“Learn to Manage Common Behavior Problems” (anger, hallucinations, nighttime wakefulness)

This will be of interest to those dealing with dementia (not only Alzheimer’s Disease) and related behavioral problems.

This guide is titled “Learn to Manage Common Behavior Problems.”  The problems addressed include:

  • wandering
  • rummaging around or hiding things
  • belligerence,  anger or aggressive behavior
  • hallucinations, illusions and paranoia
  • nighttime wakefulness and other sleep problems
  • refusing to eat

Though the guide is focused on Alzheimer’s caregivers, Lewy body dementia and other caregivers are challenged by these same problems.

You can find the guide online here:


I’ve copied some excerpts below.  (I read about this online resource tonight on a caregiver discussion group.)



Excerpts from

Alzheimer’s Behavior Management:
December 19, 2007

…Most behavior problems pose serious difficulties for the person trying to provide care. Management of this behavior will require the caregiver to modify the home environment and change communication styles.

In This Article:
Management of wandering
Management of rummaging around or hiding things
Management of belligerence, anger or aggressive behavior
Management of hallucinations, illusions and paranoia
Management of nighttime wakefulness and other sleep problems
Management of refusing to eat
Related links


Management of belligerence, anger or aggressive behavior
Following are some ideas about caring for an aggressive Alzheimer’s patient. Consider each idea independently of the others.

Don’t confront the person or try to discuss the angry behavior. The person with dementia cannot reflect on their unacceptable behavior and cannot learn to control it.

Do not initiate physical contact during the angry outburst. Often, physical contact triggers physical violence in the patient.

Provide the person with a “time-out” away from you. Let them have space to be angry by themselves. Withdraw in the direction of a safe exit.

Distract the person to a more pleasurable topic or activity.

Look for patterns in the aggression. Consider factors such as privacy, independence, boredom, pain, or fatigue. Avoid those activities or topics that anger the person. To help find any patterns, you might keep a log of when the aggressive episodes occur.

If the person gets angry when tasks are too difficult for them, break down tasks into smaller pieces.

Minimize stress and novelty.

Maintain calm within yourself. Getting anxious or upset in response may escalate the aggressiveness.

Let the person play out the aggression. Just be sure that you are safe and that they are safe themselves.

Get help from others during the activities that anger the patient.

Don’t take the aggressiveness personally.

Management of hallucinations, illusions or paranoia
Hallucinations can be the result of failing senses. Unidentifiable sounds, shadows, and highly contrasting colors all can become the basis for fantasy. Decrease the number of things in the environment that can be misinterpreted as something else, such as patterned wallpaper or bright, contrasting surfaces or objects. Increase lighting so that there are few shadows while avoiding glare, and remove or cover mirrors if they cause problems. Maintaining sameness in the environment may also help reduce hallucinations. Also, violent movies or television can contribute to paranoia – avoid letting the patient watch disturbing programs.

When hallucinations or illusions do occur, don’t argue about what is real and what is fantasy. Discuss the patient’s feelings relative to what they imagine they see. Respond to the emotional content of what the person is saying, rather than to the factual/fictional content.

Medications can sometimes help to reduce hallucinations, so seek professional advice if you are concerned about this problem.

Management of nighttime wakefulness and other sleep problems
Brain disease often disrupts the sleep-wake cycle. Alzheimer’s patients may have wakefulness, disorientation, and confusion beginning at dusk and continuing throughout the night. This is called “sundowning.” There are two aspects to sundowning. First, confusion, over-stimulation, and fatigue during the day may result in increased confusion, restlessness, and insecurity at night. And second, some Alzheimer’s patients have fear of the dark, perhaps because of the lack of familiar daytime noises and activity. The patient may seek out security and protection at night to alleviate their discomfort.

Following are some strategies to reduce nighttime restlessness:

Improve sleep hygiene

Physical activities will help the person feel more tired at bedtime. Walk with the person during the day. If the person seems very fatigued during the day, give them a short rest in the afternoon to regain their composure. This can lead to a better night’s sleep. But don’t let them sleep too long – too much daytime napping can increase nighttime wakefulness. Also, limit the patient’s caffeine intake.

Be consistent with the time for sleeping, and keep a routine for getting ready for bed.

Create a calm atmosphere for sleeping

Give the person a bath and some warm milk before bed. Provide a comfortable bed, reduce noise and light, and play soothing music to help them get to sleep.

Close the curtains and leave a night light on all night. Some people with dementia imagine things in the dark and become upset. Stuffed animals or a pet may soothe the patient and allow them to sleep.

Have the person use the toilet right before bedtime. Place a commode next to the bed for nighttime urination. Walking to the bathroom in the middle of the night may wake the person up too much, and then they can’t get back to sleep.

The person may prefer to sleep in a chair or on the couch, rather than in bed. Furniture must be designed so that the patient won’t fall out while sleeping.

Resolve common problems
If the patient paces during the night, make sure that the primary daytime caregiver can sleep. This requires either a very safe room for the patient to pace in, or else another caregiver who takes over at night. You need your rest, too. Do not restrain the patient in bed, but consider a hospital bed with guard rails in the later stages of Alzheimer’s.
If night wakefulness has gotten too hard for you to manage, consult with a doctor if you wish to try administering sleeping pills.


Doug Russell, L.C.S.W., Suzanne Barston, and Monika White, Ph.D., contributed to this article. Last modified on: 12/19/07.