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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.

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I read your update about your mom who is now staying with you. I'm trying to recall why she is getting up so much to use the bathroom. You first post says that she does not have AD, but she does have dementia. Is that right?

I think I might have asked about ruling out diabetes as that makes you go a lot during the night. AND sleep apnea also makes you have to go a lot during the night. I'd try to rule out physical causes of her having to go during the night.

My cousin is in Memory Care and she sometimes tries to get up during the night. She cannot walk, so may fall. They have put a sensor on her bed, that alerts the staff and they then come to her and assist her with changing and getting back into bed.

The doctor may also suggest a light med for bedtime that will help her sleep for at least 6 hours. I would try that, since she's not getting her rest either if she's up and down so much.
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Thanks for your response churchmouse. It sounds like you did all you could in a difficult situation. Fortunately my mother isn't a wanderer, she's just getting up to use the bedside commode. The issue is she's falling asleep on the commode for sometimes an hour at a time and she's struggling with her depends at times. I can watch her the next day on the camera history. That camera is both a blessing and a curse. I guess if I had someone come in, it would be to wake her up and just prompt her to go back to bed and to alert me if she falls. I don't know, it's not a great answer and I don't really want to have someone in at night. My mother isn't even handling having an aide for 4 hours in the afternoon right now. It would really just be for my peace of mind I guess. My sister is staying here with me and she is telling me she wouldn't be able to sleep with my mother getting up all the time. I'm starting to think I have no choice but to have someone in at night.
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Some nursing homes have motion sensors in bedrooms so that if a resident gets up and moves around an alarm sounds in the nurses' station. In the respite home my mother stayed in, residents and their families were offered that option but it wasn't insisted on. Unfortunately at that point the manager considered my mother to have capacity to decide this issue and asked her. I don't dispute that my mother understood what a monitor was and knew whether or not she wanted to be watched over (guess!), but I couldn't help feeling we were missing the important point there. Not the only time I felt that. The OTs got very snotty about "Deprivation Of Liberty" when I wanted to trap mother in her armchair with a table that was too heavy for her to move by herself, too. Deprivation of the liberty to chuck herself round the room and break her hip, if you ask me; but there was a lot of paperwork involved in applying for a licence to do it and your Loved One had to be demented enough to be constantly running naked into the street, or of that order, for it to be granted. I expect the system in the States is pretty similar.

I don't know, but I think nursing homes are probably used to a significant proportion of their residents being awake and active at night. They monitor them, is what they do. What else?

I'm sorry, I know (I really do know) how stressful it is when a person who is a falls risk wanders around unattended. I wish I could say you get used to it - but I for one didn't. I got very stressed and stayed stressed until my mother had a stroke which confined her to bed. Then I was sad. And still stressed. Albeit about other things.

I'd have done better, isn't hindsight a wonderful thing, to watch her as closely as possible and otherwise carry on regardless. As it was, I wore myself into a frazzle and was still unable to prevent numerous falls including three hospital visits, one with an open fracture of her right wrist.

The thing is, you can have someone watch her but what are they to do? They can't lay hands on her round the clock, and if she wants to get up then she'll get up.
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GardenArtist and Veronica91, thank you for your additional responses. My gut was telling me it isn't practical to keep her awake constantly during the day and probably won't be effective anyway so thanks for confirming my feelings. GardenArtist, yes, she does have a railing on the bed that she uses when getting in and out of bed.

Unfortunately, I don't think I'm going to be able to manage with the way things are right now. My sister is staying with me temporarily and we have been working in shifts. I've been going to bed early and my sister has been staying up until 2-3 am so my mother is alone for a few hours and then I'm up at 6. My mother is getting up every 2 to 3 hours and is falling asleep on the commode. We have a Nest camera and my sister watched her and my mother was on the commode asleep for almost an hour. My sister waited just to see how long she would sit there. My sister put her back in bed and could not fall asleep because she was on edge my mother would get up again. My sister did not sleep at all and had to go in 2 more times to get my mother back into bed. My sister is not an anxious person but could not relax. I am an anxious person and have been under a lot of stress in taking care of my mother for the past 5 years and moving her to my home. I don't think I'm going to be able to relax enough to fall asleep. My mother needs a lot of care and it is exhausting caring for her, I don't think I'll be able to handle it without at least 5 to 6 hours of sleep. Sorry I sound like a wimp, I know people on this forum do it but I know myself and my health will be affected. I already feel sleep deprived and feel like I'm getting a cold, even though I am sleeping with my sister here. If something happens to me we have to place her in a nursing home and I do not want to do that.

