Sleep problems are common in Alzheimer’s and other dementias. They also commonly drive family caregivers crazy, because when your spouse or parent with Alzheimer’s doesn’t sleep well, this often means that you don’t sleep well.
To make matters even worse, not getting enough sleep can worsen the thinking or behavior of someone with dementia. Of course, this is true for those of us who don’t have Alzheimer’s as well: we all become more prone to irritation and emotional instability when we’re tired. Studies have also shown that even younger healthy people perform worse on cognitive tests when they are sleep-deprived.
Hence getting enough sleep is important, for people diagnosed with dementia, and for their hard-working caregivers. Now, sleep problems do often take a little effort to evaluate and improve. But as I explain below, research has found that it is often possible to improve sleep problems in dementia.
The key is to know what common causes to look for, and then come prepared to provide useful information to the doctor. In this article, I’ll cover:
- Common causes of sleep problems in Alzheimer’s and other dementias,
- How sleep issues should be evaluated
- Proven approaches that help improve sleep in dementia
- What to know about commonly tried medications for this problem
Common Causes of Sleep Changes and Problems in People with Dementia
It’s hard to manage a problem if you don’t understand why it might be happening. There are several factors that can cause older adults with dementia to have sleep problems. These include:
- Sleep changes with aging. Healthy aging adults do experience changes with their sleep as they age. Sleep becomes lighter and more fragmented, with less time spent in deep REM sleep. One study also estimated that total sleep time decreases by 28 minutes per decade, starting in mid-life. Although these changes are considered a normal part of aging, lighter sleep means it’s easier for aging adults to be woken up or disturbed by any other sleep-related disorders or problems, such as arthritis pain at night. Aging is also associated with a shift in the circadian rhythm, so that many older adults find themselves sleepy earlier at night and hence wake up earlier in the morning. For more, see here: How Sleep Affects Health, & Changes With Aging
- Chronic medical conditions and/or medications. Studies have found that older adults often experience “secondary” sleep difficulties, which means that the sleep problems are being caused by an underlying health problem. Many people diagnosed with Alzheimer’s have additional chronic health problems that may be associated with sleep difficulties. Treating such problems can help improve sleep. Common causes of secondary sleep problems include:
- Heart and lung conditions, such as heart failure or chronic obstructive pulmonary disease
- Stomach-related conditions such as gastroesophageal reflux disease
- Chronic pain from arthritis or another cause
- Urinary conditions that make people prone to urinating at night, such as an enlarged prostate or an overactive bladder
- Mood problems, such as anxiety or depression
- Medication side-effects, and substances such as alcohol (which is known to disrupt sleep).
- Many sleep-related disorders become more frequent with aging. Common sleep-related disorders include sleep apnea and related conditions (known as sleep-related breathing disorders), which may affect 40-50% of older adults, as well as restless leg syndrome, which is thought to be clinically significant in 2.5% of people.
- Alzheimer’s and other neurodegenerative diseases change sleep. The brain deterioration associated with various forms of dementia tends to affect the way the brain sleeps. In most cases, this causes less deep-sleep time, and more awake time at night. Problems with the circadian rhythm system (the body’s inner system for aligning itself with a 24-hour day) also become more common in dementia. Furthermore, Lewy-body dementia and Parkinson’s dementia are also associated with a sleep disorder called REM sleep behavior disorder, which can cause violent movements during sleep and can even emerge before thinking problems become substantial.
In short, most aging adults develop lighter sleep as they age, and many older adults have health problems that prompt nighttime awakenings. Sleep-related disorders such as sleep apnea are also common in aging. Older adults with Alzheimer’s and other dementias are likely to be affected by any of these factors that change sleep as people age, plus dementia brings on extra changes that make night-time awakenings more common.
Hence, it’s not surprising that sleep problems are so common in people with dementia! Now let’s talk about what can be done to improve things.
How to Diagnose the Sleep Problems of a Person with Dementia
Like many problems that affect older adults, sleep problems in dementia (and generally in aging) are almost always “multifactorial,” which means that there are usually several underlying issues creating the problem.
Multifactorial problems can be improved, especially if a family and the doctors are diligent about trying to identify as many contributing factors as possible. But you’ll need to start by helping the doctors understand what kinds of sleep-related symptoms and problems a loved one is experiencing.
