medications for Alzheimer's-related sleep disturbances?

[everdrew89]

Hi

Does anyone have any good experiences with using medications for Alzheimer's-related sleep disturbances?

Husband has young onset Alzheimer's, moderate to severe, in residential care. He's on standard Aricept and Memantine and since 2 weeks on Trazodone to help with sleep disturbances. Trazodone seems to have lifted his mood but not helped with sleep disturbances (zero hours sleep last night). Maybe 2 weeks is too early to judge ...

Got appointment with psychiatrist from Community Mental Health Team on Wednesday morning so would appreciate any recommendations based on good experiences of managing sleep disturbances ...

Many thanks ...

PS he does some form of physical exercise every day so we are doing the max from a non-medication point of view ...

 

[LadyA]

No experience at all, I'm afraid. My husband used to only sleep for a maximum of two hours at a time. He was on quite a bit of medication, including anti psychotics and trazadone. They helped with his paranoia and hallucinations, and he was much less agitated and more content and relaxed. Didn't really sleep any better though.

 

[everdrew89]

Thanks LadyA. That's helpful, if somewhat depressing ... did he just have two hours here and there at any time of day or night then? I read somewhere that a person may only get about 6 hours sleep over a 24 hour period ... and that the carer's expectations about how much sleep they will get need to be realistic ...
He does seem to be in a much better mood since being on Trazodone so I'm tempted to keep him on that despite it not seeming to help much for sleep ...

No experience at all, I'm afraid. My husband used to only sleep for a maximum of two hours at a time. He was on quite a bit of medication, including anti psychotics and trazadone. They helped with his paranoia and hallucinations, and he was much less agitated and more content and relaxed. Didn't really sleep any better though.

 

[PollyP.]

Hi Everdrew

Not much help really, but my Mum is 101 now! and is in a really lovely care home. She has great difficulty with sleeping at night and they (with the help of the Doctors) have tried lots of medication, but have now stopped it all as it really didn't agree with her.

She has a couple of paracetamol which seems to relax her. but she can still nip up and down the corridor all night...the carers all say they wish for her energy! She does sleep a lot during the day, sometimes in a comfy armchair and sometimes on her bed.

It seems to be a very common problem with dementia (Mum's is Alzheimers, she was diagnosed 8 years ago.) It''s very hard for us to understand how some-one can keep going without sleep, I know that if I don't have a good 8 hours I don't function properly, but then it seems that dementia can affect the way that the brain operates when it comes to sleeping. We did try Melatonin for about a month, but the Doctor said it wasn't doing anything and took her off it.

In the end it all comes down to the individual, I hope that they can find a suitable medication for your husband. It is quite upsetting for you thinking that he cannot sleep. Are the Care Home coping with him at night time?

Pauline
xx

 

[everdrew89]

Many thanks for your reply PollyP.

My husband has very high energy levels too ...

He's had sleeping problems on and off for about six months but he never remembered if he hadn't slept and it didn't seem to affect his energy levels or ability to function ...

But in the last few weeks there were increasing reports from the home that he was becoming a bit aggressive, kicking and banging doors at night and sometimes waking up other residents (which is problematic as far as I am concerned).

My theory is that it's anxiety-based, since he apparently can't tell the difference between day time and night time and is pacing around the home wondering why there's no-one around ...

Someone in our support group said her husband is on Melotonin ... we'll have to see what the psychiatrist suggests on Wednesday, I just wanted to get an idea of what is generally suggested for this ...

Technically the care home is coping with him not sleeping, although if it results in 'behavioural issues' then it probably would become a problem in the care home that he is in (because they only do 'easy dementia'). However, I'd already come to the conclusion that the current care home wasn't going to work in the long term and have put him on a waiting list for a better care home which copes with all types of challenges ... we're waiting for a room to become available ...

Thanks again for the reply anyway, it all helps ...

 

[knoxy07]

Hi

Does anyone have any good experiences with using medications for Alzheimer's-related sleep disturbances?

Husband has young onset Alzheimer's, moderate to severe, in residential care. He's on standard Aricept and Memantine and since 2 weeks on Trazodone to help with sleep disturbances. Trazodone seems to have lifted his mood but not helped with sleep disturbances (zero hours sleep last night). Maybe 2 weeks is too early to judge ...

Got appointment with psychiatrist from Community Mental Health Team on Wednesday morning so would appreciate any recommendations based on good experiences of managing sleep disturbances ...

Many thanks ...

PS he does some form of physical exercise every day so we are doing the max from a non-medication point of view ...

My Nanna used trazadone for over 2 years, I fount it very useful and it did work, she always had it in liquid form 7.5ml per evening, some can have up to 10ml. Or x1 tablet.
I've recently fount it's stopped working and not doing its original job, when she didn't sleep I always got her urine checked for UTI as this would be a symptom of her not sleeping, so maybe check get a urine sample to the GP?, and I've tried exercising throughout the day the make her feel tired at night, lights dimmed at bed time, I've now been given a tablet that's meant to be for hayheaver as this apparently helps with sleep insomnia, so first night trailing this tonight. But I know we're you're coming from, broken sleep,no sleep is the worst.
Also Lush cosmetic store have brought a cream out called Sleepy, apparently if you rub that over your chest and face this helps with sleep, so the review says, I've brought some to try.

 

[everdrew89]

Thanks knoxy07. Yes I already checked for a UTI ...

Might try the Lush cream for myself?! Think hubby needs something a bit stronger though ... I use the hayfever tablet option myself sometimes too ...

Just been reading another thread (Like a hyperactive toddler) as it seems pretty relevant ... a couple of other medication ideas in that thread too ...

