Why People With Dementia Sleep So Much, and What Helps During the Day

Yes, people with dementia often sleep a lot, and it usually increases as the condition progresses. Long naps in the armchair, dozing through the afternoon, ten or twelve hours in bed and still tired, and in the later stages sleeping most of the day and much of the night. Families ask about it constantly, and there are usually two worries underneath the question: is this normal, and is this the beginning of the end.

The honest answer is that dementia and sleeping a lot go together for several ordinary reasons, that most of it is not an emergency, and that a small part of it is. So the most useful thing this page can do is help you tell those apart. It also covers what helps during the day, what to do when day and night swap over, and how to spend the hours somebody is awake, because those hours matter more than the total.

Why do people with dementia sleep so much?

Sleep and dementia are connected in more than one direction, and most of the reasons below are usually in play at the same time.

• Ordinary things take enormous effort. Following a conversation, working out where you are, finding a word, getting dressed: work that used to be automatic now uses everything available. Tiredness on that scale is real, and it is earned.
• The brain's sleep and wake controls are affected. Dementia damages the parts of the brain that hold the body clock steady, so sleep becomes lighter, more broken, and scattered through the day rather than gathered into one block at night.
• Less daylight and less to do. A day spent indoors in a chair gives the body clock almost nothing to set itself by, and boredom looks a great deal like sleepiness.
• Medicines. Sedating medicines, some painkillers, some antidepressants and antipsychotics, and combinations that suited somebody five years ago can all add drowsiness. That is worth a proper medicines review with the GP or pharmacist rather than a guess at home, and nothing should be stopped without advice.
• Low mood. Depression is common in dementia, easily missed, and often looks like sleeping, withdrawal and no appetite. It is treatable, so it is worth raising.
• Other health problems. An underactive thyroid, anaemia, a heart or chest problem, poorly controlled pain, sleep apnoea. Sleepiness is a general-purpose symptom.
• The stage itself. In advanced dementia, sleeping most of the day is common and expected, and not in itself a sign that something has gone wrong.

What is normal, and what needs a GP the same day

The pattern matters more than the hours. Sleep that has increased gradually over months, in somebody who wakes, knows you, drinks, eats something and is themselves while awake, is usually the dementia and the stage. A change that arrives over hours or a day or two is a different thing entirely.

Ring the GP the same day, or NHS 111 when the surgery is closed, if somebody becomes suddenly much sleepier or much more confused; if they are hard to rouse or cannot be woken properly; if they have stopped drinking; if there are signs of infection such as fever, shivering, a cough, or dark, strong-smelling or painful urine; if their breathing changes; or after any fall or knock to the head. Sudden change of this kind is very often delirium, and delirium usually has a treatable cause: infection, pain, constipation, dehydration, or a new or changed medicine. Say the word sudden on the phone. A head injury in somebody taking blood-thinning medicine always needs urgent medical advice, however well they seem afterwards.

When day and night swap over

The hardest version of this is not the sleeping. It is sleeping all afternoon and then being awake, dressed and busy at two in the morning, because that pattern breaks the carer rather than the person. It builds gradually: a long afternoon nap makes the night lighter, a light night makes the next afternoon heavier, and after a fortnight the clock has turned over.

Turning it back is slow work, and it is done in the morning rather than at night. Morning light, morning activity and a firmer line on the afternoon nap achieve more than anything attempted at midnight.

