Dementia, talking all night, no UTI or other infections. Any suggestions for helping her sleep better?

I'm assuming you've contacted her prescribing doctor to inform them that of what's going on so that they have either adjusted her meds or prescribed something else...

Does she do anything physical during the day to burn energy? When my 99-yr old aunt with mod/adv dementia was having problems sleeping we started having her fold a large pile of kitchen towels at least 2x per day; she also did an electric pedal machine 2x a day for 15 minutes each arms then legs. Then we'd walk her out to the mailbox every day. The caregiver has her sorting things and playing card games (Auntie's rules). Once we started doing this she now sleeps through the night without any medication or even melatonin. If your mom's already getting some activity see if it can safely be increased. Things that occupy her mind also burns mental energy and it all works to make her tired.

I would stop the melatonin since it is not a literal sleep aid -- our bodies make it naturally and it's released when it's time to sleep. Taking it tells our minds it's "time to sleep". But if you're giving it to your mom when she isn't sleepy, you may be reinforcing the wrong pattern. It is only a food supplement so is safe to stop taking it, especially when it obviously isn't working. One less med to have to manage. Let us know if you figure out a solution for her! Blessings to you!

I know what you mean about them staying up all night. It seems to be part of dementia. Talking in the sleep (I mean conversations) and acting out things they use to do in past – (our case driving log truck, hurdling cattle, etc.). Maybe we didn’t get the light therapy right as well so also gave up that one. Same questions over and over. It also seems part of dementia. Is mom sleeping as one example? Yes, she is resting (mom is deceased and so is his dad, mom, sister, and a brother that he asks about quite often). Is it raining outside? You just asked me a few minutes ago. Roll your transport chair over and look out the window. Over and over and over lol. Other times I will repeat the question he asked me over and over and I got looked at like I’m a nut or he will say stop that.
 
I have tried so many brands of melatonin. Some caused stomach upset and others did nothing. The only brand that is half-decent (at least so far but still at times hit or miss) is Spring Valley Adult Gummy Melatonin. I still have to try and get the timing right. Many other prescriptions caused insomnia so get the help of your doctor to see if your loved one can be taken off any med that you find from research that can cause insomnia and is not absolutely necessary,
 
Dad has gradually gone from 15 prescriptions to a sugar pill morning, half of a 300 mg Full Spectrum CBD Gummy noon, and escitalopram an hour or so before dinner. I'll also add during the night if I happen to wake up and see him tossing a 5 or 10mg melatonin gummy. But I’m still testing because it seems if given late it keeps him awake more than helping with sleep. But so far with this last regimen, one speaking of, (fingers still crossed) no more bad sundowning, agitation, or having those conversations and acting out when should be sleep. He sleeps just enough now that I don’t have to be overly concerned.

Does she nap a lot during the day? Sleep late? Even as I ask, I am wondering if the dementia is too far advanced for these things to even matter?

While she's up all night talking, I'm guessing that she's keeping you up all night too. This is not good for YOU. And you need to be your first priority. You need good sleep, every night. I would hire someone (with mom's money) to sit with her at least a few nights a week so you can be off duty and sleep. Put on a sound machine, let the helper help and sleep!

Try dual-release melatonin (works now & works later). Start small and dose up gradually. If the dose is too large, it can CAUSE sleeplessness. Also, if she gets the same dose at the same time every night, she may do better. My mom gets 3 mg dual-release melatonin after dinner -- helps get her sleepy and mitigates some of the effects of sundowning. I know it's early, but it seems to help.

I see others mentioned brands of melatonin -- so I'll add that I use SwansonVitamins.com - dual-release 3 mg.

You could try not letting her nap during the day. It may be hard to make her stay up, but it will help at night. Also, psychiatric drugs cause all kinds of different effects in elderly people.
Does she have anxiety and panic? She could benefit greatly from a benzodiazepine like ativan (lorazepam) taken as needed. Melatonin might work well for her if used with an anti-anxiety drug.

DaizyMae: Try melatonin. Be careful for her not to take too much, though.

