Any tips on changing a person's sleep schedule?

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My 91 year old mother is coming to live with me in a few days - she had a stroke 5+ years ago that left her with poor memory and balance problems. She can walk with a walker but due to inactivity her leg muscles are weak and as a result she has mobility issues. She also has cognitive impairments and is weak and frail. She needs constant care and is not completely helpless but close. She does not have AD - she is in touch with reality and her dementia symptoms have not worsened very much over the years. She has been living with my brother in her home and I have been traveling over an hour 4 times a week and spending 2 nights a week at my mother's to give him a break. She has been complaining about my brother and he seems burned out so that is why she is coming to my house. My main concern is her completely reversed sleep schedule, which has been somewhat encouraged by my brother. She will go to bed at 1:30 in the morning and is awake during the night and uses the bedside commode several times, sometimes as much as 4, during this period. She sleeps fairly soundly from 7 am to 3 pm. This is when my brother sleeps. So far she seems to be able to handle using the commode at night without falling but the thought of her moving around in the dark, even with night lights, is stressing me out and causing a lot of anxiety for me. I don't want to place her in a nursing home but if I can't get a little sleep I won't be able to function and take care of all her needs.

Her doctor suggested melatonin - I have not had a chance to give it to her regularly since I'm not at her home every night but on the nights I'm here it doesn't have any effect.

I feel desperate to the point where I'm considering changing my sleep schedule to match hers.

Thank you in advance for any advice and support you can give me. I'm trying to do what I think is right but I don't know if I'm strong enough for this.

Answers 1 to 10 of 22
Top Answer
Jayne, based on personal experience, I urge you to have mom evaluated at a sleep clinic or by a sleep specialist MD or Psychiatrist. Sleep issues are far more serious challenges in caregiving than many people realize. An evaluation may or may not result in some practical suggestions for dealing with this, but at least you'd have a clearer idea of what you facing.

If Mom's circadian rhythm -- her internal clock -- is out of whack, that is an extremely difficult problem to "fix." Melatonin is substance our bodies produce naturally. Taking a supplement can help adjust when the body gets the signal that it should be sleeping in a couple of hours. But it only works within a limited range of what the body finds "natural." If Mom "naturally" goes to sleep now at 7:00 am, the melatonin could help her fall asleep at 6, or maybe even 5, but it is highly unlikely, by itself, to encourage her body to fall asleep at 1:30. Melatonin is definitely worth trying, but under the guidance of a sleep specialist who understands how it works.

If Mom is safe on her own at night, this whole situation might be tolerable. Maybe helping her be safer is a good approach. I wonder if some physical therapy would improve her strength a little. Does she have a bedside commode near her bed? But since you say she needs constant care, you may need to have a night caregiver with her. Or sleep when she sleeps, as your brother did. (I don't recommend that, because you have your own circadian clock to deal with, but many people can handle a night shift.)

Sleep irregularities often tip the balance on whether a person needs the safety of a care center with three shifts of rested and trained carers. I know that you want to keep your mom home with you. Do your best to make that feasible. Get professional help from specialists. And recognize this is a very widespread issue and it is Not Your Fault.

Great advice above, IMO.

How long will your mom be staying with you? You say you are giving your brother a break. If it's just for a few months, then I wouldn't try to change her sleep pattern, as it will switch back again when she returns home. I would try to work around it somehow. But, if it's for a longer period, say a year or longer, then I would discuss with her doctor. I would suspect that changing her pattern might involve a very gradual change. Like getting her up one hour earlier than normal and putting her to bed one hour earlier. Let her adjust and then gradually get her back to a normal schedule. I would bet the doctor may have some advice as sleep issues are huge. He may be able to prescribe something to assist her as well on a temporary basis, though, that sometimes has its drawbacks.

I would keep in mind that she may have to adjust to a new schedule, if she has to enter a long term care facility or rehab for some reason. Fractures are not uncommon with seniors and dementia patients. Good luck. Please post back how it turns out. I am curious.
BTW, I think that solutions for very old people and people with a shortened life expectancy are different and can be more drastic than for younger persons. My husband (dementia) took two drugs to help him sleep through the night, and one to help him be alert during the day. I have circadian problems and no one is prescribing powerful drugs for me. If the specialists suggest strong medications for your mother, I think I'd go along with that, even though it would not likely be appropriate for you.

In my husband's case the consensus was that enabling him to stay at home safely overrode any concerns about addiction or shortened life span, etc. Drugs have drawbacks and it is always a matter off weighing the pros and cons.
Thank you SO much for your quick responses, makes me feel like I'm not alone in this and I have some support.

