I have an Alzheimer's patient who doesn't want to get up in the morning. Any suggestions?

I came across this article here on Aging Care regarding Alzheimer's and sleep.

https://www.agingcare.com/articles/alzheimers-and-sleep-156720.htm

My mom needed to get up in the morning because she had to get out of her wet pull up and have her morning pills, I was able to get her to cooperate with the promise that she would feel better after she changed and she could come back to bed as soon as she had her pills and breakfast.

Today I saw a bit of a segment on Dr Oz about how smells help us. One idea was to set a timer so that the coffee pot would turn on before the alarm went off so that when the alarm went off you would awaken to the aroma of morning coffee. Supposed to make it easier to get up.
If your patient drinks coffee might be worth a try. I love the smell myself.

My husband (LBD) attended an adult day program a few times a week. The van that picked him up had several others to pick up so hubby had to leave earlier than if, for example, he took a taxi directly there. We struggled with this. He had to get up earlier on those days than on other days. Well, duh, finally I called the program and had him start an hour later. This was much better for all of us!

When he could no longer go to the program we had in-home help. I scheduled the PCA to start at 9:00 am. That way she could get him up, supervise his shaving, dressing, etc. and give him breakfast. (It also allowed her to get her kids ready for school before she left for work.) Starting any earlier would have just annoyed my husband. Who wants a cranky patient (or husband?)

What time do you attempt to wake your patient up? Why is it that time chosen? Would she get up more readily and with less animosity if that time were moved an hour?

Light has a big influence on our sleep cycles. I sincerely wish I had a maid to come in and open my curtains about a half an hour before get-up time, and a half and hour later come in with a steaming cup of tea. And having the smell of cinnamon rolls or bacon wafting in from the kitchen would help, too. Really. I have a problem called sleep inertia and I have discussed it with a sleep specialist. But all I really need is a morning maid. Maybe you could be your patient's morning maid.

You say she has gotten worse since January. That is the nature of dementia ... it gets worse. She may stay at the level she is at now for a while, or may continue to decline.

Have you taken care of a patient with dementia before? It really does present some special challenges.

Sometimes low blood sugar can be an issue. Can you get a few sips of orange juice in her. Maybe try a little bit in a big cup - to lessen the spill risk or it getting thrown at you - and tell her that you'll let her sleep longer once she drinks her juice. Then try again in twenty minutes.

I ask, too - what time are you getting her up? Also how many hours sleep does she get a night? Personally, I am a huge "not a morning person". HUGE. I have awful insomnia- suffered from it all my life, even as a child. Typically, I don't fall into a solid sleep until 3am - sometimes not even then. But regardless, I've found a huge difference between getting up at 8am and even 7:30am. It doesn't matter how well I slept the night before - at 8am, even though it's only 30 minutes I feel much better.

I think it was Jeanne who touched on light. From years of research on insomnia cures - there is much debate on light. Pitch dark vs natural light. The philosophy that works best for me is natural light. I have no blinds or curtains on my bedroom windows - good thing my house is up on a steep hill as no one can see in - anyhoo, the theory is that your body clock will set its self to the light. Kind of an "up with the sun" thing as the caveman did prior to alarm clocks. Although if you live in a bleaker climate this can be problematic if it doesn't get light out at a reasonable time - winter for instance. Sooo - perhaps try going into the room and opening the shades/curtains twenty minutes prior to your first attempt to get her up - remember the O.J. on that first attempt!

My mother with dementia resides in a nursing home. One of the first things we told the staff is that mom has NEVER been a morning person and likes to stay up late. They have arranged to keep her last on the list of Katie 3rd to be gotten up and dressed and last to be readied for bed. If, on occasion, she is still not ready to arise when staff comes around in the am, they come back in an hour or so.

What is her preference for when she gets up?

Lately my DH will go back to bed. I just keep asking him if he's ready for breakfast. I get him moving around, fix his breakfast and he tends to go back to sleep again after eating. But at 95, I was told this is normal - they revert to sleeping more, just like toddlers.

You didn't say how old your patient is - but if it is age related as opposed to dementia, then you're fighting nature. I've been advised that it is not uncommon for a 95 year old to sleep upwards to 20 hours daily. He has started watching TV in the afternoons, and I am thankful.

Is your patient willing to get up later in the day and eat breakfast? I know for us, time no longer matters. He wakes up and I offer to feed him. Breakfast, lunch and dinner don't have to be at a special time for us.

My mother is 90 with moderate dementia. I start getting her up an hour before the caregiver comes. I play her favorite music while I lift the shades half way. I then lie on the bed with her and we sing the songs together while we cuddle. After a little while she will say she has to go to the bathroom. Once in there i get her dressed and we are off to breakfast.

Had the same problem with my wife, but lasted all day. Her doctor prescribed an antidepressant. That fixed it. Depression (as a brain disorder), causes a person to be sleepy.

My Mom is 89, has LBD. I take care of her 2 days, 12hrs, a week. When I arrive, if she is wet or soiled, I clean and change her. I let her go back to sleep with just her pamper on. I tuck her her gently under the covers and kiss her on the forehead. She wakes up around 10am. I make her a small cup of coffee. Give it to her w/a spoon. I patiently coax her into waking up. She's in her wheelchair by 11. At which time I give her breakfast. The aide I have does the same ( accept for the kiss..lol). Love, kindness, consistency and lots patience.. PRICELESS 😊

My LO used to be very difficult to get up in the mornings. She would have stayed in bed for most of the day, if not encouraged to get up. Her doctor prescribed medication for her anxiety and depression and it worked quite well. Her mood improved and she was ready to get up in the mornings. It is my understanding that as dementia progresses, eventually, the patient will want to sleep more and more though. So, I'd ask her doctor if she has reached that stage yet.