Daizy,

I'm experiencing the same thing with my mother. She's on 4 prescribed meds, including a "sleeping pill". It's very rare that she sleeps through the night. She does full conversations with all / different voices, and often she yells and screams. (I call it "dinner theater" in my head.).

Fortunately, this doesn't happen every night, but it happens most nights. It's very disruptive, as you know. And it's the same thing - a combination of deceased relatives, invisible people that no one else has ever heard of, miscellaneous babbling. Actually, it was worse a few months ago, because she was cursing, too. At least that has stopped. I think that the improvement came when we made sure that she got ALL doses of her meds, even if that meant waking her up to take them. It's still nowhere close to perfect.

I wish I could tell you something helpful.

I just want you to know that you're not alone.

I would first speak with her Dr and get her off the psychotic drugs as her brain dealing with dementia is enough.
If she sleeps thru the day. You can't expect her to sleep thru the night.
Try having her stay up all day and she'll have a better chance of sleeping thru the night.

I would give my Dad a 3 mg Melatonin at night.

If she gets up to ge to the bathroom then don't have her drink anything after 6 or 7 PM.

If she deffiently can't or doesn't want to sleep at night then let her stay up.

Maybe watching TV will help her fall to sleep.

Try Music Therapy and let her listen to calming music all night.

Prayers

We've been there. My mom had auditory and visual hallucinations. Especially when she had the former, I knew the 1 voice she really needed to hear was mine. Luckily, these hallucinations came mostly during the day. I'd keep my mom as active as possible during the day, so she'd sleep at night. I address this issue in a book I wrote about taking care of my mom called, "My Mother Has Alzheimer's and My Dog Has Tapeworms: A Caregiver's Tale." Once, she was insistent that someone was knocking on her door. Since her bedroom was near the laundry room, I said it must have been the washing machine lid going up and down, as I was transfering clothes to the dryer. I was a liar, liar, pants in dryer. Once, my mom apologized to the studio audience on TV, that when I offered her some tea, I didn't include them. I can only offer you tea and sympathy. In time, we all got used to the hallucinations, (even the dog, who looked a little confused at first). I think you're doing a great job with all the things that you're doing. I'd just keep your mom as physically and mentally stimulated as possible during the day, and maybe ask her doctor for other advice.

If your state allows, apply for a medical marijuana card for her and a caregiver card for yourself. Our neurologist preferred cannabis over melatonin. He said that it acts in the same manner so don’t give both. My husband takes the tincture prior to going to sleep and usually sleeps quite well.

Your mother needs help from a psychiatrist that specializes in dementia. They take a bit to find, but can medically help. Not sure anyone in a chat group is qualified to gelp your mother at her stage of illness.

If medication she is taking is not working, it should be changed. Rarely is a General Practioner going to have the specialized knowledge to help her.

You either need a much stronger sleeping pill to make her quiet and sleep the night or your lives will be shot to hell. I think you have to face the fact she is gone and should be placed. Please don't wait - do this now. This is only going to get worse.

Are you familiar with CBD products? They do not contain THC that gets one 'high' but these natural plant compounds work with the body's own chemistry; some are formulated with relaxing herbs as well to ensure good sleep/relaxation.Check with the doctor so there's no potential risks/interference with current pharmaceutical medications. There are many highly regarded producers of CBD products now; ask around, shop around; and more and more intriguing parts of both the Hemp and Cannabis plants are being discovered all the time with great healing potential. CBD comes in liquid tinctures, even rub-on salves (and some smell heavenly, as with Rose, etc.) Between the brain changes with dementia and stress hormones, the body's chemistry is distorted; CBD could help restore some balance since the body has natural opioid receptors as any doctor will confirm. These are Not opioid drugs (oxycontin, etc.) which are highly addictive and problematic, but plant-derived compounds that the body recognizes, can utilize, and have helped many people.

Talk to her doctor. It seems she needs medications to help her fall asleep and stay asleep,

How much melatonin are you giving her? BIL does this all the time he has dementia. He usually talks to someone one his cellphone for hours at a time day or night. Lately he has been talking to someone telling them to sit down but there is no one there how we know this is because we have ring cameras set up in his kitchen/livingroom and the bedroom. Every 2 minutes while we are there he keeps repeating himself asking us what we have been up too.

