Norman worked as a night watchman at the airport for over 40 years. Since being diagnosed with dementia, Norman has been a resident at Memory Care Lane. The routine here is very different for him, and Norman is having difficulty adjusting his “natural time clock.” In fact, Norman gets up and wanders during the night. He doesn’t use his call bell to call the nurses. One night, Norman climbed over the siderails of the bed to go to the bathroom. Norman’s eyesight is failing, and the caregivers are worried that one of these nights he may fall and injure himself.

Norman’s family has shared information about their Dad’s employment history as a night watchman. The caregivers now welcome Norman to sit at the desk with them for a few hours on their night shift. Norman enjoys a cup of warm milk and a biscuit and shares many good stories of his night watchman duty at the airport. Seems he can’t tell these stories enough times.

And, when the agitated or uncooperative person is prescribed sedatives, the medication may in turn cause the person to become dizzy and fall.

“Some nursing homes are trying a different approach, so–called environmental intervention. The strategies include reducing boredom, providing intellectual and physical stimulation, exercise, calming music, bringing in pets for therapy and improving how the staff approaches and talks to dementia patients.” New York Times, June 24, 2008

I have discovered in my practice that many of the elders spend their entire day in a drowsy state, moving from bed to wheelchair, back to bed for a nap, and back to wheelchair.

Perhaps, they feel bored and disengaged with their environment. This may be one answer to the question. However, another answer is that the person with dementia has their biological clock all turned around. Day is night and night is day. So if Norman needs to wander throughout the night on his night watchman duty, the care staff must adjust to Norman’s reality.

In the above situation, the nursing staff has worked together with the family member to set in place a realistic and much safer plan for Norman’s care and sleeping routine. In fact, this challenge has become a sleeping solution. (excerpt from “Norman”, The Living Dementia Case–Study Approach, deGeest, 2007

. . . the identification and classification of distinct phenotypes of sleep disturbance in different dementias may allow more targeted treatment of sleep disturbance to try and improve the quality of life for patients and carers.

Having a poor night’s sleep is a common experience. Approximately 70 million Americans are impacted by chronic sleep loss or disorders, more than one–quarter of Americans experience the occasional poor night’s, and 10% suffer from chronic insomnia.

Nearly half of older adults report difficulty initiating and maintaining sleep. With age, several changes occur that can place one at risk for sleep disturbance including increased prevalence of medical conditions, increased medication use, age–related changes in various circadian rhythms, and environmental and lifestyle changes.