, and some medicines contain caffeine. Consider avoiding caffeine in the afternoon and evening.

Alcohol may make someone drowsy at first, but it can disrupt sleep later and may interact with medicines. Ask the healthcare provider what is safe.

Keep the home well lit as daylight fades

Dim rooms can create shadows and make it harder for a person with dementia to understand what they are seeing. As daylight fades:

• Turn on lights before rooms become dark.
• Close curtains or blinds to reduce glare and reflections in windows.
• Check for shadows that may look frightening.
• Reduce background noise and evening commotion.

Closer to bedtime, gradually lower the light and activity level to signal that the day is ending.

Make the bedroom comfortable

Check that the bedroom is quiet, comfortable, and not too hot or cold. Familiar bedding, photos, or another comforting item may help the room feel safe.

A soft night-light can help the person recognize the room and find the bathroom. Avoid bright overhead lighting during the night unless it is needed for safety.

What Should I Do When My Loved One Wakes During the Night?

Your response can affect how quickly the person settles.

1. Approach calmly. Use a quiet voice and slow movements.
2. Check for an immediate need. Look for pain, breathing trouble, the bathroom, wet clothing, hunger, thirst, or an uncomfortable temperature.
3. Offer reassurance. Try, “You’re safe. I’m here with you.”
4. Avoid arguing about the time. If they believe it is morning, a long explanation may increase frustration.
5. Gently redirect. Offer the bathroom, a small drink, calm music, or a few quiet minutes in a chair before trying bed again.
6. Keep the environment peaceful. Avoid turning on the television or starting a stimulating activity.

If the person is calm and safe but does not want to return to bed right away, forcing the issue may make both of you more upset. Sometimes a short period of quiet activity works better than a struggle.

Make Nighttime Wandering Safer

Nighttime wandering can lead to falls, injuries, or leaving the home. Plan for safety before the next difficult night.

• Clear pathways between the bed and bathroom.
• Remove loose rugs, cords, and clutter.
• Use night-lights in the bedroom, hallway, and bathroom.
• Keep needed mobility aids within reach.
• Store medicines, cleaning supplies, weapons, and car keys securely.
• Consider a door alert or motion sensor if the person may leave the room or home.
• Make sure smoke and carbon monoxide alarms work.
• Have a plan for how you will get help if you cannot keep the person safe.

Avoid locking a person alone in a room or using restraints. Ask the healthcare provider or a dementia care professional for help choosing safer options.

Be Careful With Sleep Medicines and Over-the-Counter Products

Do not give a sleep aid simply because it is sold without a prescription. Some over-the-counter nighttime products can increase confusion, dizziness, urinary problems, and fall risk in older adults.

Sleep medicines may also cause daytime drowsiness, poor balance, worsening confusion, or unusual nighttime behavior. Non-medication approaches are usually tried first.

Melatonin helps some people, but it is not right for everyone and may interact with other medicines. Talk with the doctor or pharmacist before giving melatonin, an herbal product, CBD, or any sleep aid.

If medication is being considered, ask:

• What problem are we trying to treat?
• Could another medicine be causing it?
• What are the possible benefits and risks?
• Could it increase confusion or falls?
• How will we know whether it is working?
• When should it be reviewed or stopped?

When Should You Call the Doctor?

Contact the healthcare provider when:

• The sleep change begins suddenly
• The person is much sleepier or harder to wake than usual
• They stay awake most of the night for several nights
• You notice new pain, weakness, fever, coughing, shortness of breath, urinary symptoms, constipation, or a recent fall
• They snore loudly, gasp, or seem to stop breathing during sleep
• Nighttime confusion, hallucinations, or agitation are new or getting worse
• A medicine was recently started, stopped, or changed
• The person is falling, wandering outside, or cannot be kept safe
• Sleep loss is affecting your ability to provide safe care

Call 911 for severe trouble breathing, chest pain, signs of a stroke, a serious injury, or any situation that seems life-threatening.

When the Person Begins Sleeping Much More

Some people sleep more as dementia progresses, especially in the later stages. They may tire easily, spend more time in bed, or be awake for shorter periods.

Do not assume that a large or sudden increase in sleep is only part of dementia. It may be related to an infection, dehydration, depression, pain, a medication, or another health change.

If the person spends much of the day in bed or a chair, ask the healthcare team about:

• Repositioning and protecting the skin
• Safe movement and range-of-motion exercises
• Eating, drinking, and swallowing safety
• Mouth care
• Signs of pain or illness
• Equipment or extra help that may be needed

Caregiver Sleep Matters Too

Repeatedly losing sleep can affect your patience, memory, mood, balance, and ability to make safe decisions. It may also make driving unsafe.

You cannot continue giving around-the-clock care without rest.

If possible, ask someone to cover an evening, early morning, or overnight shift. Talk with family members, friends, respite programs, home-care agencies, adult day programs, or the healthcare team. If the person is receiving hospice care, ask what overnight support or guidance is available.

Needing help does not mean you have failed. It means this level of care is too much for one tired person to carry alone.

Common Questions About Dementia and Sleep

Why does my loved one sleep all day and stay awake at night?

Dementia may disrupt the brain’s sleep-wake cycle. Long daytime naps, too little daylight or activity, medicines, pain, illness, and an inconsistent routine may also contribute. Track the pattern and discuss ongoing or sudden changes with the healthcare provider.

Should I keep someone with dementia awake all day?

No. An exhausted person may need rest, and pushing them to stay awake can increase distress. If naps seem to disrupt nighttime sleep, try a shorter nap earlier in the day and watch what happens.

Is nighttime wandering part of dementia?

It can happen in dementia, but look for a reason. The person may need the bathroom, be in pain, feel frightened, believe it is daytime, or be following an old routine. Safety planning and tracking the pattern are important.

Can poor sleep make dementia symptoms look worse?

Yes. Poor sleep can increase confusion, irritability, restlessness, and fall risk. It can also affect the caregiver’s health and ability to provide safe care.

Should I give melatonin or an over-the-counter sleep aid?

Talk with the doctor or pharmacist first. Even products sold without a prescription can cause side effects or interact with medicines. A product that is safe for one person may not be safe for another.

Is sleeping more always a sign that dementia is getting worse?

No. More sleep may happen as dementia progresses, but it can also be caused by illness, pain, depression, medication effects, dehydration, poor nighttime sleep, or another treatable problem. A sudden change should be reported.

Final Thoughts

Dementia sleep problems can be exhausting, frightening, and lonely. You may not be able to create a perfect night, but you can look for clues, improve safety, strengthen the daily routine, and ask for help when the problem becomes too much.

Remember:

• A sleep change is information.
• A sudden change may need medical attention.
• Small changes in light, activity, comfort, and routine may help.
• Tracking can reveal patterns that memory misses.
• Your need for sleep matters too.

You are not failing because the nights are hard. You are caring for someone whose brain may no longer understand nighttime the way it once did—and you deserve support along the way.

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