BIL is on 30mgs of melatonin at night within about 2 hours of taking it he is down for the night. He sleeps now from 9 to 12 hours. His best time where he can function during the day is 10 hours of sleep. If he gets longer sleep he is confused during the day. The dosage is what the sisters at a nursing home would give their patients with dementia to sleep.

She could be sundowning that is what dementia people do they get active at dusk. BIL has done this too. At certain times of the night he gets his quarters out and counts them he maybe at this for 30 minutes or 2 hours.

The way is to take their mind off of the questioning change the subject we do this with him.

Prayers that you find something that works for you and her.

I began with Melatonin with my husband who has vascular dementia. He was diagnosed back in 2014. We added valerian tea for a time, but it didn't seem helpful. Over time I increased the melatonin to 30mg per night. I have a DIL who used as much on the time zone differences she had on her job. A couple of years ago our GP prescribed Trazodone. It has made all the difference! 50mg an our before bed. No more anxiety, sleeps through the night. Calmer in the morning. He still has some sundowning, but I'll take that over the sleepless nights.

Check her medications side effects
the delusional states you refer to are common side effects of the meds given to treat dementia
Have the case dr reduce her meds to an absolute minimum with a goal to stop then altogether.
Dr Christophers Relax Eze caps and Goats Colostrum have helped my grandfathers mental stability and got him sleeping so much better
catnip tea with honey
Epsom salts on a hot washcloth applied to neck shoulders & down the spine while bathing

give her only distilled water to drink & cook with. This will make a Big improvement
Sage & Rosemary tea are very beneficial for brain function & overall health

There is a lot of research and investigation happening about the use of antipsychotics in dementia/alzheimers. You may want to discuss with the doctor alternatives that are safer such as antidepressants (ssri) and benzo. https://labblog.uofmhealth.org/rounds/why-antipsychotics-and-dementia-may-not-mix

Talk to her doctor about any medication assisted solutions. Medication interactions should be a consideration. Also, have you tried talking to her about the people and/or experiences related to her evening conversations? Normalizing it may help her reconcile some conflicts she is unknowingly having?

My mom sometimes stays up all night talking to the dead, as well. She’s on many night meds to help her sleep. Most times they work. But you should consult her doctor for recommended medication.

If a person is on meds that put her in a weird twilight - not really asleep, not really awake - it can invite hallucinations. If this seems relevant to your situation, you might want to consult a psychiatrist who can effectively titrate (dosing and timing) meds.

Does she then sleep during the day, or is she dozing off so that she doesn't need to sleep at night? Timing can go out of the window when the brain is involved and it isn't always the elderly or dementia, my son has become virtually nocturnal since he was diagnosed with MS (age 37). You can get the Dr dealing with her sleep to up the dose, but this is always a bit iffy in the elderly, a change may be better but you will need to discuss this with him. However I do wonder if a part of the brain dealing with sleep can be damaged and this just throws the clock out of the window - talk it over with the Dr and see what he suggests.

A vascular dementia is an organic brain syndrome. It is incurable and progressive. Medicines in general and particularly anti-psychotics can make it worse. Therapy is useless. Let us face it, her brain has sustained irreparable damage from her mini-strokes and she will only get worse with time. Anti-psychotics should no be used in the elderly because it may induce more cerebro-vascular accidents. Her hallucinations are caused by her brain damage. It is called delirium. They will not respond to anti-psychotics. Melatonin might help a normal brain, not a damaged one. She might need some heavy sedation at night so that you can get some rest. Ask her doctor. Eventually, she might requiere placement in a special facility that cares for brain damaged people, where she can get professional assistance.

My mother is 95 next month with advanced dementia. She too continuously asks about the deceased relatives (she's the last living sibling out of 8) and insists they've 'abandoned her'. She never sleeps through the night; nothing helps. In fact, all medications make her much WORSE. Melatonin, which everyone swears by, can, in fact, CAUSE nightmares and night terrors in people who are sensitive to it. My mother is sensitive to EVERYTHING and all medications make her dementia much worse. The wellbutrin doesn't seem to bother her, but she's taken it since 2011.