Here is a list of questions that a group of geriatrics experts recommends, for evaluating sleep problems. (These are addressed to a patient; replace “you” with “your parent” if you are gathering information in preparation to see a health professional about a parent’s sleep issues.)
- What time do you normally go to bed at night? What time do you normally wake up in the morning?
- Do you often have trouble falling asleep at night?
- About how many times do you wake up at night?
- If you do wake up during the night, do you usually have trouble falling back asleep?
- Does your bed partner say (or are you aware) that you frequently snore, gasp for air or stop breathing?
- Does your bed partner say (or are you aware) you kick or thrash about while asleep?
- Are you aware that you ever walk, eat, punch, kick, or scream during sleep?
- Are you sleepy or tired during much of the day?
- Do you usually take 1 or more naps during the day?
- Do you usually doze off without planning to during the day?
- How much sleep do you need to feel alert and function well?
- Are you currently taking any type of medication or other preparation to help you sleep?
- Do you have the urge to move your legs or do you experience uncomfortable sensations in your legs during rest or at night?
- Do you have to get up often to urinate during the night?
- If you nap during the day, how often and for how long?
- How much physical activity or exercise do you get daily?
- Are you exposed to natural outdoor light most days?
- What medications do you take, and at what time of day and night?
- Do you suffer any uncomfortable side effects from your medications?
- How much caffeine (eg, coffee, tea, cola) and alcohol do you consume each day/night?
- Do you often feel sad or anxious?
- Have you suffered any personal losses recently?
Many families will be unsure of how to answer some of these questions initially. So to get the best help from the doctors, it’s best to prepare ahead of time. I always recommend families try to keep a journal related to these questions for at least a week. Some families may also be able to use a sleep tracker or activity tracker, to gather useful information.
Based on the information above, and after conducting an in-person examination to check for other medical issues, a doctor should be able to place the sleep difficulties in one (or more) of the following categories:
- Difficulty falling or staying asleep
- Excessive daytime sleepiness
- Abnormal breathing patterns during sleep
- Abnormal movements or behaviors during sleep
Sometimes additional testing is necessary, such as a sleep breathing study to evaluate sleep apnea.
Based on the category of sleep problem, and the underlying causes that have been identified, the doctor should then be able to propose a plan for improving the sleep difficulties.
How to Improve Sleep Problems in Dementia
The exact approach to improving sleep in a person with Alzheimer’s or another dementia will depend on what underlying factors are causing sleep problems. Still, certain general approaches have been found to improve the sleep of many people with dementia. These include:
- Outdoor light or bright light therapy during the day. Bright outdoor light helps keep the circadian signals (the body’s inner clock) on track. For older adults who can’t get outside for at least an hour per day, bright light therapy with a special lamp might help. A study found that bright light therapy in Alzheimer’s patients improved sleep.
- Increase daytime physical activity. Research has suggested that walking during the day can help improve nighttime sleep in people with Alzheimer’s.
- Optimize environmental cues for sleep. This means keeping the sleeping environment dark and quiet at night. This is especially important in nursing homes, which have sometimes been found to have staff active at night.
- Establish a regular routine with a consistent wake-up time. A regular routine can help maintain better sleep. The ideal is to have a consistent bedtime and wake-up time, but many experts believe it’s best to start by focusing on a consistent wake-up time.
- Identify and adjust any medications (or other substances) that might be affecting sleep. Taking stimulating medications later in the day (or sedating medications early in the day) can affect sleep. Discontinuing or adjusting medications that affect sleep can help improve sleep.
A research study published in 2005 found that training dementia caregivers to use these techniques in combination did lead to improved sleep of the care recipients with Alzheimer’s.
Medications to Manage Sleep Problems in Dementia
You may be wondering whether medications can help manage sleep problems in dementia.
To begin with, it is important to check current medications and make sure they are not negatively affecting a person’s sleep. For example, sedating medications during the day may cause a person with dementia to sleep or nap too much, resulting in more awake time at night. Or a diuretic offered too late in the day might be causing extra nighttime urination.
As a caregiver, you may simply want to know: “Isn’t there a medication we can give in the evening, to help my parent sleep better at night?”
It’s true that sleeping pills, sedatives, and tranquilizers exist, and they are often prescribed to help keep people with dementia quieter at night. These include antipsychotics like olanzapine, risperidal, and quetiapine, benzodiazepines such as lorazepam and temazepam, sleeping medications like zolpidem, or even over-the-counter sleep aids (which usually contain some form of sedating anti-histamine).
