Dementia and Night-Time Waking: Why It Happens and What Helps Families and Carers Cope

Dementia not sleeping at night is common, because dementia can damage the body clock, change how much deep sleep a person gets and leave them anxious and confused when they wake. The Alzheimer's Society says sleep problems tend to become more common and more severe as dementia progresses, and that a steady routine should be tried thoroughly before medication, because medication is not very effective for sleep in dementia. For most families the most useful steps are daylight and activity in the day, a calm and repeatable evening, a safe bedroom and route to the toilet, and a visit to the GP if the problem lasts several weeks.

Night-time waking is also one of the hardest parts of caring for someone at home, because the carer's sleep suffers too. If nights have become too much, a carer who stays awake in the home can give you a night of proper rest. We explain below when a wake night or a sleep over is the right choice.

Why dementia disrupts sleep

A damaged body clock. It becomes harder for the person to feel alert in the day and sleepy in the evening.
Less melatonin. This is the hormone that helps a person feel sleepy as it gets dark, and the brain may make less of it as dementia progresses.
Pain, medicines and the toilet. Some medicines for other conditions make sleep worse, and pain or urinary problems can wake a person repeatedly. Medicines prescribed for dementia itself, such as donepezil, rivastigmine and galantamine, can also cause insomnia and vivid dreams. Taking them in the morning rather than at bedtime may help, so ask the GP or pharmacist before changing the timing.
Too little to do in the day. A person who has not been active may not feel tired enough at night, and shorter sleeps tend to be lighter.
Confusion on waking. The person may not know what time it is, believe it is time to start the day and get dressed to go to work or take the children to school.

What sundowning is and what may sit behind it

Sundowning means a person becomes intensely distressed or agitated, and sometimes has hallucinations or delusions, in the later afternoon or towards the end of the day, and it can carry on into the night. The Alzheimer's Society says it is not necessarily linked to the sun setting, can happen at any stage of dementia and is more common in the middle and later stages. The reasons are not well understood, and the list of possible contributors is long: tiredness, hunger, pain or other unmet needs, too little sunlight in the day, an overstimulating day, a damaged body clock, hearing or sight loss, anxiety or low mood, and side effects of medicines.

Sometimes what looks like sundowning is your relative telling you about a need they cannot put into words, such as needing the toilet, being hungry or being in pain. Winter shortens the daylight, and too little daylight is one of the listed contributors. The clocks go back on Sunday 25 October 2026, so it is worth getting your relative outside in the morning from now on.

An evening routine that helps, from morning to bedtime

When	What helps	Why
Morning	Open the curtains and get outside in daylight if you can, ideally before midday. Keep breakfast at a regular time	Daylight helps set the body clock. If your relative cannot go out, a bright lamp or lightbox has a similar effect
From lunchtime	Switch to caffeine-free drinks	Caffeine reduces sleepiness and increases trips to the toilet, and its effects last several hours
Afternoon	Walking, gardening or another activity they enjoy for 20 to 30 minutes, several times a week. If they are exhausted, one or two naps of under an hour around the middle of the day	Activity builds tiredness for bedtime, and short midday naps should not get in its way
Late afternoon	Watch for restlessness, and check for hunger, thirst, pain and the toilet before assuming the cause is dementia	Agitation can be an unmet need
Early evening	A lighter meal several hours before bed, less noise and fewer screens	Hunger or fullness can wake a person, and screens overstimulate
Late evening	Dim the lights gradually, unless your relative is getting sleepy too early. Follow the same bedtime steps in the same order: a warm caffeine-free drink, the toilet, changing for bed, washing, teeth, bed, then something calming to listen to	A familiar routine tells the body clock it is night
The bedroom	Quiet, dark and cool (about 18°C), a night light on the way to the toilet, a clock that shows day or night, and a glass of water by the bed	Fewer reasons to wake, and less confusion if they do

These steps come from the Alzheimer's Society factsheet, and they work best when they are the same every day.

What a wake night carer does through the night

A wake night means a trained carer stays awake in the home from the moment they arrive to the moment they hand over in the morning. They are not resting on standby. Here is how a typical night goes for a person living with dementia who wakes often.

The carer arrives at about 10pm and hears how the evening went, what settled your relative and what unsettled them. They check that the route from bed to toilet is clear and lit. Through the night they stay awake nearby and check quietly at agreed intervals, without switching on bright lights. If your relative wakes, the carer stays calm, offers the toilet, a drink and a small snack, and reassures them. If your relative is sure it is morning and wants to get dressed, the carer does not argue about the time. They sit with a warm drink and talk about something your relative enjoys until they settle. In the morning the carer hands over with notes on when your relative woke, what they needed and what helped.

"The nights that go best are the ones where we do not argue about the time. If someone is certain it is morning, we say it is early, offer a cup of tea and ask about whatever is on their mind, which is often work or the children. Within twenty minutes or so most people are ready to settle again. The harder nights are when a person is in pain or needs the toilet and cannot tell us." - Carer, Blossom Healthcare Solutions.

Keeping your relative safe if they get up and try to leave

Start with the bedroom and the route to the toilet. The Alzheimer's Society advises keeping the bedroom uncluttered and using a night light for a person who is afraid of the dark or worried about finding the toilet.

