Wisdom we wish we had about all phases of incontinence before it began.

As caregivers for our loved ones with Alzheimer’s and other types of dementia, we’ve learned overnight incontinence is one of the most challenging aspects of the journey. It’s not a topic often discussed, yet it’s a reality for us to face with compassion, dignity, and preparation. 

We are Nancy Treaster and Sue Ryan. Through our experiences, and what we’ve learned from support groups and others on their journeys, we’ve developed four important tips to help you navigate overnight incontinence on your caregiving journey.

Understanding Overnight Incontinence in Dementia Care

Before we dive into our tips, it’s important to understand what to expect with overnight incontinence in dementia care:

 Overnight incontinence can be particularly challenging because it affects the sleep of both the care receiver and the caregiver.

It often requires a balance between managing a mess and getting necessary rest.

This stage can be an inflection point in the caregiving journey, potentially requiring additional help or considering moving your loved one into a care community.

It’s important to maintain your care receiver’s dignity throughout this process.

Sue’s Experience:

There’s a tough balancing act here. While we want to minimize messes, we also need to get sleep. We need to prioritize ourselves too. This is an example of when we talk about self-care, where we are not shaving something off. Don’t shave off sleep – it’s not sustainable. It’s very important to reach out for support during this time if you’re not able to get sleep. If you’re a family member of a caregiver, ask them how they’re sleeping at night. This is an area where you can really lean in to help.

Nancy’s Experience:

I feel that, until they’re completely incontinent (both urinary and bowel), if you have no additional support, there will be accidents you can clean in the morning, rather than getting up multiple times during the night. Prepare the night before for cleaning them thoroughly in the morning, along with, potentially, their bed linens.

Here are four tips to help you navigate this challenging phase:

Tip 1: Transition to Nighttime and ultimately Disposable Incontinence Underwear

It’s important to ensure your care receiver has appropriate protection overnight.

Sue’s Experience:

Right after my husband was diagnosed, I brought up the topic of incontinence. I said, “Honey, there’s going to be a day when you’re incontinent and you’re not going to be able to get to the bathroom on time. I want to make sure that while you can still tell me what’s comfortable and not comfortable, we try some of these products out.” We explored different types of disposable incontinence underwear (there are multiple brands available for men and women and multiple options for whether they have tabs or are pullup).  When the time came, I knew what to do. 

As his diagnosis progressed and it became time to transition to overnight incontinence underwear, over the course of a week, I started replacing his underwear with urinary incontinence underwear. I would do this every other day and, if he asked where his underwear were, I’d just say, “Honey, they’re in the laundry.” After a week, all his underwear were the adult disposable urinary incontinence underwear.

Nancy’s Experience:

My husband didn’t wear nighttime underwear initially. We did start with washable incontinence underwear. When they’re beginning to be incontinent, they have to have something on to absorb the liquid even when they just can’t get to the bathroom fast enough, including at night. You really have to transition them into some kind of nighttime underwear.

Tip 2: Protect the Mattress

Accidents will happen, so it’s important to protect the bed.

Nancy’s Experience:

The best waterproof mattress cover we both found was the allergy-proof mattress bags. They say they’re waterproof – and they are. Most of the rest of the mattress covers that say they’re waterproof might be fine for a child, but they’re not waterproof for a grown adult who might completely go to the bathroom in the bed.

To better protect the mattress, I use four layers. The bottom layer is the waterproof mattress bag. The next layer is a waterproof mattress cover that’s fitted to the bed. On top of this is a loose ‘waterproof’ mattress pad. It is absorbent but not enough on its own. The top layer is another fitted waterproof mattress cover. Depending on the size of the accident, we may only need to take off one layer, or we may need to take off three layers.

Sue’s Experience:

Another tip that’s really helpful, especially if you’ve got a king bed, is making it two twin beds you put together. This way, you’re not changing the entire bed every time there’s an accident. If you keep your loved one home and they become bedbound, it’s also easier to be able to get to both sides because you can separate the two beds.

Tip 3: Make the Bathroom Easy to Find

Help your care receiver locate the bathroom easily if they wake up during the night. We cover this in detail in podcast episode 9 Preparing for Incontinence.

Sue’s Experience:

We call it making it a beacon. You want to make it as easy as possible to find the bathroom. Have lights on the way to the bathroom, and leave a bright light on in the bathroom, so it’s like a beacon.

Take everything away that could be distracting to them – no glass, no harmful products. For each of my care receivers, I observed them making their way to the bathroom to see what interfered with their ability to get straight there.