Unfortunately, all these medications are likely to cause concerning side-effects in people with dementia, namely worse cognition and increased fall risk. The antipsychotics have also been associated with a higher risk of dying. Last but not least, comprehensive scientific review articles conclude that in clinical trials, these drugs do not conclusively improve sleep.
Hence, the recommendation of experts in geriatrics is that these medications should generally be avoided, and only used as a last resort once behavioral approaches (e.g. setting a routine, more walking, etc.) have been tried.
That said, there are a few medications that may be less risky, and are sometimes used:
- Melatonin. Melatonin is a hormone involved in the sleep-wake cycle. A Scottish study found that 2mg of melatonin nightly improved the sleep of people with Alzheimer’s. However, a more recent randomized trial of melatonin in people with dementia was negative. Also, in the U.S. melatonin is sold as a poorly-regulated supplement, and studies have found that commercially sold supplements are often of questionable quality and purity.
- Trazodone is an older weak anti-depressant that is mildly sedating. It has long been used by geriatricians as a “sleeping pill” of choice, as it seems to be less risky than the alternatives. A small 2014 study found that trazodone improved sleep in Alzheimer’s patients.
To summarize, although medications are often used to manage sleep problems in dementia, most of them are pretty risky. So it’s better to avoid sedatives until you’ve exhausted all other options.
Non-drug approaches like plenty of outdoor light, regular exercise, a stable routine, optimizing chronic conditions, and checking for pain often help. Plus, these usually improve the person’s quality of life overall.
Remember, sleep is important for health, and it’s especially important for family caregivers.
For more on sleep in older adults (whether or not they have Alzheimer’s), see these posts:
- How Sleep Affects Health, & Changes With Aging
- 5 Top Causes of Sleep Problems in Aging, & Proven Ways to Treat Insomnia
This article was last updated in July 2024.
Teresa says
Hello. Thank you for your website. So much helpful information in one place. My Dad suffers from Alzheimer’s and is in the moderate to severe phase. He is having trouble staying awake during the day. He has even fallen asleep while eating. We try and get him outside throughout the day or go for a ride in the car. It has been precious to see my elderly parents slow dance to songs that they still love. Our main challenge right now is keeping my Dad awake during the day. His neurologist has suggested Ritalin. What do you think of this idea?
Nicole Didyk, MD says
Hi Theresa and thanks for sharing your experience. Ritalin aka methylphenidate is a stimulant and has been studied for the treatment of apathy in persons with Alzheimer’s disease.
The ADMET study found that 20 mg a day did help with apathy and didn’t have many adverse effects (some abdominal pain or weight loss, not significantly more than the placebo group). It was a small study (60 patients) and ADMET2 is underway to confirm those findings.
I haven’t personally had a lot of success using methylphenidate in my patients with apathy, but it seems to have the data behind it to make it worth a try.
UtahRed says
I’m 49 years old and having problems with losing train of thought mid sentence, forgetting where I left things, I have to write everything down (appointments) or I will forget and sometimes forget things on the stove (which I shouldn’t be leaving anyway). I am on 1/4 mg xanax, 100mg trazadone, 20mg lexapro, 15mg bupisperone and occassionally amitriptaline for anixiety, depression and pain related to my scoliosis and fibromyalgia with complex migraine disorder. I’ve been on these meds for 12 years. Wondering if my cognitive issues is related to long term use of meds, premenopause or something more troublesome. Thanks.
Nicole Didyk, MD says
Hi Utah and thanks for sharing your story. There has been a lot of study about whether long-tern use of antidepressants can increase the risk of dementia. For example, this meta-analysis reviewed 18 longitudinal studies of older adults with depression, and found that depression itself, as well as use of antidepressants seemed to increase dementia risk. More data is needed to be sure of these findings though.
Antidepressants are frequently found on the lists of medications that we use with caution in older adults, although at age 49, not sure you are in this category.
Depression can be a life-threatening illness. In older adults, probably about 40 to 60% of those with depression are undertreated. Whether or not to take an antidepressant is a decision to make with your health care provider, considering all of the aspects of your health and lifestyle. Again, the treatment of depression involves more than just taking a pill with things like exercise and socializing with other people also being therapeutic and potentially less risky.