 

[cuppatea]

Hi and sympathies! My husband is on Kalms tablets - valerian - recommended by the consultant while he was in hospital. They're not brilliant as he still wakes and walks a bit but they seem to keep him calm. HTH

 

[marionq]

The anti histamine promethazine acted like a knock out drop with my husband but it does depend on what else the person is taking at the time. Zopiclone is a very effective sleeping tablet with the right dose but can make the person groggy next day. Trazodone has been the most successful in calming my husband down and ultimately allowing him to sleep peacefully at night.

Whatever you do it will not be a 100% for ever and ever. You have to keep reviewing the situation and looking at other methods and means of getting a nights sleep for yourself.

It seems to me that as my husband becomes more frail some of the problems which were most taxing are fading and only coming to the fore now and again. Let's hope this happens with your broken sleep patterns

 

[LynneMcV]

My husband was taking promethazine as and when needed, and as Marion says, it has quite a powerful knockout effect so it isn't really something to give if there are plans to go out and about the next day

However, within the past week he has started going through some extreme paranoia and delusions , so for now he has been moved to a low dose of quetiapine instead.

It is still early days, but I have found that he remains calm during the day for the most part and he has been sleeping through the night very well. I don't know if he will stay on it because it is just a two week prescription aimed at managing the situation until the consultant is back off holiday.

 

[everdrew89]

Many thanks for your replies cuppatea, marionq and LynneMcV ...

marionq ... can I ask what Mg of Trazodone your husband is on ...?

 

[marionq]

He started on 50 mg of Trazodone and nothing else because I was so suspicious of drugs. It helped but it was not enough at that time to stop his epic wandering and getting up during the night to get ready for work. His psychiatrist was keen to up the dose and so over a period it went up to 250 mg and she said if need be we could go to 300 mg.

However I have done the reverse and got him down to 200 mg at the moment which seems to be the optimum for keeping him calm, sleeping soundly, and not any more confused than normal.

I am sure it doesn't suit everyone but has made it possible for me to keep him at home.

 

[everdrew89]

Many thanks marionq, that's very helpful ... We're on 50 mg at the moment so it looks like upping it a bit would be one course of action to try ...

 

[Kevinl]

I know a man who doesn't sleep, sometimes for days and nights at a time, both in the secure unit and now in a nursing home the doctors refused to prescribe medication.
They said it was unethical to use a "chemical cosh", it would show up on a CQC inspection and might land them in trouble and the home didn't want it either as he is already classed as a fall risk and the tablets could make the risk much higher.
His wife showed me his care records recently and he sets the pressure pad by his bed off several times in the 3 or 4 hours he's recorded as being in bed each night.
I think you might get more sympathy from a GP if he was at home and the GP could see the effect it's having on you, but in a care home it might be seen as the staff taking the lazy way out giving someone sleeping tablets even if you requested it.
I used to give my wife Trazodone when she was at home, but gave up giving it at night after she ended up on the bedroom floor the third time and we ended up in A&E for 6 hours, luckily no bones broken.
K

 

[Kevinl]

so over a period it went up to 250 mg and she said if need be we could go to 300 mg.

I'm rubbish at calculations but my wife was prescribed 2.5ml twice a day and again at night. The bottle label says 50mg/5ml, so her 7.5ml would be 150mg, 300mg sounds like a lot to me, half that made my wife an incontinent zombie some days.
K

 

[marionq]

300 mg is the maximum allowed Kevin and it never got quite that high - it was during the period when John was being picked up by the police after going awol numerous times. He of course takes nothing else now and doesn't need more than the 200 mg to keep things on an even keel. No zombie appearance and no one would describe him as having a chemical cosh.

I think if he was taking a combination of drugs that might seem high but his psychiatrist assured me he was not taking too much and any time he has been in respite they don't think he takes much medication compared to others.

What do I know - what is normal anymore?

 

[Selinacroft]

Dad is on Mirtazapine and Melatonin. Not cured the wakeful nights but a great improvement on before

 

[LadyA]

My husband was on 150mg of trazadone per day as well as rivastigmine, 1.5mg of risperidone (which doesn't sound much, but the consultant said it's the maximum he'd be prepared to risk for an elderly person with dementia), and memantine. He was still up every couple of hours, and spend most of his time walking!

 

[everdrew89]

Hi Kevinl. One could argue it's unethical to withhold medication, especially if the reason was because they were just worried about their own backs. Having done some work for CQC, I doubt they would be in a position to judge such a case ... Bodies need sleep and rest, even those of people with dementia ... In the past my husband didn't seem to remember if he hadn't slept and it didn't affect his energy levels, but more recently he gets headaches all the time and has become more angry and at times aggressive, and one team leader at the home decided this was down to lack of sleep ... I'm aware of the risk of homes dishing out drugs in order to have a quiet life, but I'm not worried about that in this case. If he spends all night wandering around the home, that's no real problem for the staff ... if he gets angry and disturbs other residents trying to sleep, then that's another issue ... More recently, the lack of sleep seems to be affecting him more ... Like the rest of us, I just want him to not be distressed and to feel mentally and physically as well as is possible under the circumstances ...

 

[everdrew89]

Just wanted to thank everyone for their input. The meeting with the psychiatrist yesterday went well and she has recommended that he should be on Mirtazapine rather than Trazodone so he will be switching over once the prescription comes though ... Although the Trazodone had lifted his mood it didn't seem to have helped with the sleep disturbances which have now become pretty bad, so let's hope Mirtazpine works better for him ... Thanks again all anyway ... xx