My Dear, my Mother has, slapped me, punched me spit at me & cursed me. IT IS NOT HER... it's this wretched disease. The harder you try the more they may resist. Walk away. Come back. See if she is still in "that place mentally " if so.. .Walk away again. What's the rush? In my case, I'm in no rush just to sit Mom in her wheelchair.

I go into Mom's room singing some silly song quietly while opening the blinds. I then tell her that there are Cardinals/Bluejays, etc. on the bird feeder and the baby groundhogs (7 of them) are outside, perhaps the baby deer (we have 3 babies, up to 11 deer in the backyard at the same time) and squirrels. I tell her she is going to have pancakes with fresh blueberries or oats with fresh strawberries with freshly made coffee to warm her up, she seems to like to hear the menu (kind of reminds me of Hee Haw, "What's for Supper" : P for those of us old enough to remember that). I get her cleaned up on our way to the kitchen (I need to brush my teeth, wash my face, brush my hair, etc. standing along side her or she won't do it, she watches me to know what she should do with all those activities).

From the beginning, I have found she likes to look outside so I bought a 6 foot by 30 inch folding table to place in front of the kitchen window for her to look out into the backyard, the bird feeder is about 5 feet away from the window. We live in the city but this part of town has lots of room for wildlife. She looks outside while I use the computer (a little entertainment for me) on the other side of the table. I read emails or work on our genealogy online and sometimes I look up video on youtube for her to watch on my pc screen that is large enough for her to see sitting beside me. You can find any song from almost any era on youtube! We look at stored photos on my pc of years past.

If I don't stay at the table with her, she gets up and goes back to bed. I believe you need to give her a good reason for her to get out of bed, something to get her excited about. Something good to eat, or visual activity to entertain her.

We had a hired caregiver come in every day at 9 or 10 a.m. to spend a few hours with my mother. Getting her up, washed, dressed, diapered, fed, and settled for the day.  (I wished they could have come in earlier, at 8 a.m., but 9 or 10 was the earliest time they could come. ) It was important to get Mom cleaned up and ready for the day.  What good was it for Mom to lie in bed snoozing most of the day?  We had to keep her on some kind of schedule, the caregiver had only a few hours a day to spend with her.  If Mom just slept in,  she was then awake, up and roaming around the house all night, hiding things or putting herself in possible danger.   

This is a common occurrence with Alzheimer's & most memory impairments. If this was her behavior & self, not wanting to get up, that's an old memory & probably will always be a challenge. Does she fight you on other needed tasks as well; showering, changing, etc? Due to progression of the disease she may be having a harder time following your directions, she may be more confused, getting frustrated, the kicking is an agitated state, be cautious of that.

You sound like you are doing everything right, giving her time, then trying again. You could try enticements or "fibs," such as a nice breakfast or an outing. You mention an hour may lapse, that's a long time for you & her. Any aggressive behavior, verbal or physical, is not healthy for either of you. She may be picking up on any of your frustration or stress in your behavior; voice tone, body signs. It seems that senses are heightened with this disease. You also have to remember as her primary caregiver, you're it as far as her behavior issues. As the disease progresses, there's no rhyme or reason on behavior. It could be caused by any number of things, even medical, it may be time for a check up. Or if someone was always miserable that may not change, just get  worse. You may have to make a decision on this case & know that it's ok. You haven't failed at your job, it's not your fault.

I'm my brother's primary caregiver, he was tough prior to this d*** ALZ, so, need I say more. As the doctor said from day 1, that was his self, it would probably stay the same & possibly worsen.  This ALZ has been a roller coaster ride for us both. As the disease has progressed I do see a compliancy, he may take direction easier or allow things to be done for him, sometimes. 

I have to say the "right person" makes a difference and it's usually evident from day 1 if the fit is right. I find hearing & watching an aide struggle with any behavior issues more stressful than helpful.  I don't want anyone disrespected or hurt. I realize I don't have an abundance of good help for him & me these days & I am always looking. I've educated myself on this d*** disease & most of the times I'm it, 24/7.  I hear no a lot & proceed with caution at times.  I love & care, but I'm me, I'm an old memory, this he knows.

Caregiving is not for everyone, there are mental & physical responsibilities, challenges of doom & gloom.  I question if it's a "forever job" for anyone?  Blessings 🌸 

Providehope, has anything we've said been useful? Are you finding some solutions on your own? Come back and tell us how things are going now. We learn from each other!

I appreciate all of your answers. Thank you so much. Most of you are recommending things I have already tried: giving her more time being the most recommended. Unfortunately, I am her Caregiver and have only so much time to spend with her. I also care for her husband, but he is generally up when I arrive. While I am with this couple, I have to prepare breakfast for both (and they eat different things), ensure they get their meds, bathe and dress her, make beds, do laundry, clean kitchen, etc etc., and I'm only there 5 hrs. Fortunately, a previous client has asked that I return to their mother. Today was my last day. I am sorry I have to leave because I like both of them. (I agree there may be depression.) I must say, when I finally get her out of bed, she is fine and we laugh and sing together.

Thank you all for your suggestions. I am only with my client from 8 a.m. to 1 p.m. Aside from her husband, no one else is at home. My client is 72. I have no one to ask about her bedtime or interaction with other family members. Her husband has Parkinson's, is capable of caring for himself, but primary activity is TV. She lives with her daughter and family and no one is around during the time I am there except her husband. Once she is up, she's okay. She no longer recognizes herself in a mirror and comments to me on the activity she sees reflected in the mirror that is herself. I have the feeling her main activity with her family is watching televsion.

The person should be able to be roused out of bed with something that smells good to them-a piece of toast with grape jelly and a cup of coffee. They need to use the toilet and get pills into their system. They can always rest on the sofa or chair later.