Dementia patients often become paranoid at night due to a combination of brain changes, disrupted sleep patterns, and confusion about their surroundings. One key factor is something called sundowning, where symptoms like confusion, restlessness, and paranoia worsen in the late afternoon and evening. This happens because dementia affects the brain’s internal clock, or circadian rhythm, making it hard for patients to distinguish between day and night. Their brains may produce less melatonin, the hormone that helps regulate sleep, leading to poor sleep quality and increased agitation.
At night, the environment can feel unfamiliar and more threatening to someone with dementia. Reduced lighting, shadows, and less activity can cause them to misinterpret what they see or hear, fueling feelings of suspicion or fear. Fatigue also plays a role—mental and physical tiredness can make it harder to think clearly, increasing paranoia. Additionally, disruptions in REM sleep, which is important for memory and emotional regulation, can worsen symptoms.
Certain types of dementia, like Lewy body dementia, are more likely to cause vivid hallucinations and paranoia, especially at night. Patients may wrongly believe that caregivers or loved ones intend to harm them or steal from them, which can lead to anxiety and even aggression.
In summary, dementia-related paranoia at night arises from a mix of brain changes affecting sleep and perception, environmental factors that confuse the patient, and exhaustion that lowers their ability to cope with these challenges.
