Sleeping Seated: Protecting Vulnerable Patients

When a resident with dementia experiences brainstem damage, two significant consequences often occur:

1. Disruption of the sleep–wake cycle¹

1. Autonomic nervous system (ANS) dysfunction²

Both of these conditions can put the resident at serious risk — especially if their seating posture is incorrect. Proper positioning in a seating system is crucial to prevent additional health complications.

1. Sleep Cycle Disruption in Dementia^1,3

Residents with dementia may experience changes to their sleeping patterns, including:

• Disruption of deep sleep and the REM cycle
• Reduced alertness
• Persistent fatigue
• Insomnia and other sleep disorders

In advanced stages, residents may be awake for up to 40% of their time in bed, leading to:

• Decreased alertness
• Daytime fatigue
• Sleeping while seated in a chair

Unfortunately, sleeping in a chair often causes slouching, sliding downward, and leaning, which can constrict the chest and abdomen — severely compromising breathing, digestion, and circulation.

2. Autonomic Dysfunction²

The autonomic nervous system controls essential, involuntary functions. Damage can lead to:

• Irregular heart rate
• Abnormal respiration patterns
• Poor regulation of blood pressure
• Digestive disturbances (loss of appetite, weight changes)
• Impaired temperature regulation

When combined with poor posture in a chair, these dysfunctions may intensify, putting the resident at higher health risk.

The Effects of Chest and Abdominal Constriction⁴

When posture or chair design causes compression of the chest and abdomen:

Breathing becomes less efficient:

• • Diaphragm movement is restricted
  • Lungs fill with less air → shallow, rapid breathing
  • Increased energy needed for breathing → fatigue of abdominal muscles
  • Reduced oxygen delivery to the body
  • Higher risk of lung fluid accumulation → pneumonia.

Digestion is impaired:

• Slow digestive transit → reflux, gastritis, constipation/impaction

• Aspiration and choking risk increases

Urinary function is affected:

• Incomplete bladder emptying → increased UTIs and kidney infections

Positioning Strategies for Residents Who Sleep in Chairs

While the ideal solution is to avoid sleeping in a chair altogether, in reality, this often occurs. The goal is to:

• Keep the chest and abdomen open to prevent compression
• Reduce fall risk during unconscious or drowsy states

Avoid:

• Chairs that are too upright → abdominal fatigue, trunk collapse, increased fall risk
• Overly tall backs → promote sliding into sacral sitting and exaggerated kyphosis
• Recline-back chairs → excessive angle encourages sliding and thoracic kyphosis, causing chest compression
• Immersion-only cushions → less stability when muscles are inactive during sleep

Wheelchair Selection Guidance

Choose chairs with adjustable positioning features that:

• Redistribute pressure safely
• Support trunk alignment
• Promote optimal heart, lung, digestion, bowel, and bladder function
• Minimize the risk of sliding into harmful postures