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Sleep-wake disturbances and sleep disorders in patients with dementia

Ariel B Neikrug, PhD
Sonia Ancoli-Israel, PhD
Section Editors
Cathy A Goldstein, MD
Ruth Benca, MD, PhD
Deputy Editor
Janet L Wilterdink, MD


Sleep disturbances are common complaints among patients with dementia and their caregivers. Multiple factors contribute to sleep impairment in this population: age- and dementia-related changes in sleep and circadian rhythms, primary sleep disorders, institutional and environmental factors, and comorbid illnesses and medications. Sleep disturbances and disorders are important to recognize and treat in patients with dementia, as they are a major contributor to caregiver distress and are associated with an increased likelihood of institutionalization [1].

This topic will review the clinical features, evaluation, and treatment of common sleep disturbances and sleep disorders in patients with dementia. The evaluation and treatment of other neuropsychiatric symptoms of dementia are reviewed separately. (See "Management of neuropsychiatric symptoms of dementia".)


Both the normal aging process and dementia can be associated with major physiologic changes in sleep and circadian rhythms. Changes can be observed in total sleep time, time spent awake after sleep onset, sleep architecture, and circadian rhythms.

Sleep quality and duration

Age-related changes – Total sleep time decreases by an average of approximately 30 minutes per decade starting in mid-life [2]. Subjective reports of worse sleep quality, which increase with age [3], have been linked to cellular aging [4].

There is also an age-dependent increase in the prevalence of sleep disorders that may impact sleep quality and duration, including insomnia, obstructive sleep apnea (OSA), restless legs syndrome/Willis-Ekbom disease (RLS/WED), periodic limb movement disorder (PLMD), and rapid eye movement (REM) sleep behavior disorder (RBD). (See "Overview of insomnia in adults", section on 'Epidemiology' and "Overview of obstructive sleep apnea in adults", section on 'Age' and "Clinical features and diagnosis of restless legs syndrome/Willis-Ekbom disease and periodic limb movement disorder in adults", section on 'Epidemiology' and "Rapid eye movement sleep behavior disorder", section on 'Epidemiology'.)

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Literature review current through: Nov 2017. | This topic last updated: Sep 19, 2017.
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