Are there any sleep aids that don't have side effects for dementia patients?
Sleep patterns can be drastically affected by Alzheimer's disease and by other related disorders that cause the symptom of dementia.
Of greatest importance, is being sure your parent is kept busy during the day with easy repetitive chores and tasks along with exercise and social interaction to help tire her while preparing her for an adequate night's sleep. Folding clothes, setting table, dusting are all simple tasks that can make her feel helpful and contributing; the outcome does not matter!
There are over-the-counter meds and alternative herbs and supplements that have been reported to help sleeplessness. These may be worth a try. Before intrducing any new product, be sure to check with both your physician and your pharmacist for efficacy and possible side-effects.
It is frequently difficult to find the most effective treatments for elderly folks and, in particular, those with a dementia. The possible reactions and the side-effects seem to be heightened, making the ability to find the most appropriate products very complicated. I do know that some children's medications used to treat allergies seem to aid sleep in AD people and may be worth a try. Also some alternative-supplements used by travelers may also be helpful. Again, check with your doctor before introducing any new products as the interaction between meds and natural herbs or supplements may be more harmful than the sleeplessness.
Be sure to take care of yourself.
My mother goes to an adult daycare 5 days each week for 5 hours. I try to keep her busy as I do recognize that boredom seems to be a big factor for outbursts. She does dishes, fold clothes, go for walks, dust and sweep the house. I never interfere with her whenever she is engaged in these tasks, except for "walking". I have tried prescribed sleep meds and also herbals and otc sleep aids. Almost always my mother seems to have the worse type of reaction to all of these sleep aids and sleep medicine. I do understand and appreciate all that you have said in your response. Alzheimer's/dementia is in my opinion the worst disease anyone can battle and not win. My mother have some very good days and then some really bad days. The days when she is disoriented, upset, confused are the worst days, because on those days, I feel truly helpless. There is not easy solution to this disease. Thank you for your response, Joanne.
My father suffers greatly because he doesn't sleep. He is 87 and also has Alzheimer's. We have tried a long list of medications--from melatonin---didn't help at all, to antidepressants, to antipsycotics like Haldol. We keep him busy during the day so it's not like he is napping all day. He gets up at least 5-10 times a night. He expends more energy trying to get out of the bed. I think his brain is so damaged from this disease that medications don't even help. My siblings and I are with him 24hrs a day because my mother can't care for him herself. She is 76 and has her own health issues. We made a promise that we'd keep him at home because we don't want him to die in a hospital. His mind seems to have deteriorated more in the last 2 weeks and we are also feeling helpless and hopeless. His primary care physician doesn't seem to offer us any other suggestions, and the psychiatrist has had him on several different meds that haven't helped. This is such a horrible disease. I have been a reader of this website for months and this is the 1st time I am writing. It helps knowing others are going through the same ordeal but at the time it feels like you are alone in the struggle. God bless everyone.
Melatonin... I swear by this stuff for my mom as well as me. The type I particularly like is the 5 mg dissolve on your tongue strawberry flavor. I have ONLY found it at Walmart, dark bottle with a purple lid. There are other Melatonins out there but this one works THE BEST!! Good luck!
My 91 year old aunt lives with my husband and I, she has mild dimentia, more severe if her sleep is out of control. We've tried many drugs to help her, but Trazadone has been the winner, and of course watching her caffiene and chocolate intake, good luck, sorry have to get back to work, love this site. Steph
Medicines that are commonly prescribed for dementia patients often have side effects that negatively affect sleep and wakefulness. Aricept, for example, can cause dream disturbances and/or insomnia. Antidepressants (especially SSRIs) can induce or exacerbate periodic limb movements in sleep (PLMS). Check for possible adverse effects of the medicines your loved one is on at:
http://www.rxlist.com.
Also, drug interactions can make a drug less effective, or exacerbate side effects. Look for possible drug interactions at:
http://www.drugs.com/drug_interactions.php
Pain is undiagnosed or undertreated in a staggeringly high percentage of dementia patients, and is a major cause of agitation and sleeplessness. Tools to help evaluate whether your loved one is in pain:
http://www.painanddementia.ualberta.ca/
http://www.alzbrain.org/pdf/handouts/2049.%20MANAGEMENT%20OF%20PAIN%20IN%20PERSONS%20WITH%20DEMENTIA.pdf
Ask for a referral to a sleep clinic. There are many different types of sleep disorders that may develop in dementia patients, such as sleep-disordered breathing, PLMS, restless legs syndrome (RLS), obstructive sleep apnea, nocturnal myoclonus, and parasomnias (e.g., REM sleep behavior disorder, RBD.) The treatments that are most likely to be helpful depend on the specific type(s) of sleep disturbances involved. For example, patients suffering from sleep apnea have difficulty breathing; with each apnea event, the brain briefly arouses the person in order for him to resume breathing, but consequently sleep is extremely fragmented and of poor quality. Depending on the cause of the apnea, treatment may be a change in diet, simple devices to encourage sleeping in a different position, a specially designed oral appliance which prevents airway blockage, or a CPAP (continuous positive airway pressure) machine. RLS is caused by a functional disturbance in the dopaminergic system, and so the treatment of choice consists of dopaminergic drugs or dopamine agonists such as pergolide or pramipexole.