Then plan for the worst night, before it happens. The Herbert Protocol is a national scheme in which family or carers fill in a form in advance with a photograph, medication, routines, previous addresses and places the person has gone before. Essex Police is a partner, and you can complete the form on the Essex Police website. If your relative lives in Hertfordshire, ask Hertfordshire Constabulary for its version. Keep the form somewhere easy to find and update it when medication or routines change. If your relative goes missing, call 999 and say you have a Herbert Protocol profile. You will not be criticised for calling, as the Metropolitan Police's guidance makes clear.

In our view, if your relative is at risk of leaving the house, falling or reaching the cooker during the night, someone needs to be awake. A night light and a good routine do not cover that risk.

When to see the GP about night-time waking

The Alzheimer's Society advises speaking to the GP or nurse if the sleep problems last several weeks or more and your relative is becoming more unwell.

A GP or nurse will look for a cause that can be treated, such as pain, anxiety, urinary problems or a medicine that disturbs sleep.
A diary of when the problems happen helps the clinician see what is going on. Note the time your relative woke, what they needed and what helped.
Some sleep disorders need a specialist, such as an old age psychiatrist or a consultant geriatrician. A referral can take time, so see the GP early.
Sleep medication is not recommended for a person with dementia. Some doctors suggest a short trial if the problem is severe and non-drug approaches have not worked. If your relative takes it, they may be more confused and more likely to fall the next day, so take extra care.

When to book a wake night rather than a sleep over

The Alzheimer's Society notes that a person with frequent night-time waking may be helped by a night sitter, a carer who looks after them at night so that you can sleep, and that severe sleep problems may need a live-in or visiting carer. A sleep over carer sleeps at the property and gets up if your relative needs them. A wake night carer stays awake and active all night. A week of notes in a diary will usually show which you need.

What the nights look like	What usually fits
Wakes once, perhaps twice, and settles after reassurance or a trip to the toilet	Sleep over
Mostly sleeps, but you would like someone in the house for peace of mind	Sleep over
Needs help more than once or twice a night	Wake night
Agitated, wandering or trying to leave, or up for long stretches	Wake night
Needs repositioning, continence care or medication at set times in the night	Wake night

Looking after yourself when you are the one who is awake

Growing exhaustion affects the person with dementia and the person caring for them. If the stress of caring is making you unwell, the Alzheimer's Society advises talking to your own GP.

The Alzheimer's Society Dementia Support Line is on 0333 150 3456.
The Dementia UK Admiral Nurse Dementia Helpline is free on 0800 888 6678. It is open from 9am to 9pm on weekdays and from 9am to 5pm at weekends and on bank holidays, and it is closed on 25 December.
You can ask your council for a carer's assessment, which is free for anyone over 18 and can recommend someone to take over caring so that you can take a break, according to the NHS. Essex County Council Adult Social Care is on 0345 603 7630 and Hertfordshire County Council Adult Care Services is on 0300 123 4042.

Questions families ask about dementia and nights

Should I tell my relative it is the middle of the night?

Arguing about the time rarely helps. If your relative is agitated, the Alzheimer's Society suggests calming them by distracting them, perhaps by talking about a favourite memory. A clock that shows night or day can help them work out the time for themselves. If they stay agitated, check for a need that has not been met, such as the toilet, hunger or pain.

Is it safe to let my relative wander around the house at night?

It depends on the house and on your relative. If the route is clear and lit, they are steady on their feet and nothing dangerous is within reach, staying quietly nearby is often calmer than insisting they go back to bed. If there is a risk of falling, leaving the house or using the cooker, someone needs to be awake.

Will a sleeping tablet help?

The Alzheimer's Society says medication is not very effective for sleep in dementia and that sleep medication is not recommended, although a doctor may suggest a short trial in severe cases. Do not give your relative anything to help them sleep without asking their GP or pharmacist first.

Can the same carer come every night?

Where continuity matters, we do everything we can to send familiar faces, so your relative is not waking to a stranger every night. We also stay in close contact with families, so each morning starts with a clear picture of how the night went.

Talking it through with us

If nights have become too much, call us on 01279 437923. We are happy to talk things through before you make any decisions, and we will tell you honestly whether a wake night, a sleep over or something else suits your situation. There is no pressure and no obligation. If your relative also needs company in the day so that you can rest, a sit-in covers a few hours at a time.

We provide care at home across West Essex, Epping Forest and East and North Hertfordshire, including Harlow, Epping, Great Dunmow and Stevenage. Our article on why the same carer every week matters explains why continuity matters even more at night.

Sources and when they were last checked

All sources below were checked on 20 October 2026.

Alzheimer's Society, Factsheet 534: Understanding sleep problems, night-time disturbance and dementia (last reviewed January 2021): causes, routine, sundowning, GP advice, medication, night sitters, Dementia Support Line.
Essex County Council, Pre-plan in case a loved one goes missing: Essex Police and the Herbert Protocol.
Metropolitan Police, Herbert Protocol guidance: how the scheme works and what to say when you call.
Dementia UK, Admiral Nurse Dementia Helpline: number and opening hours.
NHS, Carer's assessments: who can ask, and what an assessment can recommend.
Essex County Council, Contact us, and the Hertfordshire County Council Adult Care Services CQC contact record: adult social care numbers.

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Dementia and Night-Time Waking