How do you manage patients with dementia who have insomnia, agitation or aggression at night?

For people wtih dementia who have trouble sleeping or experience agitation at night, lifestyle and behavioral modifications are critical. Ensuring good sleep hygiene is important - routines around bedtime, dimming lights, ensuring a comfortable environment, monitoring caffeine intake or avoiding stimulating activities just prior to bed. Staying physically active, getting good daylight exposure, reducing alchol consumption and eating a balanced diet are also important lifestyle and behavioral steps to take that nurture the sleep-wake cycle.

Another important pillar for managing agitation for patients with dementia is reviewing medications that may disrupt the sleep-wake cycle as people with dementia may be more sensitive to these changes.

Lastly, efficacious treatments to specifically manage agression at night are focused more around psychologic and social treatments like music, massage therapy and caregiver education. Medications like atypical antipsychotics (ie: quietiapine) have been studied and are still used today. However, the evidence has not overwhelmingly shown them to be effective.

Talk to your health care provider about what options are available to you.