Bed Safety for Restless Sleepers and Night Wanderers

Why some people are restless at night

Restlessness is a symptom, not a diagnosis. Common causes include:

• Dementia. Sleep patterns break down, with daytime napping, evening agitation (sundowning), night waking and disorientation; see dementia sundowning and dementia daily routines.
• Delirium, sudden confusion caused by infection, dehydration, medicines, pain, constipation or other illness, which needs urgent medical attention; see delirium in older adults.
• Pain, from arthritis, pressure on the skin, a fracture or cancer; see chronic pain in older adults.
• Needing the toilet, constipation or a full bladder; see night-time toilet trips and falls.
• Hunger, thirst, cold or heat.
• Breathing problems, sleep apnoea, heart failure; see sleep apnoea in older adults.
• Restless legs and cramps; see restless legs and night cramps.
• Medicines: some cause restlessness, vivid dreams or insomnia; others cause drowsiness and confusion. Review with a doctor; see polypharmacy and deprescribing.
• Anxiety, depression or fear; see anxiety in older adults.
• Sleep disorders, such as REM sleep behaviour disorder where a person acts out dreams, common in Parkinson's disease and some dementias.
• Environment: noise, light, strange room, hospital stay, travel.
• Poor daytime routine: too much napping, little daylight, little activity; see sleep problems in older adults.
• Unmet needs and boredom.

Always start by asking what the person may be trying to tell you. A person who gets up repeatedly may be looking for the toilet, searching for a familiar place, or acting on an old routine.

Get a medical review

A doctor should check any new restlessness or night confusion, especially if sudden. They may look for:

• infections, such as urine, chest or skin infection;
• dehydration, constipation or low blood sugar;
• pain and side effects of medicines;
• thyroid, anaemia or other medical conditions;
• sleep disorders, mood and cognition.

Do not give sedatives, sleeping tablets or leftover medicines without a doctor's advice. Sedatives increase the risk of falls and confusion, and they are not a safe long-term answer. See medicine side effects families should watch and dementia and medicines at home.

Making the bed safer

Height. A bed at a safe height, with feet flat when sitting at the edge; or a low bed if the person is likely to roll or fall out; see bed height and getting out of bed and bed choices for dementia.

Floor protection. A soft crash mat beside the bed to reduce injury from a fall; remove it if the person walks, to avoid tripping.

Mattress. A firm edge, with no soft edge that tips a person; a mattress that matches the bed.

Rails: caution. Rails can trap limbs, necks and chests, and encourage climbing over, with falls from greater height. For restless people, they are often unsafe; see bed rails guide. Choose alternatives first. If rails are advised by a professional, follow strict checks.

Bumpers and bolsters. Some firm foam bolsters along the bed edge, fixed under the sheet, can reduce rolling out, but check entrapment risk and avoid soft pillows that may suffocate or be climbed over.

Bed placement. One side against a wall, if the person rolls to that side, and a clear exit on the other, with a mat. Keep the bed away from windows, heaters and furniture with sharp corners.

Clear floor and furniture. Remove clutter, rugs and cables; keep furniture sturdy and corners padded.

Light. A night light to help the person see and to reduce disorientation; see motion-sensor night lights.

Temperature and noise. Keep the room comfortable and quiet.

Bedding. Light, smooth, breathable, with no loose items to tangle in; see bed linen and fabrics for sensitive older skin.

Sensors and alerts

The aim is to know when the person is up, so that someone can come quickly.

• Bed or mattress sensor that signals when the person leaves the bed, sometimes with a short delay.
• Floor mat sensor beside the bed.
• Motion sensor in the room or hallway.
• Door sensor on the bedroom door, bathroom door or front door; see door sensor guide.
• Baby monitor, audio, and video only with consent and respect for privacy; see privacy and dignity with monitoring.
• Wearable alarm or GPS tracker, particularly for those who may leave the house; see gps tracker for seniors guide and wandering and dementia safety.
• Smart plugs, lights and chimes that signal a family member.

Where the receiver should sound depends on the home. In a joint family, a chime near the carer's bed is better than an alarm that wakes the person. Sudden alarms can startle and frighten a confused person; use soft chimes. Test regularly, replace batteries and plan who responds; see responding to an alert: who does what and safety device batteries and checks.

Door and exit safety

A person who wanders can come to harm outdoors, in traffic, in heat or cold, or get lost.

• Door alarms or chimes on external doors, balcony doors and gates.
• Secure locks placed high or low, out of the usual sight line, such as a latch above eye level; ensure the household can open them quickly in a fire, and that keys are available. Never lock a person in a room alone. See lock and door safety for seniors.
• Camouflage the door with a curtain or a mural, so that it is not obvious.
• Remove coats and shoes from view.
• Safe outdoor spaces, such as a fenced garden or a balcony with secure rails and screens; see garden, balcony and terrace safety.
• ID bracelet and contact card with the person's name, address and phone; see emergency contact card and medical summary.
• A recent photograph and a plan if they are missing: call neighbours, society security and police; see wandering and dementia safety.
• In apartments, tell security staff and neighbours; see safety in gated societies and apartments.
• Kitchen and bathroom safety for wandering at night: stove guards, auto-off devices, and water temperature limits; see auto-off kettle and stove safety.

Calm routines that reduce restlessness

• Daytime light and activity. A morning walk or sit in daylight, light exercise and meaningful activity, so that the body clock stays steady; see chair exercises for seniors.
• Limit naps to a short one in the early afternoon.
• Avoid caffeine after midday and heavy meals late at night.
• A set evening routine: a warm wash, quiet music, a familiar prayer or song, a light snack, toilet before bed.
• A calm bedroom with a comfortable temperature, soft light and few distractions.
• Check basic needs before bed: pain, toilet, hunger, thirst, warmth.
• Soothing touch and voice if the person wakes distressed. Speak slowly and simply, and reassure, rather than argue.
• If the person gets up, guide them gently to the toilet, then back to bed. Use a calm, friendly manner. If they are very distressed, sit with them for a while, offer a warm drink, then try again.
• Do not restrain. Tying hands or using belts is dangerous and distressing, and can cause injury, and is not acceptable as routine care. See dignity and consent in care.

Looking after the carer

Night-time care is exhausting. Share the load: take turns, ask neighbours or paid attendants to help, and allow yourself a rest in the day; see night-time caregiving routines, caregiver burnout signs and prevention and respite care and taking a break. If you are worried that you cannot keep your parent safe at home, talk to a doctor or social worker about options; see when home care is no longer enough.

When to ask a professional

Call a doctor promptly for sudden restlessness or confusion, which may be delirium, for falls, head injury, fever, new pain or new symptoms. A memory clinic, geriatrician or psychiatrist can help with dementia-related sleep and behaviour. An occupational therapist can assess the bedroom, bed and sensors. A nurse can advise on continence, skin and positioning. A dementia helpline or support group can advise carers. Call emergency services if the person is missing, has a serious fall or becomes unresponsive.