Managing Sleep Reversal in Dementia Patients

1. Sleep Hygiene Checklist

Maintaining healthy sleep habits is the foundation of correcting day–night reversal in dementia.

✅ Daytime Activity

• Exposure to morning sunlight (10–30 minutes)

• Light exercise during the day (walking, stretching)

• Avoid long naps; limit naps to 20–30 minutes if needed

✅ Consistent Daily Routine

• Wake up and go to bed at the same time every day

• Keep meal times consistent

✅ Sleep Environment

• Keep the room dark, quiet, and comfortable

• Use the bed only for sleeping

• Reduce TV and smartphone use 2–3 hours before bedtime

✅ Food & Drink

• Avoid caffeine (coffee, tea, chocolate) after 2 p.m.

• Avoid heavy or spicy meals close to bedtime

• Encourage hydration during the day; limit fluid intake at night

✅ Behavioral Strategies

• Minimize stimulating activities in the evening

• Use a warm shower before bedtime to help relaxation

2. Managing Early-Morning Wakefulness & Nighttime Wandering

🔍 Why Dementia Patients Wander More at Night

• Poor time/place orientation

• Low daytime activity

• Anxiety, hunger, pain

• Fear of darkness

• Medication effects

📝 Management Strategies

① Ensure Safety

• Install alarms or sensors on doors, exits, and stairs

• Use non-slip flooring

• Place nightlights along walking paths

② Responding to Nighttime Wandering

• Stay calm; do not scold or resist

• Provide reassurance with simple, repeated phrases
  (“You’re safe here. Everything is okay.”)

• Check for basic needs: hunger, bathroom, discomfort, pain

③ Provide Safe Alternative Activities

• If the patient insists on “working” or “doing something,”
  → Offer simple, safe tasks such as folding towels or sorting items

• For anxiety-driven wandering
  → Play soft music, offer hand massage, provide warmth with a blanket

④ Adjust Daily Habits

• Increase daytime physical and mental activities

• Avoid late or long naps

• Create a calm evening atmosphere with dim lighting and low noise

3. Medication vs. Non-Medication Approaches

🟦 Non-Medication Approaches (First Choice)

🟩 Medication Approaches (Use Cautiously)

Medications such as melatonin, sleep aids, or antipsychotics must only be used under a physician’s guidance.

Conclusion

• Non-pharmacological interventions should always be the first line.

• Medications should be used only after medical evaluation, at the lowest effective dose and for the shortest duration necessary.