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You are here: Experts > People/Relationships > Senior Health > Alzheimer`s Disease > Not sleeping in the nursing home
Expert: Paula Damgaard - 11/6/2009
Question
My Mother began showing short-term memory loss and confusion about 7 years ago. She was diagnosed with Alzheimers by one doctor, (but perhaps it could be Vascular Dementia due to unmanaged type 2 diabetes?) My Father has been her caregiver and done very well for so long. However in the last few months, she began a more significant decline in all areas. It became harder for my Father to attend to all the personal care issues. However,, the greatest problem was that she began a pattern of not sleeping, sitting for hours on the side of the bed at night. My father found it impossible to do anything with her, and quickly became overwhelmed with the increased confusion, incontinence, and inability to get her to sleep. He was finally convinced to move her into the nursing care facility which is a part of the assisted living community in which they lived. (It is not a specialized Alzheimers facility, but a general nursing home.)
We expected a difficult adjustment, that she might get a little crazy looking for Dad, as she was very dependent on his presence at all times. It was however much worse than that. She wandered the halls, more walking than she had in a year, sometimes in a state of panic, through whole days and nights.
They were in the process of adjusting her to the medication schedule and tried something new, which seemed only to increase her agitation. She even became quite combative, something that we had never seen in her.
It's going on three weeks, and much of the anxiety has settled down, as the meds have gotten regulated. She is still combative sometimes with taking the meds, and with having the staff give her showers and personal care (dressing, toileting, etc). However, the sleeplessness at night continues. She wanders the halls or sits up in the common rooms many nights. Nursing staff do not push her to get in bed if she expresses agitation, but simply try to keep her calm and comfortable and monitored.
Of course, sleepless nights make for more difficult days. After missing one night, she's utterly exhausted the next, and more likely to sleep then. I don't think she is napping at all during the day for more than a few minutes at a time.
We have a caregiver who has worked with her a great deal in the last years going into the nursing ward in the evenings to "tuck her in" and sit for a while until she sleeps. In my own experiences with her before admission, IF you could get her lie down, she would just lay "stiffly", quiet but very fidgety, and moments later was popping her leg out of the covers to get up. If you could keep her in the bed, she might eventually fall off to sleep, but unless she quickly moved into a good snore (a sure sign of deep sleep for her), she would be up again in a short period of time. This is what is happening most regularly now.
The doctors/staff has seemed reluctant to sedate her for sleep; I'm assuming that they don't want an increased fall risk. We as a family are greatly confused as to WHY she doesn't seem to be able to sleep and HOW she can remain awake for such long stretches. We also question whether the impact on her overall condition is critical enough to readdress heavier meds for sleep with her doctor. I'm calling several times a night and keeping notes based on the information I'm being given about her behavior.
FYI, I estimate Stage 6 ... still some sense of recognition of family, very little short term memory, much difficulty processing even one step direction, much difficulty verbalizing, unable to dress and toilet herself altho still has bowel continence, stiff shuffle walking in super slow motion! difficulty sitting down properly in a chair alone, trouble feeding herself but manages a bit altho appetite began to decrease in the last four months.
We'd appreciate any information or suggestions you can offer. Thank you!
Answer
Julia, my 1st thoughts as I started reading were: she might have a urinary tract infection. While I still have that thought and would encourage you to have them check it out, I want to say this, demented people don't need as much sleep as you think they would. I don't know if you have children, but if you do, remember when they were toddlers and if you let them sleep for even 5 minutes in the car, there was no naptime at home! Dementia patients are similar. An innocent 5 minute snooze in the middle of the day can charge their battery for 24 hours or more. Which is what you are seeing with your mom. I commend the nursing home for not forcing her to bed and for not medicating her. As you said they maybe afraid she will fall, this is a huge concern in any nursing home.
We don't know what "drives" these patients to wander but it is not uncommon. The one way to try to keep her up all day (which could be impossible!) and to exhaust her so that she might sleep that night. But again, 5 minute shut eye and you can forget it. I think the home has a good handle on her and the fact that they are not forcing her makes me want to hug all of them!
Another thing you might wonder is: is she in any pain? Does she have arthritis? Is she being medicated for that? How are her toe nails? Any ingrown? Teeth? She couldn't tell you she is in pain so you have to be a detective and check her out. Like with urinary tract infections, they can't tell you, they just have changes in behavior.
I hope this helps. Please feel free to ask again if anything isn't clear. Good luck and get some sleep yourself. You won't be any good to either your mom or dad if you fall apart.
Paula
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