by Jeff McSpadden, Co-Founder & CEO at Composure

The following article is Part 1 of an ongoing series "Reimagining Sleep in Dementia Care". It was originally published on LinkedIn, January 7, 2025.

For older adults living with dementia, sleep is often a significant challenge. Not just a nighttime inconvenience, poor and insufficient sleep is a pervasive issue that can accelerate cognitive decline, heighten agitation, and place immense strain on caregivers. Despite the well-documented importance of restorative sleep, traditional dementia care environments are rarely designed to promote it.

There are solutions. Addressing poor sleep requires a shift away from reactive, symptom-masking measures and toward comprehensive, innovative solutions. To do this, we must first explore the importance of quality sleep for health and well-being, the common causes of sleep disruptions in dementia care, and the emerging solutions that are redefining care practices.

Dementia & Sleep Are Connected

Up to 70% of people with dementia experience sleep disturbances, contributing to lowered coping abilities, cognitive decline, and caregiver burden (Alzheimer’s Society of Canada). Dementia disrupts the brain’s ability to regulate sleep-wake cycles. As a result, individuals may experience "sundowning" (an often misunderstood phenomenon), frequent waking, and increased distress during the night.

Regular, restorative sleep is essential for:

• Cognitive Function – Sleep supports memory consolidation and helps remove toxins from the brain (NIH), potentially slowing cognitive decline.
• Emotional Stability – Poor sleep heightens anxiety, aggression, and depression, exacerbating symptoms of dementia.
• Physical Health – Sleep helps regulate immune function, cardiovascular health, and mobility.

Without consistent, restorative sleep, individuals with dementia face a faster rate of decline, which in turn elevates caregiver burnout and stress.

The Challenge to Sleep in Today’s Dementia Care

Standard dementia care practices often fall short in fostering environments conducive to sleep. Current approaches often overlook key areas essential to fostering restorative sleep, beginning with the environment itself.

Environmental Design and the Sonic Landscape

Most dementia care environments prioritize safety and accessibility over sleep quality. While physical hazards are addressed, sensory hazards—particularly noise—are overlooked.

• Distracting Noises – Alarms, doors opening/closing, and nighttime staff activity unintentionally create a sonic environment that fragments sleep.
• Lack of Auditory Control – Sound waves are very difficult to isolate and control. Unexpected noises can startle residents awake, exacerbating confusion and agitation.

Over-reliance on Sleep Medications and Antipsychotics

Pharmacological interventions are often the default response to sleep disturbances in dementia care. However, these come with significant risks: