An 86-year-old woman with dementia manages her confusion reasonably well during daylight hours. But when darkness falls, terror sets in. She doesn’t recognize where she is or who’s with her. Across Toronto, another senior living alone lies awake worrying—convinced someone knows she’s vulnerable and will break in during the night.
Whether rooted in physical changes, psychological anxiety, or dementia-related conditions, nighttime presents unique challenges for many older adults—especially those living alone in East Toronto neighbourhoods.
Why Seniors Struggle with Sleep
A 2005 Gallup poll found that fewer than one-third of adults over 50 reported getting good sleep all seven nights of the week. Yet these same respondents ranked quality sleep as more important than interpersonal relationships.
The problem isn’t simply aging itself, but the physiological changes that accompany growing older.
Physical Factors Disrupting Sleep:
Dr. Harrison Bloom, geriatrician and senior associate at the International Longevity Center–USA, explains that older adults spend less time in certain critical sleep stages. Medical conditions compound these changes:
- Congestive heart failure patients can’t lie flat comfortably
- Arthritis pain makes finding comfortable positions difficult
- Medications cause side effects that interfere with sleep
- Bladder and prostate issues require frequent bathroom trips
- Each interruption fragments sleep further
Dr. Sonia Ancoli-Israel, professor of psychiatry at UC San Diego and director of the Sleep Disorders Clinic at the Veterans Affairs San Diego Healthcare System, adds that psychiatric conditions and changes in circadian rhythms also contribute to poor sleep in older adults.
Public Health Sudbury & Districts offers 12 practical sleep tips specifically designed for older adults, including keeping a sleep diary to identify patterns.
Circadian Rhythm Changes and Dementia
Our internal clocks—circadian rhythms—shift as we age, affecting when we naturally feel sleepy and alert. For seniors with dementia, this becomes even more pronounced.
Ancoli-Israel’s research exposed nursing home residents with dementia to bright light therapy, either in the morning or in the evening, to adjust their circadian rhythms. Both approaches improved nighttime sleep quality.
Sundowning and Dementia
Many seniors with Alzheimer’s disease or other dementias experience “sundowning”—increased confusion, agitation, and anxiety as daylight fades. The Alzheimer Society provides detailed guidance on sleep disturbances in people living with dementia.
Managing sundowning requires consistent routines, adequate daytime activity, and environmental modifications. Elder.org’s sundowning advice for caregivers emphasizes the importance of maintaining familiar surroundings and reducing evening stimulation.
The Medication Question
Between 2000 and 2004, prescription insomnia drug use rose 16% among people 65 and older. While understandable, sleep medications may not be the best solution for many older adults.
Dr. Sharon Brangman, professor of medicine and division chief of geriatrics at SUNY Upstate Medical University, cautions that sleep medications can cause confusion and disorientation—symptoms that shouldn’t be exacerbated in seniors already experiencing them due to dementia.
Choosing Wisely Canada explains why sleeping pills are risky for older adults and what alternatives work better. The Canadian Deprescribing Network provides evidence-based strategies to sleep well without medication, including cognitive behavioural therapy for insomnia (CBT-I).
For more clinical information, the Canadian Guidelines on Benzodiazepine Receptor Agonist Use Disorder address appropriate use in older adults.
The Caregiver’s Nighttime Challenge
Dr. Brangman describes a typical scenario: “I have an 80-year-old Alzheimer’s patient who is very anxious during the afternoon. She naps in front of the television in the evening and doesn’t want to sleep at night. Her husband—her primary caregiver—is exhausted but afraid to sleep because she might wander. When she does sleep, he often lets her sleep until noon.”
The recommendation? Discourage daytime napping, encourage daytime activities, and arrange respite breaks so the caregiver can rest.
Alberta Health Services provides sleep support tools and resources specifically for older adults and their caregivers.
Psychological Anxiety After Dark
Beyond physical issues and dementia-related confusion, many seniors experience heightened anxiety at night for purely psychological reasons.
“Many seniors undoubtedly are anxious because they know it’s harder to reach help at night,” Ancoli-Israel observes. “There’s also more time to think about all the things that might be going wrong.”
Living alone amplifies these fears. The senior who worried about break-ins wasn’t experiencing dementia or sleep disorders—she simply felt vulnerable in the darkness.
How Overnight Companionship Helps
The 86-year-old woman with dementia we met at the beginning receives overnight care. When she wakes confused and frightened, her Care Pro immediately reassures her, helping her understand where she is and that she’s safe.
For the woman afraid of break-ins, practical solutions made the difference: securing doors and windows, adding motion-sensor lighting at the front and back of her house, and having someone present overnight to provide reassurance.
“Our Care Pros are regularly called upon to provide overnight care for seniors and assist them with the anxiety that often sets in at night,” notes Paul Hogan, CEO of Home Instead Senior Care. “It’s those kinds of ‘extras’ that can mean the difference between seniors having peace of mind, or being afraid in their own homes.”
Overnight Care Options in Toronto East
Home Instead Toronto East provides overnight companionship and care services that address both practical needs and emotional reassurance:
- Assistance with nighttime bathroom trips
- Medication reminders
- Reassurance during periods of confusion or anxiety
- Help if falls or emergencies occur
- Peace of mind for family members who can finally sleep
Whether your parent experiences dementia-related sundowning, physical conditions that disrupt sleep, or feels afraid alone at night, professional overnight support can transform their experience—and yours.
Request information about overnight care options to discuss your family’s specific situation and how we can help restore peaceful nights for everyone.
