Awake at three in the morning

Her clock has come loose

The body keeps time using light, activity and habit, and memory loss weakens all three at once. Days spent indoors in low light, with long naps in the chair and nothing that has to happen at any particular hour, give the internal clock nothing to hold on to. So it drifts, and three in the morning stops being obviously the middle of the night.

She is usually not distressed, which surprises families. She is simply up, because as far as her body is concerned it is a reasonable time to be up. The distress mostly belongs to whoever has work at nine.

Fix the day, not the night

Almost everything that improves nights is done between seven in the morning and six in the evening. This is slow and unglamorous and it is where the actual improvement comes from.

Give it two weeks before deciding it has not worked. You are moving a body clock, not flipping a switch.

• Real daylight in the morning. Twenty minutes on the balcony or in the garden, ideally at the same time daily. This is the strongest single lever and it is free.
• Cap the afternoon nap at about forty minutes, and never after four o clock.
• Move the body some time in the day. A walk to the gate and back counts.
• Tea and coffee stop after lunch. Older people clear caffeine slowly and the evening cup is frequently the whole problem.
• Same order every evening: food, wash, change, one quiet thing, bed. The sequence is what she is following, not the clock.

What to do at three in the morning

Not much, and quietly. The aim is to make the night boring rather than to win an argument about the time.

Keep the lights low, your voice low, and the television off. Do not announce that it is three in the morning, which only produces an argument you cannot win. If she wants tea, give her a small cup of something warm without caffeine and sit with her for ten minutes. Most of the time she will go back once the wanting has been met.

If she is going to be up regardless, let her be up somewhere safe rather than fighting her back to bed. A lit hallway, a clear floor, and a chair she likes are worth more than an hour of persuasion.

Make the house safe for a dark walk

Assume she will get up and move without waking anybody, because she will. The point is that this should be survivable rather than prevented.

Plug in night lights along the route from her bed to the bathroom. Take the loose rugs and the extension cords out of that path entirely. Keep the bathroom light on all night, since a lit doorway is the cheapest way to make the right room obvious. If the stairs are on the route, put a gate on them. Bolt the front door somewhere she does not look, which is usually low down.

Divide the nights before somebody breaks

A family where one person does every night is a family running out of time, and it usually ends not in a decision but in a collapse.

Split it explicitly rather than by default. Alternate nights between two people. Pay an attendant for the night shift two nights a week so one person gets a real sleep, which is a far better use of money than most things families spend on. If somebody lives abroad and is awake anyway in their own daytime, give them the hours nobody else can cover.

And say plainly that sleep loss is not a character test. Weeks of broken sleep make anybody short tempered, tearful and slow, and a family that understands that will forgive things it otherwise would not.

Where else to look

These are other people’s pages, not ours. Our own published work and the neurologist who reviews it are on the research page.

• Cultural adaptation of Alzheimer’s disease assessment scale-cognitive subscale for use in India and validation of the Tamil version for South Indian population.
  The cultural adaptation of the same questionnaire for use in India.
• Hindi Version of Addenbrooke’s Cognitive Examination III: Distinguishing Cognitive Impairment Among Older Indians at the Lower Cut-Offs.
  A Hindi memory questionnaire validated for older adults in India.
• Alzheimer’s and Dementia Support, India
  The Alzheimer’s Association’s own pages for families in India.