Better night sleep for people with dementia

— with the result that quality of life is increased through better daytime activities

The narrative is part of the Find & Enlarge movement. Success stories of courage and willingness to innovate in the public sector.

The challenge

Many people with dementia find it difficult to keep track of their circadian rhythm. They are often interrupted in their sleep, get up at night, and think that it is tomorrow/day. It results in a poor quality of sleep, which affects the individual's well-being and can cause negative symptoms such as anxiety and insecurity. This can translate into outward-reacting behavior and consequent increased medication.

The ambition

The ambition is for our residents with severe dementia to get a better night's sleep, so that they would be more healthy and healthy during the day. By doing so, they could engage in more activities and thus achieve a physical fatigue for the next evening. In this way, they would start a positive spiral, with fewer symptoms and, in the long run, less medication.

The solution

Based on research results from England and especially the Netherlands, we implemented that our night watchmen, in our section for people with severe dementia, wore pajamas, turned down the lights and, by the way, 'activity' (cleaning, etc.) at night.

When residents awaken, they are now met by a pajama-clad night watchman, who knocks his hair out and yawns loudly. In professional terms, this is an expression of the concept of 'mirroring', in which the resident with dementia is helped to find out that it is night — by reflecting on the attire and behaviour of the night watchman. As pack animals, we humans orient ourselves, fundamentally in relation to, our fellow humans and act in accordance with them.

Measurable results and side effects

We have achieved that residents, who used to be very up at night, now wake up fewer times. When they wake up, they are up for less time because they are quickly helped to time orientation by mirroring themselves in the night shift.
We have not measured medication consumption, where we also have other measures in progress, but we would like to work on this more systematically, together with our new nursing home doctor.

As a side benefit, night watchmen have been given a calmer working environment, where it has become legal that they do not have to do all sorts of practical tasks at night. It is already a health burden to work at night, so this action is expected to have a positive impact on the health of night watchmen, where it is darker and calmer at night. We are also working to introduce circadian lights, which will support the measures in relation to better night sleep for residents and a better working environment for employees.

The spreading potential

In October 2021, when we were the first in Denmark to implement pajamas in the night shift, we were exposed to this on national TV, and more people have approached us since then to hear more about how we have done it. Since then, you can see on social media that many other places have seized on the idea and introduced pajamas into the night shift. It's super easy to get started with — it only 'costs' some pajamas, and then of course the staff has to be on board with the idea. Our night watchmen are crazy about it and certainly don't want to go back to old practices.

Other messages

The very way we work with, implementing and testing knowledge, evidence, research from other areas/countries has also been mentioned in connection with the award for the most dementia-friendly staff at the Dementia Summit 2022. Night guards in pajamas are one example of this, other examples are colored service that supports appetite and thirst, the involvement of nature and 'person-centered documentation' — where we document in 'I-form' and thus shift the focus from 'having to solve a task' to 'having to help a unique human'.