Should we encourage someone with dementia to wake up at a normal time or let them follow their own schedule?

A fellow caregiver asked...

My dad has had dementia for approximately three years. He is 94 years old. About a month ago, his sleeping habits changed and now he doesn't get up until around 2 in the afternoon but it could be anywhere from 9:30 a.m. to 4:30 p.m. When he gets up, he has breakfast (2 eggs and 2 pieces of toast--every day). He might have a piece of pie later in the afternoon and he always has a large dinner. He's usually in bed by 10:00 p.m. (but that varies also). Should we get him on a better routine, i.e., wake him up around 9 for breakfast, so that he can have lunch and then dinner with the rest of the family. He spends most of the day, once he "gets up," sleeping in his chair.

This behavior makes it more difficult for my mother (also 94) who sits and waits for him to get up every day so she can fix his breakfast.

Incidentally, he has also decided to wear his pajamas all of the time. My mother can convince him to change pajamas about every 3 days, but he puts on another pair vs. getting dressed.

My question is, would it be better to encourage my dad to get up, get dressed, and try to get/keep him on the family's routine or just let him continue what he's doing? Is this typical for someone with dementia?

Expert Answer

Jytte Lokvig, PhD, coaches families and professional caregivers and designs life-enrichment programs and activities for patients with Alzheimer's disease and related dementia. Her workshops and seminars help caregivers and families create a healthy environment based on dignity and humor. She is the author of Alzheimer's A to Z: A Quick-Reference Guide.

Wake up schedules for dementia are as different as the individuals with the disease. Many progressive long term care facilities have changed their policies to support their residents in making decisions that affect their daily lives, such as when to bathe, eat and sleep. The results have been happier and healthier residents and less work for their staff. People in their nineties often experience changing sleep patterns; some may sleep only in 3 "“ 4 hour segments, while others will sleep 14 "“ 16 hours at a time. Alzheimer's and other dementias may affect people's natural body clocks, causing them to switch their patterns, sleeping during the day and staying awake at night. It's very difficult to change people's body clocks back.

Even with real effort on your part, there's only a slim chance that you can get your father back to a more conventional sleeping pattern. You say that when you get him up for breakfast, he often sleeps in his lounge chair during the day. By waking him before he's ready to rise in the morning, you may inadvertently be promoting his body clock to switch to a night-for-day pattern.

You've raised three issues in your question: sleeping, eating, and dressing. From your description your father eats well and your biggest problem is really your mother's anxiety because your father doesn't choose to eat his breakfast in the morning. Explain to her that his body apparently needs the rest, so it's good to let him sleep in and also that it's perfectly alright for him to eat his breakfast at any time of the day; you may want to add that many restaurants now serve breakfast twenty-four hours a day.

The pajama issue: Many elders will wear the same outfit days on end, including going to sleep in it. They may simply not notice, or have forgotten that they didn't change their clothes that day. Or they want to avoid that whoosh of cold air that comes with disrobing.

When your father insists on wearing his pajamas for day-wear, it could be for his comfort or convenience, or he may be unsure about dressing himself. Pajamas are easier to handle; there are no zippers or few buttons to manipulate.

There are several things you can do. You or your mom can help him by laying out his outfits for him. If he takes pride in choosing for himself, you can move his pajamas to a place that's inaccessible to him. Thus his only choices will be the day clothes in his closet. If you suspect that he simply prefers the comfort of his pajamas, you might consider getting him some nice sweat outfits to wear during the day.