Other things can contribute to changes in memory as well, including hormonal changes, pain, and other medical factors. Hope you find some of these links helpful!
Frank says
Good EARLY morning, I’ve been up counting 5 times tonight. It’s now 3:30 am. My mom who is 80 has had dementia since 2016 per multiple Dr’s. Initially is was considered “alcoholism” issues after multiple falls. In early 2017 she received a VP shunt for hydrocephalus. Set at 1.5. This has improved her “gate” somewhat. She lives with my wife and I. Allow me to preface this with the following: I am an only child. Father passed in 1997. Every night my mom is up multiple times searching for Frankie, (ME tho I haven’t gone by that name since I was a youth) I have installed Ring camera system as she is an escape risk. So whenever movement occurs I’m shaken from sleep. Dr currently has her on the following meds with hope of a better night’s sleep. @ bedtime hydroxyzine hcl 25mg. Donepezil 10mg 1x Daily & Fluoxetine 10mg 1x daily. I’m at my wits end as nothing is helping her sleep. Like so many others on this site, my loved one does much better when she receives 4-6 hrs sleep consistently. But that hasn’t been the case in several months. You had spoke of anti-psychotics which should I suggest to her PCP. Because both my wife and I work full-time 10hrs, and can’t be up all day and all night and continue to function. Please help!
Nicole Didyk, MD says
Hi Frank. I saw that you posted your question as a comment in another post, and I did answer that one…I’ll copy my answer here:
“Hi Frank and thanks for sharing your story. I’m sorry to hear about how difficult it has been for your family, but as a Geriatrician (in Canada) with a busy practice, I can tell you that you are not alone.
Medication for sleep is pretty tricky, most meds help people fall asleep but not stay asleep, and the donepezil and fluoxetine can actually be a bit activating, I usually prescribe them to be given in the morning. Anti-psychotics (such as risperidone, quetiapine, olanzepine) can be sedating for sure, but can also increase the risk of stroke or death in older adults with dementia, so we try to avoid them most times.
When there is a change in a behaviour pattern for someone with dementia, a good start is to review medical issues with a physician and make sure there isn’t something else brewing (like an infection or issue with the VP shunt). If that’s all clear, then it may be worth finding a behavioural consultant who can help you come up with strategies to redirect your Mom or prevent her nighttime restlessness (for example, maybe more daytime activity or exercise). Here is an article from Dr. K about behaviours with more information.”
teresahorne says
my mom will soon be 90! my mom has had Dementia since 2015,as we know of,starting with hearing things that aren’t there,people in the basement,forgetfulness,during in that time range,which I didn’t know of anything going on,but now I’ve moved in with her,because she s always said when I would leave to go home which is in her side yard,she’d always say ‘I don;t know what to do,will you stay tonight’ but dumb me I went home ,so when things started to get alittle more tinse and I moved in I seen differently,it broke my heart knowing there was something she was trying to tell me but I just didn’t listen close enough,but then when I did moved in Iseen all that was going on with her through the night,but anyway! shes ok through the day but when its time for the sun to go down as called sundowners,she gets all upset and crys,I’m not getting sleep and its really bringing me down terribly,I cry to myself I pray for things to get better but not! so last night done it it hit me hard,so I broke down today in front of my brother he didn’t know what was going on because I always said everything is!!!!e talked ,so we’re going to take mom to a different dr.next wed. they said that they would help her get back on track,the other dr. never helped in anyway,like i said shes ok during the day but at night is when she doesnt sleep and me also we’re needing something to make her sleep at night because her mind is just going so out of control,not being mean but just can’t stop the talking all night just praying for something to help her to get some relief its not just the person with this diease but its also the caregivers its not a good thing at all,praying for all who is struggleing with this may God be with you all
Leslie Kernisan, MD MPH says
Sorry for delayed response, we changed part of our system last month and some of the comments fell through the cracks. It sounds like you’ve been working very hard taking care of your mother and you are getting worn out.
Medications may or may not help. They certainly can sedate a person with dementia and that can help caregivers get more rest at night, but they will generally increase fall risk and they might make her memory or thinking worse. There is no good or easy answer. If you’ve tried other approaches to help her sleep, then it might be reasonable for her health providers to prescribe something. The key is to make an informed decision, to understand the risks, and to conclude that the likely benefits outweigh the risks. Your health and wellbeing are very important, too.
