10 reasons people living with dementia get up in the night, and what often happens when they do

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Contrary to what many people believe, people who live with dementia behave, for the most part, in the same way the rest of us do. Their behaviour is – again, for the most partNOT the result of their dementia or whatever disease (e.g. Alzheimer) caused it. Rather, like all behaviour, it is driven by human emotions, perceptions and physical conditions, which means that the reasons people living with dementia get up in the night are the same reasons the rest of us do.

For example, they may:

1) Feel afraid

I remember being terrified during thunderstorms when I was a kid. I would cross the hall to my parents bedroom and ask if I might crawl in with them. My mother never said no; she always lifted the covers to let me in, and then cuddled close to comfort me. When Mom felt afraid and wanted to crawl into bed with me, I also never said no.

2) Be lonely

Who among has not at some point in her or his life felt alone, lonely and disconnected – especially at night, and/or when experiencing loss. When we feel lonely, it’s natural to search out others…isn’t it?

3) Need to use to the toilet

For the last forty years or so, I’ve gotten up to have a pee on average once a night, sometimes more. Luckily, because I don’t yet have dementia, no one has drugged me for doing so. But, unless things change, if and when I get Alzheiemer disease and am locked up in a Dementia Jail, I’ll be sedated for the thing that I will have done for half a century by then because it’ll be labeled as “wandering.” How do I know? Because that’s what happened to my mom. She got up in the night to use the toilet, and as a result was drugged into a catatonic state for the next four years.

4) Feel restless / not be able to sleep

I’ve suffered from insomnia since I was a teen at which time I was prescribed Valium by my family doctor. Valium. At age 15. Drug culture then; drug culture now. The Valium didn’t stop my insomnia – I still endure it two or three times a week. When I do, I just get up. One day, if and when I have dementia of some kind, I may be labeled a “wanderer.” Maybe you will be too, unless we change the broken system.

5) Not know where they are / think they are in a strange place

Have you ever woken up while staying in a hotel or at a friend’s place, and been momentarily disoriented? You ask yourself where you are because the surroundings don’t look familiar. When this happens to me, I usually remember fairly quickly that I’m travelling and not in my own home. But during the time between waking up, and becoming re-oriented I feel confused and kind of scared. I imagine this is what it must be like for someone living with dementia, except the reorientation part may take much longer (i.e. minutes, or sometimes even hours, or days). Listen to what it might sound like when this happens, and what not to do when it does!

6) Be physically uncomfortable (i.e. hungry, thirsty, hot, cold)

Do you sometimes get up in the night for a snack? Or an extra blanket because you feel cold? Or to open the window because you’re too hot? Besides trudging to the WC at least once a night, I also get up almost every night and have a glass of soy milk and a piece of chocolate – sometimes in a sleep-walking-kind-of-slumber!

7) Have a bad dream

Ever wake up with a start in a cold or hot sweat because you’ve been dreaming something dreadful? And the dream is so vivid that you are unsure if it was dream or reality? I bet the same happens to people who live with dementia. Maybe even more often than it happens to the rest of us, particularly to those living with dementia with Lewy Bodies.

8) Have heard an usual sound or noise

One night a few years ago shortly after I moved into a new house, I heard a big crash. I was scared to death. I didn’t get up to investigate. I hid under the covers instead. But that’s me. Some people would get up to check it out. When I got up in the morning, I found that a big mirror had fallen off the wall and onto the living room floor. Miraculously it hadn’t broken.

9) Be a “night owl” or have worked the night shift

Some people work at night all their lives. For others, being a night owl is their way of being in the world. Sleep all day, stay awake all night. And then oops! We want them to fit with our schedule. No wonder they get angry and upset.

10) Think it’s daytime, not night

So this is the one that’s out of the ordinary. It’s tough to imagine how someone might think it’s the middle of the day when in it’s the middle of the night and vice versa. Nevertheless, try to conjure up what that might be like, or read this real-life nighttime conversation between Mom and I.

Most of us respond in a normal way when we find ourselves in certain sets of circumstances. Most of us wake up in the night from time to time, or even frequently. When we do, we may get up – it’s normal to do so.

But what happens when people who live with dementia get up in the night for any of these reasons above? Their behaviour is labeled aberrant, partly because once they are up, they forget the reason why they are up, and they become lost and/or confused because of their dementia.

Is this stressful for family members who are care partners? Yes, of course. Do they get frustrated and exhausted as a result? Yes, they often do. I know, because I’ve travelled that road. Is it inconvenient and challenging for care workers in institutions when residents walk around at night? Yes, it is. But the onus is on us to find compassionate solutions to address these issues, and not to blame the behaviour we find challenging or inconvenient on those who are living with dementia, and who are behaving just as the rest of us would under similar circumstances.

And all of this is yet ANOTHER reason we need to #BanBPSD.

More posts and PDFs in the “20 questions”series.

20 questions to ask when a care partner or resident walks around at night

“wandering” is not a symptom of dementia

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