Each year, World Alzheimer’s Day brings attention to the millions of people worldwide living with Alzheimer’s disease and their caregivers. While memory loss is often the most recognized symptom, one of the most challenging and under-discussed aspects of Alzheimer’s is sleep disturbance. Poor sleep not only affects quality of life but can also worsen cognitive symptoms and caregiver stress.
The Connection Between Alzheimer’s and Sleep
Sleep disruption is more than a side effect of Alzheimer’s. It is intertwined with the condition itself. Estimates suggest that up to half of people with moderate to severe Alzheimer’s experience significant sleep problems, including difficulty falling or staying asleep, frequent awakenings, excessive daytime sleepiness, night wandering with confusion or agitation related to sundowning, and comorbid sleep disorders such as obstructive sleep apnea or restless legs syndrome (Mayo Clinic, 2024; Cleveland Clinic, 2023).
Sleep disturbances may also appear years before noticeable cognitive decline, suggesting a bidirectional relationship between sleep and Alzheimer’s pathology. Short or fragmented sleep has been associated with higher levels of beta-amyloid and tau, proteins central to Alzheimer’s disease (Gonzales et al., 2024).
Why Sleep Gets Harder in Alzheimer’s
Several factors contribute to disrupted sleep in Alzheimer’s disease:
- Circadian rhythm changes. Brain regions that regulate day–night cycles are affected, leading to nighttime wakefulness and daytime napping.
- Reduced melatonin production. People with Alzheimer’s may produce less melatonin, making it harder to feel sleepy at night (Mishima et al., 1999).
- Cognitive and behavioral symptoms. Anxiety, confusion, hallucinations, and restlessness often intensify in the evening and can disrupt sleep routines (Cleveland Clinic, 2023).
- Medical and environmental factors. Pain, urinary frequency, low lighting, unfamiliar settings, and medication effects can all worsen sleep problems (Mayo Clinic, 2024).
The Impact on Caregivers
For caregivers, nighttime agitation, wandering, or confusion can be exhausting and overwhelming. Poor sleep in a loved one is a common reason families consider memory care placement. Supporting sleep is therefore about patient well-being and caregiver sustainability (Cleveland Clinic, 2023).
Evidence-Based Strategies to Improve Sleep
Because many sleep medications increase confusion, sedation, and fall risk in older adults with cognitive impairment, non-pharmacologic approaches are first-line (Mayo Clinic, 2024). Evidence-informed steps include:
- Keep a regular routine. Consistent sleep and wake times, with daytime structure around meals, activity, and appointments (Mayo Clinic, 2024).
- Maximize light and movement. Morning sunlight and daytime physical or social activity help stabilize circadian rhythms. Bright light therapy can improve sleep timing and stability in some people with dementia (Hanford & Figueiro, 2013).
- Create a calming evening environment. Dim lights, reduce noise, limit evening screens and caffeine, and use soothing rituals like reading or soft music (Mayo Clinic, 2024).
- Address medical factors. Review medications that may impair sleep, treat pain or mood symptoms, and screen for sleep apnea when indicated (Mayo Clinic, 2024).
- Prioritize safety. Night lights, clear walkways, and alarms on doors if wandering is a concern (Cleveland Clinic, 2023).
- Consider melatonin carefully. Some data suggest potential benefits for sleep timing, though results are mixed. Discuss with the care team before use (Mishima et al., 1999; Mayo Clinic, 2024).
Learn More
Objective tracking can clarify patterns that are otherwise hard to observe. Devices like the SomnoRing® with the SomnologyMD app can surface sleep stages, awakenings, and oxygen trends that may correlate with agitation, sundowning, or sleep-disordered breathing, helping clinicians tailor care plans and giving caregivers clearer insight into nights at home. To learn more, visit our website.
Sources:
- Cleveland Clinic. (2023, October 25). How does dementia affect sleep? Health Essentials. https://health.clevelandclinic.org/dementia-and-sleep
- Gonzales, P. N. G., Villaraza, S. G., & Rosa, J. C. D. (2024). The association between sleep and Alzheimer’s disease: a systematic review. Dementia & neuropsychologia, 18, e20230049. https://doi.org/10.1590/1980-5764-DN-2023-0049
- Hanford, N., & Figueiro, M. (2013). Light therapy and Alzheimer’s disease and related dementia: Past, present, and future. Journal of Alzheimer’s Disease, 33(4), 913–922. https://doi.org/10.3233/JAD-2012-121645
- Mayo Clinic Staff. (2024, October 30). Alzheimer’s: Managing sleep problems. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/alzheimers-disease\
- Mishima, K., Tozawa, T., Satoh, K., Matsumoto, Y., Hishikawa, Y., & Okawa, M. (1999). Melatonin secretion rhythm disorders in patients with senile dementia of Alzheimer’s type with disturbed sleep–waking. Biological Psychiatry, 45(4), 417–421. https://www.biologicalpsychiatryjournal.com/article/S0006-3223(97)00510-6/abstract
- Sleep Foundation. (2025, July 15). Alzheimer’s disease and sleep (A. Fry, Author; A. Rehman, Medical Reviewer). https://www.sleepfoundation.org/physical-health/alzheimers-disease-and-sleep