My other suggestion would be to consider joining a dementia caregiving support group. You can probably find a free one locally and there are many free groups online. We also offer support for dementia caregivers in our Helping Older Parents Membership, and you can learn more about that here. Good luck and take care!
Karen Cline says
You doctors need to quit telling people to try this try that because nothing helps and then you don’t know what to do there’s nothing that helps and it just gets worse! It is what it is! And who can afford to put them any where , when they get so bad.
Nicole Didyk, MD says
It sounds like you’re feeling some frustration, Karen. Sleep problems in dementia can put an enormous strain on families and care partners and it can seem like nothing works. It might be helpful to hear that eventually most sleep problems in dementia get better. I hope you are able to spend some time for yourself despite being a care partner.
Courtney says
My father is 66 and a year and a half post stroke. He was on celexa for 6 months continuously following his stroke (prescribed as a standard medication for all rehabbing patients by his neurologist) with no problem and had progressed extremely well in rehab. Six months later his neurologist decided timing was appropriate to discontinue celexa and simply stopped filling the prescription, saying at a dose of 20mg it was unlikely to cause any problems.
Since abruptly discontinuing celexa, my father had an almost immediate mood and cognition decline, including rage episodes thought to be manic, which has resulted in numerous hospitalizations with no diagnosis aside from “it’s the stroke”. No neuro changes noted on mri or CT, more tests run than I can count excluding all kinds of other possibilities. He’d had no psychiatric problems whatsoever either pre-stroke, or while on post-stroke celexa. Once the episode passes, he has no memory of it, but he is dangerous to both himself and others when they occur.
The doctors have since tried a month of lexapro followed by a few weeks resuming celexa before giving up on SSRI’s entirely. They then moved to abilify, haldol, valporic acid, nudexta, and so far settling on lamictal to stabilize the rapid mood swings. Lamictal has been most effective stopping the rage episodes, but it seems to cause severely flattened moods that swing to agitation, which they are countering with small doses of Ativan. I’m not happy with this combination, his personality is muted while on these drugs and at best his behavior and cognition are toddler-like. While off both the meds recently for a short duration (under his current psych’s guidance) his independence and cognition improved significantly, but within a couple weeks the rage episodes resumed, causing him to resume lamictal.
I can’t seem to find a doctor willing to re-examine if any of these drugs are the right choice. It’s surprisingly slim finding psychiatrists willing to treat patients over 65. He is on his third psychiatrist, currently a neuro psych, and she is conservative in her approach, and seems to favor maintaining lamictal while removing Ativan. But the agitation and flat moods on lamictal are causing a serious quality of life issue.
Do you think my expectations are too high for how he should function on meds? Are there any options not being explored? I can’t help but feel he is being written off due to age and stroke history.
Leslie Kernisan, MD MPH says
Oh, I’m sorry that you and your father have been put through this. Honestly, I’m not sure what to tell you about your expectations, because your father is much younger than my own patients are, and I don’t have much personal experience with post-stroke patients his age. I do know that it often requires a lot of family advocacy to explore all the medical options when a person is a “challenging case”, and your father’s case does sound challenging to figure out.
One thing you could try would be to look for an online community for patients and families who are post-stroke. You might be able to connect with some other people facing similar challenges, exchange ideas, and get some support.
Another possibility would be to request a second opinion from a major medical center; this can be done remotely, such as this service at UCSF: https://www.ucsfhealth.org/secondopinion/. It might be especially valuable to request a second opinion from a major medical center that has special centers related to post-stoke care. Good luck!
Caroline says
New here… need advice.
My dad is turning 80 this year and he’s in his 6th year of this horrible illness of Alhizmers.
My sister and I are frustrated with everything because our mom just had surgery yesterday because she had fallen and broken her elbow in 2 places. I know that she has struggled to be the best caregiver for him but now it’s taking a toll on us too. We are helping the best we can and trying to be helpful. It’s just so sad that our trying is often not working. The trouble we are finding is that our dad often sleeps during the day and and night when my mom is completely exhausted and needs sleep he complains that he’s eyes are burning and itchy. Plus after 2am when he frequently wakes up it’s hard to get him back to sleep and ge can be quite nasty. We know it’s the disease affecting him but we want to know what else we can do to relieve his symptoms. We have tried everything from prescriptions to over the counter eye drops.. we are exhausted and now that she can’t even take care of herself it’s hard. Any advice is helpful…please and thank you for listening.