Circadian rhythms may be disrupted in dementia patients. If your loved one is on Aricept, consider switching to a cholinesterase inhibitor that has a better profile for supporting "normal" circadian rhythms, such as galantamine ER administered in the morning.
Also consider trying bright light therapy. Results from clinical trials on the use of bright light therapy for dementia patients have been inconsistent -- quite possibly due to differences in the type of light that was used, the length of exposure, and the time of day the therapy was implemented. Some researchers have suggested that more consistent results might be obtained if only one type of dementia were included in the study, since different dementias produce significantly different types of circadian rhythm disturbances. For a discussion on some of the bright light studies, see:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2649672/
One medicine you might consider discussing with the doctor is Prazosin. This is a mild antihypertensive with an excellent safety profile, and very inexpensive. It is being more and more widely used to treat the sleep disruption and agitation associated with PTSD, and has successfully gone through two small clinical trials for treating agitation and aggression in Alzheimer's patients, and is now entering two larger trials. Several caregivers have reported success using Prazosin for sleep disturbances and agitation on the Alz Assoc discussion forum.
Consider offering a snack when your loved one gets up in the middle of the night:
http://www.kaiserhealthnews.org/stories/2010/march/16/midnight-munchies-keep-elderly-safer-in-ny-nursing-home.aspx
Or perhaps both of you would benefit from setting up a "safe room" where your loved one can safely pace at night, which allows you to sleep more soundly. Beverly Bigtree Murphy's husband paced at night for two years. She describes the "safe room" she set up for him at:
http://bigtreemurphy.com/Symptoms%20of%20Taking%20Charge%20Stage%20of%20Care.htm#Sundowing,%20Ritualistic%20Behaviors,%20Ccompulsions
If you are considering trying melatonin, PLEASE discuss it with the doctor and the pharmacist first.
Melatonin is a very powerful hormone, and the safety of long-term use of oral supplements has not been established.
Melatonin can cause a number of serious side effects -- including confusion and depression -- which become more likely as the patient continues to receive it. Supplemental melatonin may exacerbate seizure disorders, which is a concern for Alzheimer's patients since they can develop seizure disorders at any stage. Melatonin shrinks arteries and may be contraindicated in persons with cardiovascular disease (including vascular dementia). Melatonin supplementation may aggravate autoimmune disorders such as arthritis and severe allergies. The effects of steroid drugs such as cortisone and dexamethasone may be counteracted by supplemental melatonin. Immune-system cancers such as lymphoma and leukemia may be further stimulated by melatonin supplementation.
Patients with liver or kidney disease (and the elderly, whose liver and/or kidney functions are often compromised) have a decreased melatonin clearance with increased daytime levels of this hormone. They would be more susceptible to problems associated with taking melatonin.
Melatonin can have serious interactions with a number of prescription and nonprescription medications, including "blood thinners" (e.g., warfarin, heparin), blood pressure medications (especially nifedipine), products that contain caffeine, drugs that may affect your immune system (e.g., azathioprine, cyclosporine, prednisone), fluvoxamine. Tell your doctor or pharmacist if you also take drugs that cause drowsiness such as: certain antihistamines (e.g., diphenhydramine), anti-seizure drugs (e.g., carbamazepine), other medicine for sleep or anxiety (e.g., alprazolam, diazepam, zolpidem), muscle relaxants, narcotic pain relievers (e.g., codeine), psychiatric medicines (e.g., chlorpromazine, risperidone, amitriptyline, trazodone). Check the labels on all your medicines (e.g., cough-and-cold products) because they may contain ingredients that may cause drowsiness.
A Cochrane review notes: "Because it is considered a dietary supplement and not a medication, its safety and efficacy have not been evaluated by the U.S. Food and Drug Administration. Some melatonin products contain one of the contaminants associated with the eosinophilia-myalgia syndrome in L-tryptophan users, and some do not meet the standards of the U.S. Pharmacopeial Convention General Tests and Assays for Nutritional Supplements."
It's not a good idea to give melatonin on a daily basis. Melatonin use on consecutive nights should be avoided, and only the lowest effective dose should be taken. An effective dose is often in the 0.1 - 0.3 mg range.
Repeated administration of doses over 0.3mg can cause the patient to build up a tolerance, and can eventually disrupt, rather than improve, sleep in some people.
Large clinical trials failed to establish any general benefit for treating sleep disorders in dementia patients, although the possibility exists that it may be helpful for some individuals.
http://www.alzforum.org/dis/tre/drc/detail.asp?id=52
In theory, taking melatonin helps regulate the circadian rhythms. In theory, bright light therapy would help regulate melatonin synthesis/secretion, and would be a much safer alternative. I'd suggest starting there.
Have you tried an antihistamine - Benadryl, for instance? Our doc suggested that; I have seen no side effects, and it does cause drowsiness.
I tried Melatonin in an effort to help my mother's sleep and to try and diminish her nighttime wandering. She was only on it for a week and would awake confused in the morning. Today she told me that she had been having very vivid and disturbing dreams lately, which I can only attribute to the Melatonin. She has moderate dementia and is on 24 mg of Galantamine ER.