What helps during the day

• Daylight early. Curtains open, breakfast by a window, outdoors if at all possible. Daylight is the strongest signal the body clock gets, and indoor lighting is far weaker than it looks.
• Something to do in the morning. Put the walk, the bath, the visitors and the jobs into the first half of the day, when there is most to work with.
• One short nap, in a chair. Twenty to forty minutes after lunch is fine and often helpful. Going to bed in the afternoon usually is not, because the bed says night.
• Caffeine early, not late. Tea and coffee before mid-afternoon, something decaffeinated after that. Do not cut fluids to reduce night-time toilet trips: dehydration causes far worse problems than a broken night.
• An evening that winds down. Lamps rather than overhead lights, the television off, a settled hour before bed.
• A dark, quiet bedroom, and a lit route to the toilet. Dark for sleeping, but a plug-in night light or motion-sensor light on the way to the bathroom, because getting up half asleep in the dark is how falls happen.
• Something that says which part of the day it is. A clock showing the day and whether it is morning, afternoon, evening or night helps somebody who wakes and cannot tell.
• Check the body. Pain, constipation, needing the toilet, being too hot or too cold. All of these break sleep and all of them are fixable.

Our guide to a dementia-friendly home, room by room covers the lighting and the night-time route in more detail.

The later stages: an honest word

This part is hard to read and worth reading. In advanced dementia it is usual to sleep most of the day, to eat and drink less, to lose weight, and to be awake for shorter and shorter spells. Where that has come on gradually and the person seems comfortable, it is generally part of the course of the illness rather than something being missed.

It is also the point at which it helps to have the conversation early rather than in a crisis. Ask the GP or the community nurse how they see things, and ask about palliative care: it is not only for the last few days, and involving a community palliative care team early usually means better symptom control, less pain, fewer hospital admissions and more support for the family. Ask too about advance care planning, and about what should happen if the person becomes unwell at night. Dementia UK's Admiral Nurses can help you think all of this through, by phone or in person, and it is far easier done before it is urgent.

Making the awake hours count

When somebody is awake for two hours a day rather than twelve, the temptation is to fill those hours with tasks. Do the opposite. Sit close, hold a hand, put on the music they grew up with, offer a favourite taste, take them to the window. Personal care can happen when they are at their most awake rather than when the routine says. A short, calm, familiar half hour is worth more than a full programme, and hearing tends to hold on long after other things go, so keep talking to them.

What occupational therapy adds

Somebody who spends most of the day in a chair has needs that a night-time routine does not cover. An occupational therapist looks at seating and posture, whether the chair still fits, and at pressure care, because skin over the tailbone and heels comes under pressure long before anyone notices: our guides to choosing the right chair and to pressure relief cushions and mattresses cover both. They will also look at how transfers are managed and whether they are safe for the person helping, at the mealtime environment for somebody who is drowsy at the table, and at short activities that fit the hours actually available. Our page on occupational therapy for dementia sets out the wider picture.

Frequently asked questions

Do people with dementia sleep a lot?

Many do, and it usually increases as dementia progresses. Broken nights, long daytime naps and, in the later stages, sleeping most of the day are all common. What matters is whether it has come on gradually or suddenly. Gradual is usually the condition and the stage; sudden needs a GP the same day.

Why do dementia patients sleep so much?

Because everyday thinking takes far more effort than it used to, because the parts of the brain that regulate sleep and wakefulness are affected, and because days often contain little daylight and little activity. Medicines, low mood, pain and other health problems add to it. In advanced dementia, sleeping most of the day is expected.

Vascular dementia and excessive sleeping: is it different?

Daytime sleepiness and marked fatigue are commonly reported in vascular dementia, and fatigue after a stroke is well recognised and can last a long time. Excessive daytime sleepiness is also a recognised feature of dementia with Lewy bodies. Whatever the type, a sudden increase is handled the same way: treat it as possible delirium and ring the GP the same day.

Should I wake someone with dementia who is sleeping all day?

Do not force it, but do not leave them undisturbed all day either. Wake them gently for meals, drinks and personal care, open the curtains, and offer company when they surface. If you cannot rouse them properly, or they will not drink, that is not a sleep question and needs medical advice the same day.

Next steps

If sleep has changed gradually and the days have lost their shape, an occupational therapist can look at the whole twenty-four hours: light, routine, seating, comfort and the activities that fit the hours available. If it has changed suddenly, start with the GP. Find your local occupational therapist via our areas we cover page, or see our prices page for current guide pricing.