Nowadays she's confabulating wild stories about the Memory Care staff taking her out to different restaurants for dinner and then to a show afterward. Then they drive her home in a different car, and all sorts of other complicated scenarios that she feels are 'scams'. She's now 'losing little little baby teeth' at least once a week, so as you can see, the delusions and delirium is ramping up quite a bit all of a sudden.

No, she doesn't have a UTI either.

She's just been accepted in hospice so I'm curious to see what they'll give her, if anything, to calm her or help these delusions she's having. They're already taking her off of all supplements & vitamins which they feel is contributing to her chronic stomach issues and vomiting.

Her sleeplessness has been an ongoing issue for ages; Ambien was a very bad idea for her and caused her to sleepwalk and break her foot back in 2009. So yeah, sleep issues and dementia go together like peanut butter and jelly. I don't know that there ARE any iron-clad fixes for it either. Some elders get their circadian rhythms mixed up and wind up sleeping during the day & staying awake at night.

I particularly like bevthegreat's suggestion about 'letting her stay up all night' if she doesn't want to sleep. Uh, how about the rest of the household? Bet you'd all like to sleep so you can get up and FUNCTION the next day, huh? Just a hunch. Naturally you should speak to mom's MD about ideas for better sleep, but throwing more meds at VD can be a tricky thing, I know.

Wishing you the best of luck.

Eat dinner early and discontinue fluids after the meal as much as possible to avoid indigestion and bathroom trips. Add occasional roasted turkey dinners (it does actually help make you sleepy - and provides leftovers for days so it is very economical (both for time and money)).

If possible, help her take a warm shower after the evening meal/snack as a wind-down. If this is too difficult, bring her warm wet towels, like “finger towels” for clean up and give her a quick hand or foot massage.

if tolerated well, use aromatherapy. Depending on her preference, use plug ins or scented lotions such as products from Bath and Body Works or Aveda. You can also use essential oils from a health food market (but mix-in/dilute with other products as they can be strong. A little goes a long way.

Introduce soft music or a pleasant (to her) television show, such as Lawrence Welk, as a bedtime “falling asleep” ritual. The end of Lawrence Welk had a “good night” song and dancing that my mom found very calming. Get complete series on DVDs or download from YouTube.

Relaxation videos or cooking shows may be helpful in calming her. Play “nature sounds,” “relaxation,” “meditation,” or “spa” background music using an Echo Dot or similar “Alexa”-type device.

Make sure her bedroom is warm and comfortable.

When all else fails, sit with her and listen to the conversations. Is she speaking to a deceased relative? Bring in a notebook and ask her questions during the conversations. Take notes. During my experience as a caretaker I did this and later learned that many of the tidbits from these conversations held truth. A relative was pregnant (even, it turned out— before she knew it herself). Another relative was hospitalized (no one in the family knew at that time). The conversations with deceased relatives actually were not ramblings after all, but a bit of a miracle to me, as a confirmation of my faith (that had been waning).

Well, what everyone tells me is to drug them. Dad's on Lorazepam for sundowning actions and on Trazadobe for sleep. He still gets up at 5 or before. So far, I put a note on my door that says VERY NICELY to please not wake me unless he thinks about it for 5 minutes and after 5 minutes, if it can wait til 7:30, we will talk about it then. If it is truly an emergency then please wake me any time. I am here for you but I need to rest or I won't be caz I will be sick. I believe that with the waking me to go to work but he doesn't have a fire truck here or the construction crew brought him here at 2am but didn't tell him what he was supposed to work on and he's surprised to see I'm here and do I live here? Dors he live herr? Why would the crew bring him to his own house to work? I know where you are but there is NOTHING my dad would not do, within his powrr, to help his baby girl... drug him and his love for me has helped tremendously. I did have to get 2 kittens for support animals!! Hope this helps. Good luck, prayers!