Then, reverse your observation for how easily they can return to bed from the bathroom. The big issues here are their forgetting they’re coming back to bed, and shadows – with their vision changing throughout the diagnosis, shadows can become frightening for them. Options include night lights and experimenting with motion sensing lights – for one care receiver these were startling, for another they were no issue.

Tip 4: Keep Your Care Receiver Comfortable Overnight

As incontinence progresses, it becomes important to take additional steps to ensure comfort.

Nancy’s Experience:

We use Depend® incontinence underwear for my husband. For overnight, sometimes it’s not enough on its own for someone to be dry and comfortable throughout the night – even the ones with the nighttime strips in them. There are products for both men and women to provide extra support. Using the Depend brand, there is a product for men called Guards, meant to go in the Depends mostly at night for extra absorbency. Poise® has products for women that have multiple lengths and multiple levels of absorbency to add to the disposable incontinence underwear. 

At one point, I learned that some care communities change residents in the middle of the night. It never crossed my mind to change my husband in the middle of the night. I know not everyone can do this. Some caregivers require more hours of sleep, and this is not even an option. For me, it was a wake-up call. I’m a light enough sleeper. I’m able to sleep for a good four hours and then I wake up pretty refreshed and then I go back to sleep for another four hours. Now when I wake up in the middle of the night, I go to my husband’s room and change his incontinence underwear. I go back to bed and he goes back to bed. it’s a pretty easy process for me.

Sue’s Experience:

One of the things we want to make sure of is that they’re staying hydrated. It’s so important for them not to get dehydrated or develop urinary tract infections. One thing you can do is help them get that water earlier throughout the day and then stop it earlier in the evening. This way, they’ll have much less need to void throughout the middle of the night.

Final Thoughts

 Navigating overnight incontinence in Alzheimer’s and dementia care is challenging in the beginning as you’re both adapting. With patience, curiosity, compassion, preparation and the right mindset, it can be manageable.

Key points:

 Transition to appropriate nighttime protection.

• Protect the mattress and be prepared for frequent sheet changes.
• Make the bathroom easy to find.
• Keep your care receiver as comfortable as possible overnight.
• Consider a mid-night change if possible.
• Maintain hydration but manage fluid intake timing.

Sue’s Experience:

One of my key questions in evaluating each community was their incontinence procedures:

How often is the resident checked and changed throughout a 24-hour period – not just during the day?

 One component of my being the best care partner I can be while my care receiver is in the community, is observing, at different times of day and night, when and how they are changed. I came at different times of day, on different days. I periodically stayed overnight or came in before the night shift changed to see if they changed my care receiver. I always volunteered to support them in their changing process. The team in our care community knew I came in, and I was never displeased with the care my loved one received.

Give yourself a tremendous amount of grace. 

Check in with yourself: 

Is this something that you are feeling okay handling on your own at home? 

Do you need to bring in someone to help support you during the overnight hours? 

Is this potentially an inflection point for considering moving your loved one into a care community?

Nancy’s Experience:

In the beginning, this is a difficult part of the journey to manage when so much is new. While it does go through a very messy stage and finally gets more into a rhythm, it does not go away.

This phase is part of your journey. You’re not alone. Reach out to support groups, healthcare professionals, or fellow caregivers for advice and emotional support.

If you have tips you think others would benefit from, please share them on our Facebook page or Instagram page. You can find the links in our show notes.

If you’d like more information on this topic listen to the podcast here. You can find links to the products we reference in the show notes of our podcast.

We’re all on this journey together.

Additional Resources Mentioned

• Episode 4 – Wandering here
• Episode 10 – Incontinence Begins here

These resources contain affiliate links so we may receive a small commission for purchases made at no additional cost to you.

• • Child proof door knob cover or double deadbolt locks for external doors
    • Child proof door knob covers here
    • Lever child proof door knob covers here
    • Extra tall pet gate from (40” to 70”) – 57” here
• Disposable incontinence underwear
  • For women here
  • For men here
• Pads
  • Mattress pads
    • 34”x36” here
    • 72”X36” here
  • Disposable incontinence pads here
  • Brown large pet pee pads here
  • Mattress bag here
  • Peelaways here
• Cameras or baby monitor for the bedroom and bathroom
  • Baby monitors – some come with motion alarms here
  • Motion alarm here
  • Cameras – If your care receiver is still staying home alone, consider one with an intercom
    • Ring indoor with two-way talk here
• Washable incontinence underwear 
  • For women
    • Colors here
    • Cream here
  • For men 
    • Briefs here
    • Boxer briefs here
• Disposable incontinence underwear
  • For women here
  • For men here
• Disposable incontinence underwear guards 
  • For men here
  • For women here
• Adult washcloths/wipes here
• Disposable incontinence pads here
• Round tipped scissors here