Dementia-related 'sleepless nights' get worse the more you try to fix them at night. The real way to handle day-night reversal
3:00 AM. There is a rustling sound in the next room.
When you go to check, your parent has turned on the lights and is getting dressed.
You: Mom, it's still the middle of the night. Shall we go to sleep?
Mom: What are you talking about? It's morning. I have to make breakfast.
She won't listen even if you try to stop her. You have work tomorrow, and you haven't slept properly for days.
——"I feel like I'm going to collapse first." Have you ever thought that? 😢
This is called "day-night reversal," a very common problem in dementia care.
Today, I will explain the causes and how to deal with it from the perspective of a visiting nurse.
By reading this article, you will understand the following:
✅ Why dementia causes day-night reversal (the mechanism)
✅ Specific things you can do during the day to help them sleep at night
✅ Who to consult before you reach your limit, and precautions regarding medication
You should be able to see a way to face sleepless nights a little better. 😌
【First, I want you to know: This is not 'selfishness'】
Not sleeping at night, waking up in the middle of the night.
This is not a problem of the person's will or personality, but is often related to symptoms of dementia or changes associated with aging (Source: Tanzawa Hospital).
They are not waking up because they want to "give you a hard time."
Inside the person, their internal clock is out of sync, and the very sense that "it is now night" has been lost.
Please keep this premise in the back of your mind.
【4 causes of day-night reversal in dementia】
☆① The internal clock itself is disrupted
Dementia is caused by a decline in brain function, which makes it easy to cause malfunctions in the internal clock (Source: LIFULL Kaigo).
It is said that they cannot correct the gap between their internal clock and the actual time, leading to a state where they sleep during the day and wake up at night (Source: SOMPO Egao Club).
☆② Low activity levels during the day
Lazing around during the day or napping too much—when daytime activity levels drop, they won't be able to sleep even when night comes.
This is because their body doesn't get tired, and daytime activities and morning light are involved in adjusting the internal clock (Source: LIFULL Kaigo).
☆③ Losing the sense of time (disorientation)
Mistaking 4:00 AM for 4:00 PM and trying to start preparing dinner.
It is said that such behavior of confusing day and night can be caused by disorientation (Source: LIFULL Kaigo).
☆④ Inability to communicate pain or discomfort well
Sometimes they cannot sleep due to discomfort like constipation or lower back pain, but they cannot put it into words well and end up wandering around in the middle of the night (Source: LIFULL Kaigo).
Sometimes physical ailments are hidden behind "not being able to sleep."
【Things you should not do】
❌ Scolding them restrictively by saying "Go to sleep already!"
→ Trying to force them to sleep can be counterproductive (Source: Nichii).
✅ Instead: Accept it by saying, "You can't sleep, huh? Would you like some tea?" and wait for their feelings to calm down.
❌ Using over-the-counter sleeping pills on your own judgment
→ Relying on medication without looking at the root cause is considered dangerous and carries the risk of side effects (Source: Medical Care Service).
✅ Instead: If sleepless nights continue, consult your primary doctor or care manager before using over-the-counter drugs.
❌ Stopping all nighttime behavior by force
→ This can actually increase excitement or confusion.
✅ Instead: Only prevent "dangerous things" like falling or going outside, and have the leeway to watch over them for the rest.
【Things you can do during the day to help them sleep at night】
The point is "how to spend the day" rather than "what to do at night."
☆① Soak up the sun in the morning
Soaking up sunlight through walks or similar activities in the morning stimulates the internal clock and makes it easier to regulate the day-night rhythm (Source: Nichii).
If going out is difficult, just opening the curtains in the morning to brighten the room makes a difference.
☆② Increase activity levels during the day
Change clothes and move from your room to the living room, ask for help with simple chores, or use day service.
Moving your body and mind during the day is said to lead to better sleep at night (Source: LIFULL Kaigo/Nichii).
☆③ Keep naps short
Napping itself is not bad, but if it is too long, it will affect your night. The guideline is to take a short nap early in the afternoon.
☆④ Create an environment that makes it easy to sleep
Some people cannot sleep because they are anxious in the dark, while others cannot sleep if it is bright. Adjust the brightness to suit the person.
If hands and feet are cold, keep them warm with socks or pajamas (be careful of low-temperature burns from hot water bottles) (Source: Nichii).
☆⑤ Pay attention to any physical discomfort
Check for causes that interfere with sleep, such as constipation, pain, or itching.
If unexplained discomfort persists, please see a doctor and consult with them (Source: Asahi Life).
[Signs you shouldn't miss: If there is loud shouting or jumping up]
If there are signs of loud shouting or suddenly jumping up in the middle of the night, please be a little careful.
It is said that in Lewy body dementia, 'REM sleep behavior disorder,' where one shouts or jumps up during light sleep, can occur (Source: LIFULL Kaigo).
Do not dismiss it as 'just sleepwalking'; make a note of these behaviors and tell your doctor during your visit to help with the diagnosis.
[Don't carry the burden alone]
This is the one thing I want to convey most.
Not being able to sleep as a caregiver definitely wears down your mind and body.
If you keep it to yourself, thinking 'I'll just endure it,' you may end up collapsing together.
Use services that offer nighttime support (short stays, nighttime home-visit care, etc.), and honestly tell your care manager that 'the night is at its limit.'
That is not being self-indulgent; it is a necessary choice to continue providing care.
There are also cases where treatment, including sleeping pills, is necessary. First, please consult your primary doctor or care manager.
[Finally]
Caregiving that involves not being able to sleep at night quietly corners people more than any daytime caregiving.
The loneliness of being alone in a pitch-black house, accompanying a parent who has woken up. I have encountered that pain many times in the field 🍵
But please remember this.
The reason your parent wakes up at night is not because they want to trouble you, but simply because the disease has disrupted their internal clock.
You not collapsing is what leads to protecting your parent.
Please, take care of your own sleep and yourself as well.
――If you don't mind, please tell me.
How do you deal with nighttime troubles in your home?
I would be happy if you could share your experience in the comments.