Leslie Kernisan, MD MPH says
Sorry to hear of your parents’ situation. Alzheimer’s does affect sleep and it can be hard to keep people on a “normal” sleeping schedule. That said, my guess is that part of the issue is that your father is now in the habit of getting his sleep during the day, and that will make it harder for him to sleep at night. Your mother may have enabled this because he is probably easier to care for during the day when he’s asleep.
Your family could try to get him awake and active more during the day. It would take work and be a transition; you’d have to reduce his day sleep a little at a time and replace it with some walking and sunshine.
Otherwise, if your mother is exhausted, it may be time to look into transitioning to a different care arrangement for your father. This is hard for many spouses to accept, however they often find it a relief once their spouse with dementia is in memory care. Of course, this costs money, and that is a barrier for many families.
I would especially recommend that your mother — and you, for that matter — join a dementia caregiver support group, either online, in person, or both. Most support groups for people caring for aging parents have lots of participants dealing with dementia. There is a good free group at AgingCare.com. We also offer a Helping Older Parents Membership community for people like you. Good luck!
James says
54 year old male, early onset familial Alzheimer’s. His aunt had night time hallucinations as well in the later stages. Our bright happy cheerful guy turns agitated and confused almost every night seeing ‘shadow things’ in the room and his cousin outside the window standing there. We keep the drapes closed before sundown and make sure the room is well lit, putting him to bed before sundown or he doesn’t sleep at all. He is scared to death of darkness and shadows, he wakes up during the night agitated and confused, at least he gets 4-5 hours sleep by going to bed early, but we have tried everything to modify the environment, melatonin, checked for other illnesses, and even tried the sleeping schedule that the daycare and doctor prescribed (keeping him up all day and evening until tired enough).
His night time visions are just too distressing for him to be able to sleep.
His doctor will not prescribe medications for his hallucinations as they have additional risks. He has increased the amount of Namziric to 21/10 but his visions are persistent.
Our loved one does so much better after 7-8 hours sleep cognitively, his lack of sleep now is causing a fast decline that even daycare is concerned about. Still his doctor refuses to address the issue further. His aunt was prescribed haldol for the exact same condition years ago and she stopped having hallucinations, slept fairly well, and continued in a slow decline for 3 more years until her passing. I’m afraid that if we don’t address his problem now, our loved one isn’t going to make it another year. His decline is way to rapid now.
What do we do now?
Leslie Kernisan, MD MPH says
Wow, this does indeed sound like a tough situation. In geriatrics, we do try to avoid using antipsychotics such as haldol. That said, it is reasonable to consider them when many other things have been tried, because sometimes the likely benefits do outweigh the risks.
For persisting hallucinations that are distressing to the older person or are seriously disruptive to family, I actually think it would be reasonable to try a medication. You could ask the doctor about trying trazodone, but if that doesn’t have much effect, it might be reasonable to try a low dose of antipsychotic.
The doctor is correct to point out that antipsychotics have risks. However, generally it should be ok for a patient (or family, as the surrogate) to decide to take those risks, when it’s a carefully considered and well-informed decision, especially when alternatives have been explored and have failed.
I would recommend talking to the doctor further about the risks and benefits of trying medication for these persisting hallucinations. If your family states that you understand the risks but then you clarify that your highest priority is your relative’s comfort, rather than longevity, the doctor may be willing to reconsider.
Good luck and take care!
Sarah says
My grandmother is 82, she has gradually become restless and angry/irritated most of the time. She has become very weak and unable to pursue any sort of activity, not even going to the toilet on her own. Then she started experiencing confusion, she was constantly confused with the rooms in her house (where she’s lived in for the past 50 years or more). The doctors diagnosed her with first stage dementia then prescribed antipsychotic drug (Risperdal) at a very low dose (0.5 mg). She shortly experienced a severe skin rash and there was no significant improvement in her agitation and restlessness, so she refused to continue taking the medication.
I was wondering if you would be able to help on whether she was suppose to continue using the medication like her doctor recommened, or there must have been a change in prescription?
