So often, we apply root cause analysis to determine the reason for a resident’s fall or change in behavior. Could Jane have a UTI? Did Roger have his walker with him when he fell? How did the staff approach Lynn when trying to help her shower?
What we aren’t asking — and what we should ask — is, “How is the resident sleeping at night?”
Sleep is an important aspect of health for everyone, but especially for people with dementia. Although so much about Alzheimer’s and other types of dementia can feel outside of a caregivers’ control, sleep is a crucial aspect of well-being that actually can be improved.
Getting a good night’s sleep affects so many aspects of one’s wellbeing. A good night’s sleep slows cognitive decline, prevents falls and injuries, improves mood and helps regulate the sleep-wake cycle.
On the rare occasions we acknowledge a resident having trouble sleeping, it usually is only as an excuse for a resident sleeping through something during the day. Far too often, we accept that someone will be asleep during the day because he or she was wandering all night, and we do nothing to try and help the resident get back on a healthy sleep cycle.
By sleeping through the day, residents miss out on good meals, meaningful interactions with other people (including family members, now that they are allowed to visit again) and opportunities to maintain or develop skills through activities, therapy sessions and more.
So what kind of interventions can we implement to improve sleep for our residents?
Some evidence-based suggestions:
- Make sure your residents are exposed to plenty of light throughout the day. How would you feel if every day was overcast? In terms of typical light exposure, research has found, for instance, that almost half of nursing home residents with dementia experience the equivalent of a cloudy day and are exposed to an average of just one minute of bright light each day. Bright light is a signal for the resident to be awake, and helps them sleep better at night because, in contrast, their bedroom should be dark at night. How does your senior living community compare?
- Encourage participation in fitness programs. Being awake and active during the day is one of the easiest ways to help make sure a person is tired by night. Residents should exercise some time during the day — at least one to two hours before bedtime. For people with dementia, the Alzheimer’s Association recommends exercising at least four hours before bedtime. Researchers found that a daily routine of using a therapeutic lamp and walking increased the amount of time that residents with dementia spent asleep at night by 32%. Not only that, but they work up five fewer times during the night as well.
- Play soothing sounds. What is “soothing” can vary by person, but generally speaking, it is something soft and slow. Listening to music has been shown to increase deep and REM sleep. Those stages of sleep are important times when energy is restored, muscles relax and blood pressure lowers. This isn’t “Alive Inside,” so do not play music that could be too exciting. Play nature sounds, white noise or maybe a lullaby without the vocals. The purpose of the sounds or music is to help the person relax and fall asleep.
- Use aromatherapy. Research shows that inhaling certain fragrances — think lavender, sweet orange and cedarwood — promotes better sleep. You can diffuse the essential oils: put two to five drops on a towel over the resident’s pillow at night, or use relaxing aromatherapy lotion. Hand rubs, particularly using aromatherapy, have been shown to relax people with dementia so that they experience fewer sleep disturbances. Proven techniques such as Compassionate Touch are great for this.
When your residents sleep better, you will sleep better, too.
Julia Larimer, LNHA, ADC, is a gerontologist with 10 years of experience in long-term care. She is the founder of ShopAlzWell.com, where this Sleep Kit is available, combining the interventions discussed into one package.