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Improving nighttime sleep for nursing home residents with dementia

To help reduce daytime naps, consider:

  1. First, identify the root cause or the underlying reason for residents taking naps during the day—such as depression, boredom, chronic pain, and nutritional deficiencies. Treat those issues first.
  2. Engage the resident in meaningful activities. Examples include walks, going shopping, visits from friends or family members, conversation, and helping them stay as independent as possible.) Note: You may need to involve the resident’s family to identify activities the resident enjoyed prior to admission.
  3. Is there an individualized care plan in place that incorporates the likes/dislikes of each resident?
  4. Does staff take the time get to know the resident on a social level and identify what they like to hear, touch, taste, smell, and see?
  5. What medications is the resident taking? Sleep disorders are common side effects of many medications, including antipsychotics.

Do you suspect the resident has a low level of melatonin?

  1. Weather permitting, increase activities that allow residents to spend time outdoors.
  2. If not, find sunny areas in the nursing home for activities and, if winter months are long and do not permit access outdoors, try introducing artificiallight therapy.

To help reduce distress at nightime, consider:

  1. Is there an established routine for the resident at night? An established routine includes changing into night clothes and washing his/her face at a certain time and in a certain order, and going to bed the same time every night.
  2. Did staff provide the resident with reassurance and cues to orient them?
  3. Did staff provide calming activities at the end of day and before bedtime (i.e., reading, reminiscing, singing, etc.)?
  4. Are there precautionary processes in place to avoid the occurrence of loud noises at night?
  5. Did staff take the necessary steps to ensure that the resident did not watch TV less than an hour before bedtime (especially shows with violence and action)?
  6. If appropriate, increase daily activities—include walking, socializing, playing games, and participating in activities to challenge the mind.



Adapted by Qualis Health, the Medicare Quality Innovation Network - Quality Improvement Organization (QIN-QIO) for Idaho and Washington, from materials provided by the TMF Health Quality Institute and prepared under contract with the Centers for Medicare & Medicaid Services.