Does anyone have advice on regulating Mom's sleep-wake cycle?

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Does anyone have advice on regulating Mom's sleep-wake cycle?

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Mom is 86 years old with dementia. I have been trying to keep her awake more during the day so we can all (hopefully) sleep at night. Hospice has recommended her to have a minimal dose of Morphine in the evening, which scares me. I have tried other medications and natural supplements, but we just can't get her regulated. Sometimes she talks all night and sleeps all day. Other times she hallucinates both visually and verbally for about 48 hours. Needless to say, my husband and I are both frequently exhausted and often a bit testy.

Does anyone have experience with the Morphine?

Family Caregiver Medications Sleep Issues

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Its a very low dose that’s prescribed. My mom has taken it several times with no issues. A low dose of morphine helps expand the lungs for easier breathing and should help your mom rest. Hopefully you can get some rest. I can sympathize with your situation, my mom does the same thing, sleeps for short periods then awake for long periods. Morphine helped initially but now it doesn’t help so much as far as sleeping .

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I’m a retired nurse and also was here at home to give hospice care to my beloved late husband. His diagnosis was Emphysema/COPD and I gave him Morphine as advised by Hospice physician. I know it can depress respirations as many narcotics can, but it actually calmed my husband enough that his airway relaxed and he slept really comfortably. He didn’t have dementia, but I noticed his mood was calm and seemed not at all agitated or visibly depressed, which he had previously suffered with before that. Without Morphine, I know he would have had increased pain and worry and not rested well. If Hospice has ordered it, my advice is to give it a try. It’s very easy to administer with just a Few drops placed in patient’s mouth and can be repeated as per instructions given. Please discuss this with physician and or hospice care if sleep is still a problem. Best of luck and God bless you and yours!

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Oh my goodness! I know what you are talking about and it's not good! It is known as sun downing. It is a condition associate with dementia. Sun downing causes symptoms such as aggression or ignoring directions, pacing and wandering. Most of the times, these symptoms happened in late afternoon and span into the night. I did find out that my mother's symptoms were related to an UTI and doctors have said that the infection can cause the symptoms to be more worst.
I think if you look it up, you will find the match.

Not good but is fixer able!
Be blessed and hav a great day!

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Have you tried Magnesium? This works a charm for Mom with alzheimers/dementia.

400 mg magnesium glycinate (if she trends towards loose stools)
or
400 mg magnesium citrate (if she trends toward constipation)

Take at 6:00 pm or take 1 at 4 pm and 1 at 6 pm.

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DaizyMae: The Hospice recommendation of the minimal dose morphine seems to be helpful to the patient and to the rest of the family so that you all are not experiencing sleeplessness. Disclaimer - I am not a medical professional. This should be discussed with patient's Hospice team, if required. Best wishes.

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Morphine can be sedating but won't last the night unless it is a sustained or extended release formulation. It is better to talk to her doctor about her sleep issues - difficulty getting to sleep? difficulty staying asleep? difficulty getting up at same time every morning? - since there are prescription sleep medications to help with each of these types of problems. As an RN, I have had success using Benadryl (25 mg over the counter medication) and Restoril (prescription medication) to help seniors in the hospital to get to sleep and stay asleep at night.

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The first time I gave mom morphine she turned red and hot. She needed the blankets off of her and she is always freezing. She also experienced awful stomach pain. She held my hand and squeezed through the pain. She kept looking at me like please help me! After two hours w with hospice on the phone I finally gave her the nausea medication that was in her "Emergency! Kit". She is on Norco 10-325 and doing better.

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Background:
My 99 yo mom has late onset dementia and issues ranging from torn rotator cuff, arthritis, crohn’s etc. She lives at home with live-in caregivers. She is followed by a top notch neurologist, palliative doctor and primary.
Her days and nights were upside down and she was in constant pain and was having psychotic episodes and was very depressed…until we got the specialists on board.
our new normal over a 2 year period is as follows:
zoloft( anti depressant
remeron (sleep medication)
melatonin
risperadone (for psychosis)

methadone (pain)
a small dose 2x a day
Doctor explained that they found that
a low consistent dose is much better than trying to address intermittent pain that can take 1 to 2 hour to respond to medication.
our days and nights are normalized.

our goal: Mom’s life should be as joyous and as pain free as possible for as long as she is here.

