Why Prioritising Sleep Matters: Health, Caring Responsibilities and Dementia Care
Author: Hannah Neal-Donald, RGN DipHE MSc
Head of Clinical Governance
Introduction
Sleep is one of the most fundamental biological processes for health and wellbeing yet is frequently undervalued. It is estimated the average adult will spend a quarter to a third of their life in bed. However, increasing work demands, caregiving responsibilities, and 24‑hour lifestyles have contributed to widespread sleep deprivation. Recent research and literature have highlighted the impact of sleep deprivation on cognitive functioning and physical outcomes.
This article explores why prioritising sleep is essential, discusses the science of sleep and the impact of sleep deprivation on health, and the challenges faced by family carers, especially those supporting people living with dementia.
The Science of Sleep
Sleep is a complex process that involves brain activity, responsible for repair and memory and mental processing. Sleep is regulated by two interacting biological systems: sleep drive/pressure and the circadian rhythm. The circadian rhythm is the body’s internal 24‑hour clock, regulating sleep cycles, hormones, temperature and cognition. A key function is response to light—daylight promotes alertness, while darkness stimulates the hormone melatonin.
During the day as the brain uses energy, levels of adenosine accumulate signaling to the brain that it is time to rest. Sleeping later in the day for more than 30 minutes, reducing adenosine accumulation, can disrupt sleeping patterns by decreasing the drive. Caffeine works by blocking adenosine receptors.
Sleep and Dementia
Evidence to suggest a lack of sleep increases a person’s risk for developing dementia is unclear, however it is well known that dementia can significantly impact sleep quality.
Sleep disturbances are common in all types of dementia, but particularly dementia with Lewy bodies (clumps of protein inside nerve cells). Neurodegeneration in dementia disrupts circadian regulation, resulting in symptoms that affect the amount and quality of sleep. Those in the early stages of the disease may still be able to follow a relatively normal sleeping pattern, however changes become more noticeable as the disease progresses. Medications used to treat symptoms and delay the decline of dementia can also cause drowsiness and fatigue.
Excessive sleeping becomes more common during the late stages of the disease, also known as hypersomnia, which is usually involuntary. Sundowning, increased confusion, wandering and reversed sleep cycles are also common symptoms of dementia.
Health Consequences of Sleep Deprivation
Studies show a U‑shaped relationship between sleep and mortality, meaning both insufficient and excessive sleep are associated with poorer outcomes. Neurologists suggest a lack of sleep could significantly reduce life expectancy.
John Hopskins sleep expert and neurologist Mark Wu points out the many important connections between health and sleep. Researchers believe not only does sleep significantly impact brain processing and the removal of waste products, but physical implications of sleep deprivation can include depression, seizures, and compromised immunity. In addition, research has evidenced links between chronic sleep deprivation, cardiovascular disease and metabolic disorders, indicating even one night of missed sleep in an otherwise healthy person can result in a prediabetic state.
Research demonstrated reduced cognitive performance and “cognitive instability” during sleep loss, with fluctuating attention and increased errors. Consistently poor REM sleep can cause memory issues and mood disturbances, heightening amygdala reactivity, reducing rational control and increasing irritability and anxiety.
Sleep and Caring Responsibilities
Family carers frequently experience interrupted sleep due to not only the physical demands of caring i.e. repositioning, continence care, and medication support, but also the psychological demands in providing emotional support and reassurance.
Sleep deprivation among carers is associated with depression, weakened immunity, cardiovascular risk and burnout. Emotional strain combined with nightly disruption creates cumulative stress affecting care sustainability. Often the consequences of increased sleep effects meals and medication. It reduces interaction and can result in difficulty in maintaining a routine, increasing stress and concern for care givers.
If a person wakes during the night, encourage them to get out of bed. Sensory engagement can also help stimulate the brain and help reduce oversleeping, this can include activities such as folding towels and listening to music. Distraction or relaxation techniques could be particularly helpful if someone is increasingly confused or anxious in the evening, known as sundowning. It may help to close curtains and turn lights on, support the person to have a bath or sit with a blanket and warm drink to signal getting ready for bed. Reducing exposure to blue light (light from tv, phones, tablet screens) can also help prevent overstimulation.
Ensuring a comfortable environment is important for sleep, considering temperature, clothing, soft fabrics, and incontinence products that will last all night.
Caring for a family member is physically and emotionally demanding. If you care for someone with dementia, the quality of your own sleep, as well as theirs, should be a priority, practicing self-care and implementing the advice above for yourself is important. Accept help from others when offered and consider investing in assistive technology such as motion detecting sensors. You can also contact local social services to discuss a care needs assessment to determine support required and eligibility for help with care costs.
What Could Help?
If a person with dementia is having problems sleeping, they should see their GP for guidance. It’s important to be aware of other health issues that may be causing increased sleep or drowsiness, such as infection, depression, and other conditions that may affect alertness. Good pain management is also essential to ensure a good quality of sleep and if the person is taking a cholinesterase inhibitor (tacrine, donepezil, rivastigmine or galantamine), avoid giving the medicine before bed. A sudden increase in sleepiness or trouble waking a person should be reported to the person’s GP.
In addition to medical guidance, there are a few other actions that may help improve sleep quality, for example, physical exercise helps regulate the sleep cycle. Exercise can include encouraging walking or chair exercises and stretches, although exercising should be no later than four hours before bedtime. Some evidence suggests bright light therapy has benefited people with sleep disturbances and dementia. Exposure to natural light is the most helpful in regulating melatonin, ensuring curtains are open or spending time outside may be helpful. In addition, it may be helpful to keep lights low, use lamps in the evening and blackout blinds in summer.
You may be eligible for support through local charities, which can provide occasional visits, however this is dependent on location, see links below. Hilton Nursing Partners are also able to offer flexible overnight solutions, including sleep ins and waking nights to give you peace of mind.
In conclusion, sleep is a biological necessity essential to health, cognition and emotional resilience. Prioritising sleep is fundamental to safety, dignity and quality of life, for both those with dementia and those caring for them.
Links to research and further support information-
- https://academic.oup.com/sleep/article/43/7/zsz319/5813478
- https://pubmed.ncbi.nlm.nih.gov/40443808/
- The Science of Sleep: Understanding What Happens When You Sleep | Johns Hopkins Medicine
- How does dementia affect sleep? | Alzheimer's Society
- Excessive daytime sleepiness (hypersomnia) - NHS
- Carers: help and support - Citizens Advice
- Dementia and Sleep: Understanding Sleep Problems in Dementia Patients