I’d also like to add that she used to be agressive to an extent before starting the medication, but it was worsened after she stopped talking it. She constantly called us and her caregiver names and continuously complain/shout/scream.
Thank you,
Sarah
Leslie Kernisan, MD MPH says
Sorry to hear of your grandmother’s symptoms, they must be quite difficult for your family.
It is possible that the rash was a side-effect to risperidone, or it could have been caused by something else. Regardless, if she is refusing the medication, it will be hard to get her to take it.
You can ask her doctor about trying a different medication for her behaviors, but before you do, I would encourage you to read these two articles we have on dealing with difficult behaviors:
5 Types of Medication Used to Treat Difficult Dementia Behaviors
7 Steps to Managing Difficult Dementia Behaviors (Safely & Without Medications)
Good luck!
Debra Reaves says
I would just add, that when I was in the beginning process of getting my husband diagnosed, one day he started acting unusually strange. I asked his Dr to check his ammonia levels & they were high. We got him on medication & he got back to what was at the time normal. It pays to go a step further & check out quick changes in behavior.
Nicole Didyk, MD says
Sounds like you were right to advocate for more bloodwork in the case of your husband.
Ammonia levels can be elevated in people with liver disease (cirrhosis in particular) and the treatment usually involves laxatives to make sure the person is having loose bowel movements, which helps eliminate the ammonia, and relieve the confusion.
Thanks for reminding us to be thorough!
Peter Lask says
My mother is 93 and has dementia. She lives in an assisted living facility with an around the clock attendant. She has, over the last 6 months or so, begun to have days where she essentially sleeps all day and is impossible to rouse. Other days she is relatively alert, smiling and happy, and will eat, watch TV, and converse fairly well, although she is almost impossibly frail. Gradually she has weakened to the point she can no longer walk on her own and is physically unable to feed herself. Some nights she wakes with panic attacks in which she doesn’t know where she is or why. She becomes very agitated and writhes in bed, kicking at the rails. A couple of weeks ago, her doctor prescribed a very low dose of Lorazapam each day to reduce her night terrors. Some family members are concerned about whether such drugs are apt to do more harm than good. Any input you may have would be much appreciated.
Leslie Kernisan, MD MPH says
Hm. Well, it’s possible that this is her dementia progressing, but if someone starts to decline like this, we often would initiate an evaluation to make sure that it’s not a new illness or worsening other health condition. If you haven’t already done so, I would recommend asking the doctor to review what kind of evaluation has been done so far, and what the doctors think is causing this decline in energy and function.
The nighttime symptoms may or may not be related. How to manage them does depend on a good evaluation to determine what’s the most likely cause.
But in general, lorazepam would be one of the last things we would use in geriatrics, and we would probably only use it after we’d tried some safer choices. So I think your family members are right to question the use of this drug.
I wrote a bit about lorazepam for people with advanced dementia (who are often on hospice) here:
Hospice in Dementia, Medications, & What to Do If You’re Concerned
You can also learn more about medications used to manage dementia behaviors here:
5 Types of Medication Used to Treat Difficult Dementia Behaviors
Last but not least, I describe some useful ways to think about helping a declining parent with dementia in this article:
How to Plan for Decline in Alzheimer’s Dementia: A 5-Step Approach to Navigating Difficult Decisions & Crises with Less Stress
Good luck!
Vicki Countz says
It won’t work, trust me, been down that road. You need a doctor to assess the situation.
Neftali says
Hi. Does anyone have an idea of what brand of Melatonin is better and a starting dose for an 87 year old? Should it be long acting? Thanks all.
Leslie Kernisan, MD MPH says
This study of melatonin used a 2mg prolonged-release formulation, and found it improved sleep. Participants were older people diagnosed with Alzheimer’s disease, but I would expect it to work similarly in people who didn’t have Alzheimer’s.
On UpToDate, which is a well-regarded clinical reference, experts note that a physiologic dose of melatonin is 0.1-0.3mg, and that doses sold over-the-counter may raise melatonin levels by 3-60 times their normal values. This may cause more side-effects like daytime drowsiness, so the authors of the UpToDate chapter on melatonin recommend lower doses (e.g. 0.5mg) to keep the body’s melatonin levels closer to physiologic range.
I don’t know what US brands are considered best or reliable. I believe melatonin is better regulated in Canada, so if I were shopping for melatonin I might look into getting it from a Canadian pharmacy.