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Yes. I have experience with morphine. For the last month that my dad was dying, we had hospice come in 1ce or 2ce a day. They gave me the morphine to give to him. It kept him calm and peaceful and sleeping. Otherwise he'd wake up and be in a panic and try to get out bed and he was too heavy for my mother and I to hold. Morphine is what they give. Don't be afraid of it. Give as instructed, but especially at night. Sometimes I had to get up at night and give it to him. It was oral. Good luck.

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My 83 year old mother used to take a child's dose, 25 mg Benadryl at night to help her sleep. I would rather try that first than morphine. If that doesn't help, give her 2 pills. There are many other medications for sleep than morphine.

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The benefit of using drugs for making a demented person sleep normal hours, is only for the caregivers. A reverse sleep pattern, is not going to add more damage to an already impaired brain. The use of psychotropic medications in old persons with dementia makes them worse. They are also prone to falls because of prolonged over-sedation. In hospices where the worsening of the patients is not a concern, they use medications to make the patients and staff comfortable.

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I've tried so many things to keep my mother in the bed at night. She's at the mid-to-late-stage of dementia. She has lost her ability to reason and understand. Even if she could, she doesn't remember anything in the short term.

RIght now I'd be thrilled to get 4 hours of continual sleep, but we're up every 1.5 to 2 hours to go to the "peepot" as she calls it. Her doctor prescribed trazodone which has the opposite effect on her.

I've been using melatonin, a chamomile/Ltryptophan/melatonin combo and magnesium which haven't been as effective lately. So she wakes me up all night long and then she sleeps like a baby all morning. It's currently 10 am and she's been sleeping soundly since 5:30 ish. She doesn't have enough brain function to realize what's going on so I can't be mad at her. I've tried so many days to keep her up and it accomplishes nothing but making both of us miserable. It was like I had an over-tired baby on my hands.

I'm going to start using some Dandelion tea to see if it will settle her bladder down.

Like someone has said here, there is no fixing or reversing the dementia, which is at the root of the problem.

I'm currently waiting on an assessment for palliative care - waiting on her doc to send the orders - maybe when I get her on board with them, they can offer some help.

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Hi my dad was given some tablets for an overactive bladder. They seemed to work ask the GP

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Listen to Hospice and doctor. Do not think a Hospice nurse can prescribe morphine - do jot know. But your family needs medical help. You can not sleep all say and failure to fet restful sleep will harm your health.

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I can't advise you on regulating one's sleep-wake cycle because I just wanted everyone to get some sleep (like you). What has been working for dad is one 20mg escitalopram and one 0.5 mg of lorazepam given around 3:00. I try hard to keep to that schedule because that's when he used to start getting all wound-up. For now, there is no wound-up. By seven I try to have him in the recliner and by ten he is usually asleep enough to where I can get some sleep and he can still help me care for him come morning. I try to have him walk with his walker as much as possible during the day like when he is going to the restroom. I also set his tv timer for about an hour.

Our hospice was the one that asked us to try lorazepam but that alone did not work. I didn't know they would administer morphine for sleep.

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Morphine can make an elderly patient stop breathing. In hospices is OK because after all, patients are there waiting to die. As long as patients are comfortable, dangerous side effects won't matter.

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We go through the mini-mental status tests frequently. It has been a long time since she "knew" she was at home. I have played her game of being in the hospital although we were at home. I have run "people" out of her room often. I have negated her visions, but she gets upset because she feels she is never right about anything. She talks to her "people" whether there is light in the room or not. We have discontinued some medications because we knew they were causing hallucinations. Basically, we have tried everything we know to try. There is a large-numbered clock beside her bed, but she doesn't even look at it. I guess she forgets it is there. Often, she won't even open her eyes no matter how we try. Her dementia is declining, like going down a rabbit hole, but because it is inconsistent it is more difficult to manage. I appreciate your response in letting me know what has worked in your situation. Thank you for trying to help.