Jeangibbs, I agree, I'm worried my mother's cycle is so out of whack that it might not be possible to switch it. I forgot to mention that on many days my mother will continue to sleep even after I get her up at 3. She usually doesn't become alert until 11:00 at night. It makes getting things done, like bathing, eating, and drinking, difficult. Thank you for your suggestion of the sleep specialist, it is very difficult to get my mother out of the house due to her mobility issues and lethargy but I will look into taking her to one. Right now she is being seen by a visiting physicians agency and they haven't been of much help. Melatonin was the only suggestion. Your point about the melatonin only working around an established schedule is excellent, I had not realized that.

I agree that a night time caregiver might be necessary. She has a bedside commode and as of right now is able to manage but that will probably change as she becomes weaker. Unfortunately, my mother is and has been extremely uncooperative about any type of physical therapy. My brother and I tried when she first came home from the rehab center she fought us so much we just gave up. She has absolutely no interest in moving. I worry about her moving around in the dark so I am going to make sure I have plenty of night lights in the room. She is coming to my house this Sunday and fortunately my sister is helping me with moving her and will be staying for a few weeks, so I'll someone with me as I make my way through this transition.As a last resort, I might have to try to adapt to her schedule if I can't switch things around. Thank you so much for your excellent advice and support, it's been helpful and comforting to me.

Sunnygirl1, I'm thinking the same thing as you, I going to have to try to gradually change her sleep schedule. Her sleep patterns are so inconsistent that I'm not sure I can get her on a more normal schedule but I will certainly try. I really want to avoid her returning to her house, it isn't a good situation for either of them and that's why I think I'm feeling added pressure to make this work. I agree that she'll just go back to her old schedule if she does return home. My husband made the same point as you - her schedule would certainly be adjusted if she were placed in a facility. I can't imagine any facility putting up with this! Thank you so much for taking the time to answer my question, you've been very helpful and I'll keep you posted.
Jeannegibbs, thanks for the additional comments - I won't lie, I wish my mother could be prescribed something to help her sleep during the night. I think that's the only way I"m going to be able to relax enough to fall asleep myself. Your post reminded me that this issue had been ongoing with my mother for several years - she would say that she feels tired but when she gets into bed she can't fall asleep. Initially she would wake up at 10:00, then it slowly got later until years later I have to make her get up at 3:00 in the afternoon. It's crazy. I spoke to her doctor several years ago about this and he discouraged the use of a sleep aid and suggested melatonin. I felt he didn't take me seriously and the problem has just been escalating ever since. I know it's a serious thing to give an elderly person a prescription sleep aid and there can be side effects but there has got to be times it's necessary, as in your case. I feel the same as you did about your father - it it keeps my mother out of a nursing home, isn't it worth a try? Thank you for your input, you've been so helpful.
Jayne, don't forget about turkey, which contains tryptophan and induces sleep. Remember all those naps people take after a big Thanksgiving dinner?

Seriously, turkey can make a person drowsy. Try it as the evening meal, whether in sandwich form or with gravy and mashed potatoes (assuming she's not on a restrictive diet). Don't buy tryptophan in pill form; there were some safety issues with it years ago. I haven't followed that issue and can't speak knowledgeably about whether there are safe nonfood sources available at this time.

This brief NIH article helps understand its role:

There are also herbal teas that can induce drowsiness, but it's been a while since I've used them and don't remember which ones.
From what I have seen sleep meds for seniors is quite common. I would certainly ask her doctor about it. I would think that her comfort is dependent on getting her rest.
Gardenartist, excellent suggestion, luckily she's not on a restricted diet and she likes turkey. And yes, I've read there are herbal teas that make you drowsy - she likes tea so I'm going to look into it. I'm willing to try anything at this point. Thanks!

Sunnygirl1, I am definitely going to discuss this with her doctor, there has to be something that can be done to make this easier, for her and for me.

Jayne, I would also check with whoever is coordinating her meds (PCP, family doctor, internist) or with her individual doctors just to make sure there are no interactions between the teas and her meds.
GardenArtist, I wouldn't have thought of that…tea seems so harmless so thanks for mentioning it.

My mother has been here since Sunday and it is now Thursday…working on getting her up a little earlier each day…I don't know, these sleep patterns seem so engrained and also unpredictable that I don't feel very confident I'm going to be able to change them but I'll try. I'll let you know how I make out.

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