My Dad (89) has chronic insomnia and doctor won't help?

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My dad is 89. He has had constant insomnia for months, Dr at the VA was informed, but always want to wait on this, that, or the other thing before prescribing any sleep meds. Three weeks ago my dad went into the hospital for three days because of an unexplained Atrial-Fib episode. First thing the hospital doctor asked was about insomnia and sleep apnea. After reminding the VA Dr. last week, they decided to send my dad for sleep apnea testing. That doesn't happen for 8 more days. Today the Dr from the sleep apnea testing facility called my dad with a bunch of questions. My father told him he has had insomnia for months, and has not slept at all in three days. The doctor told him to call his VA doctor immediately and tell him that they suggest he be put on sleep meds. He did, and the nurse told him, "We don't like to give sleep medications." The doctor later called back and said he wants to wait until the results are in from the sleep apnea testing before he decides what he wants to do - he won't even be tested for eight more days. Today was his third day without sleep, and fourth out of the last five. He was so exhausted he was stumbling, so I tried to get him into a private doctor. The earliest they will see him is two weeks. They suggested I try a walk-in clinic. I took him tonight. They only have a nurse practitioner, and she cannot prescribe sleeping pills. They suggested I take him to a private doctor asap... Right now he is so exhausted and frustrated I am afraid it is killing him. I am certain the lack of sleep contributed to the A-Fib episode, but the doctors do nothing but wait. I want to take him to urgent care, but he is too tired and upset to go. I am disabled and exhausted, too. He wanders the house day and night unable to sleep. Please, any advice is welcome. I am too worn out to think straight.

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Thank you very much. I am working on getting him into another doctor. It would help if my brother gave me some support dealing with him, but he is no help at all.
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How much prednisone is he on and what time of day does he take it? My mom was up vacuuming at 3 AM when she was on it. She took it for temporal arteritis and they started her on a pretty high dose. They didn't warn her of any of the side effects or tell her when to take it. It can also effect you emotionally, with crying, etc.

He needs to take the prednisone in the morning if he can, because it will definitely affect sleep negatively. Albuterol can also cause insomnia - it's listed as a side effect. And on drugsdotcom, it says, "Use albuterol with caution in the ELDERLY; they may be more sensitive to its effects." So there are two meds right there than can cause insomnia by themselves. Put them together and I'm sure the effect is compounded.

There are geriatric pharmacists who understand how meds work in seniors. Find them at ccgpdotorg. For example, my mom was getting a heart catheterization and they gave her benadryl to put her to sleep and prednisone to prevent swelling. The benedryl caused her legs to jerk uncontrollably. The cardiologist refused to believe it was the benedryl, but a nurse brought me a print out about benedryl causing dyskinesia in the elderly. So the doc was a dope about using it in the elderly and the possible side effects. So you definitely need a pharmacist who understands dosages for seniors and how meds interact together.

I have a feeling your dad is more sensitive to meds because of his age and they're working together to screw him up. You need to find a sympathetic doctor who will work with a pharmacist to make sure the dosages and cross-effects will work for your dad.
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Oh, the sleep issue has only been the last half year or so. Actually, about the same time his old doctor moved away. There is an idea I hadn't thought of - the new idiot doctor immediately changed some of his meds. I'm going to look them over online. Maybe he prescribed something that the old doctor did not?

Thank you for the ideas, everyone.
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Thanks all. The first thing I did was get him melatonin. He took it for about six weeks and it didn't help. I also tried Valerian &Hops, and chamolmile. No luck. We asked the pharmacist as couple of weeks ago, she suggested that some of his meds might be contributing - he takes warfarin, prednisone, albuterol, metformin (pre-diabetic), and several others I don't remember. She sent him home with benadryl, which didn't work.

He slept about an hour last night from exhaustion, but then he was back up roaming about. I've tried to get him to stay in his room, but he starts screaming at me if I push it too much. He is very angry and irritable, which I would be, too.

I think the ER or Urgent care is my next choice if he falls again. I'm trying to at least get him to make an appointment with a private doctor, but he afraid they will all be the same way the present jerk is. I've told him that is not necessarily the case, but he really doesn't want to listen anymore.
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oh.it soo sad story but you have to consult with expertise.
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Have you considered taking him to an ER? The inability to sleep for several days upsets so many rhythms, including those systems that provide regeneration during normal sleep.

I've found melatonin and relaxing, soothing music to be very helpful as well.

If you're both tired, call 911; the EMTs can take him, and I believe that lack of sleep for days is certainly an emergency.

The stumbling could easily lead to a fall and complications.

If you do go to the ER, be sure to take a list of the meds he's taking; there might be some interaction that's causing the insomnia.

I'm wondering if he's keeping hydrated? Given the demands on his body from lack of sleep, I hope he's at least eating and drinking enough to keep some normal semblance of bodily functions.
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What are your dad's medical conditions and what meds is he on? If he's on some medications, I'd talk to the local pharmacist about his insomnia and how those might be affecting it. Have you tried quiet music, a dark and cool room, etc? Has he had this insomnia throughout his life or just more recently?

Tart cherries and kiwifruit (2 an hour before bedtime) are supposed to help...I'd also give melatonin a try - I don't think it can hurt at this point. Like Jeanne says, please let us know how things work out.
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My heart goes out to you. My husband had sleep disorders along with his dementia, and I have two sleep disorders myself. I know how frustrating and debilitating this can be! Not to mention scary.

I am glad your dad is going to have a sleep study. That will not only determine whether he has sleep apnea (which is treatable -- without drugs) but also may detect other sleep issues and have some treatment options for Dad. So you are doing the right thing there.

Having dealt with these issues over several years, I know first-hand that different doctors have very different approaches to treating sleep problems. My psychiatrist wants me to take sleep medications. (Psychiatrists are medication managers so that seems a natural bias.) My sleep specialist MD is strongly opposed to any medications but melatonin, citing all kinds of studies that meds will make the problem worse. We patients are kind of stuck in the middle, dependent on the particular doctors we see!

Instead of stumbling about, waiting the next 8 days, can your father remain calmly in bed or in a comfortable recliner for several hours at a time? He may fall asleep out of sheer boredom! Or at least he won't be at risk of falling. My sleep doctor assures me that anyone will sleep out of sheer exhaustion, regardless of sleep disorders, caffeine, drugs, jet lag, etc. etc. Sleep deprivation is unhealthy, for sure, but I bet exhaustion is going to take over long before the 8 days are up.

I can remember how awful I have felt -- almost psychotic -- with inability to sleep on a regular schedule. The good news is that once the disorders were addressed I am back to "normal."

Please let us know how this unfolds for you. We learn from each other.
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