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When I worked as a case manager RN, a daughter of a patient told me she was going through exactly what you described except rather than talking throughout the night, she was singing.... loudly.... she used melatonin sometimes and wound up getting a prescription for Seroquel.

But since your mom has Hospice, I would really listen to what they suggest and try morphine. It is a great medication when used properly.

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A reverse sleep-awake cycle in dementia, is the result of brain damage. It can't be corrected.

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I understand. Nothing can be corrected with dementia. It only worsens. I am just trying to get us all a better night's sleep. Thank you for your answer.

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I will tell you this; when I was pregnant with my son back in 1985 and having very early labor contractions associated with pre-eclampsia, I was given MORPHINE to stop the contractions and put into a light twilight sleep for about 8 hours. The contractions stopped, I had a healthy baby boy who I carried to term, no further complications, and all was well.

Don't attach an unnecessary stigma to a drug that has many, many uses. Don't question hospice too closely because they're not trying to kill your mother; they're trying to help your mother sleep through the night and thereby, help YOU sleep through the night.

Both of my experiences with hospice have been nothing but positive and excellent. If you have any further doubts about the 'danger' of low dose morphine, run it by the doctor who oversees and is associated with hospice. That should ease any further anxiety you may have.

Wishing you the best of luck.

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I’d totally support this, but would perhaps double check what IS a low dose, and what dose your mother will get (for your own future peace of mind in case you question it). I’m fairly sure that a high dose from the doctor hastened my mother’s death, which was probably appropriate and a blessing. However Hospice has nothing to gain by hastening your mother's death, a very different situation from my mother's terminal cancer pain.

My own extensive experience with codeine (which is the bottom of the range opioid) is that it does help with sleep as well as pain. More sleep will help you all.

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Don't you think mom might do better during the day if she gets a good night sleep? Listen to and trust hospice. Give her the morphine dose as suggested.

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Mom's situation waxes and wanes. One night she sleeps well, then you have a 48-hour wake cycle. We are going to try the Morphine. Thank you for your response.

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Have you tried melatonin? We started giving it to mom after she had an incident where she didn't sleep for days. In fact, it was the hospital that started it. We just kept giving it to her. It does seem to help regulate her cycle. Not completely, she would still wake up 1 or 2 times at night and rummage about. But at least she slept a decent amount.

That seemed to be a multiyear phase. For the last couple of years, she's gotten to the point where she stays up all day now and sleeps all through the night without getting up. Still on melatonin.

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We have tried the Melatonin. One night it works great, the next may be a completely different story. I love the spray Melatonin because I don't have to convince her not to chew it or to simply swallow it. I am learning the hard way not to try to reason with her because she isn't capable of reasoning anymore. Sad, but true. Thank you for your response.

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DaizyMae! What a lovely name! You are doing well and I know you are exhausted. Give yourself a little breathing time, stand outside in the daylight and take a deep breath.

THEN........ Listen to hospice, they have done this many times and know a lot more about it than any of us ever will! A minimal dose of Morphine before bed might just do the trick and you all can rest. Your momma is 86 years old, a good night's sleep might make the days easier,too.

Be brave, you can do this!
God bless. ((((Hugs))))

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Thank you for your kind words and encouragement! I appreciate you for that! I do take mini-breaks for myself. A trip to the mailbox even seems to center me now! Our Hospice team is wonderful. They are a tremendous help. I am working through my feelings about Morphine, but have decided it might be best after speaking in depth with her nurse yesterday. Thank you for your response!

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You have to been stern.about 6 months ago hallucinating started with my mother in law.some meds will trigger them.explain toher they aren't real.ask her if she knows where she is.and what's in her room.Have her explain to you what she sees and touch her so she knows your real.And tell her to go back to sleep.even if you have to turn the lights off.talk to her till she comes out of it.my mother in-law is home bound so she gets night and day mixed up.so get a clock she can look at too so she knows what time it is.i keep one next to her bed it has helped.hope this helps

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Does anyone have advice on regulating Mom's sleep-wake cycle?

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