I do have a question - how would a nursing home handle a situation like this? Would it even allow my mother to have a bedside commode and do all this moving around at night? I'm starting to wonder if a nursing home would even accept her under these conditions. I do not plan on placing her in a nursing home but am genuinely curious as to how it would handle a situation like this.

Right now I think the only answer to this is to have someone watch her at night.
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Absolutely agree with CM. If I was your Mom I would hate to be stimulated. When i need to sleep I recline my chair and get left alone well till the phone rings from some idiot telemarketer.
Consider yourself fortunate if you can sleep all night and never need to get up to pee yourself. As we get older most of us need to do that.
If you can hire someone to sit with her a night at least a few nights a week that would be helpful. Just make sure she says in Mom's room and if she falls asleep there is some way to alarm her when Mom gets up.
You are not going to extend Mom's life by trying to keep her alert and interested so let her be content with things the way they are.
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Jayne, yes, there is a chance she could fall. I know you have placed a commode in her room - have you also provided things like a rail for her to hold on to when she sits and stands to get out of bed, or anything else like that? (If not, you'll see plenty of ideas on disability store websites - but take your time before you buy, or ask an OT)

The thing is, that once you have done everything possible to make her safe, you're left with some risk that she might fall and injure herself. And hard though it is, the only thing you can do about that is cross your fingers and hope for the best. Exactly the same thing would be true in a nursing home. They don't tie people to beds any more - ;) - so she'd be at just as much risk there.

The idea of trying to keep her awake and stimulated more during the day so that she will sleep more soundly at night... I wouldn't expect too much if I were you. She's still going to need her nightly 'bathroom breaks' if I can put it like that. Stimulation is a good thing, and as much daylight as possible too, come to that; but people of her age and in her state of health tend to be extremely fatigued, and to nap, and to sleep poorly at night... As far as you can, let her be.
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Thanks to all for the additional comments -

Sunnygirl1, thanks for the suggestion. I am very upbeat and energetic when I wake her but it doesn't really do anything. Unfortunately most of the time it's going to be just me and her during the day, so the house is going to be pretty quiet. It's really hard to keep her awake and stimulated during the day; she has no interests and I run out of conversation. if I walk out of the room for a few minutes she falls asleep. I can't sit next to her every minute of the day. My husband and son will be home later in the day, but that's her alert period anyway. She is just naturally more awake from about 6 pm on. I plan on having an aide come in so maybe that will create some distraction. Right now my sister is here to help stimulate her, but she's leaving soon. We've been able to get her into bed a little earlier, and up a little earlier, but she is still waking up every 2 to 3 hours during the night to use the bedside commode. My sister is now seeing the problem and is concerned. Right now she's managing ok at night but there's always that chance she could fall.

GardenArtist, thanks for the tip, I'll try it.

Sendme2help, thanks - yes, I'm trying to wake her up periodically during the afternoon but it's tough sometimes, she's just exhausted. Letting the daylight filter in is a really good idea.

Again, thanks for all the help - feeling a little discouraged though. All I can do is keep trying but if she keeps getting up at night I might have to hire someone to watch her during the night so I can relax and get some sleep.
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Doctors have reported on sleep studies and published it on the internet.
There is actually a prescribed method ( way of doing) to change the sleep patterns.

One I remember was to go to bed one hour earlier each night to get on the correct schedule.

Another plan had advised don't go to bed before midnight if one is waking up too early and not sleeping through the night.

Then, having the daylight filter in helps set your sleep/wake cycle if you awake to the morning sun lighting up your room.

Bring Mom a cup of coffee or tea, each morning to wake her up. If she is sleeping in the daytime, make it a nap, then wake her up after 1 1/2 - 2 hours nap by bringing her a snack.

Your Mom will be so much better being cared for by you! Taking away the worry of travel to care for her will help you too. I am hoping!
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That's a good idea. I know that when I wake up, it's always nice to see something pleasant. If you have a small table in her room a brightly colored tablecloth with flowers, photos and/or her favorite things might be appealing. Of course, I know that sometimes the person isn't able to focus much, but it might worth a try if you think she is able to appreciate it.
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Another thought - fresh flowers for her room so they're the first thing she sees when she wakes up. If they're too expensive (which they are) or you don't have a garden, create some artificial bouquets.

One of my favorites is a blend of artificial white lilies and pink roses, in a vase filled with softly colored pastel stones. It always soothes me.
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Jayne, I think you're on the right path. A little bit earlier every day is a good, slow method of changing, and as we get older even little changes are harder.

I like Sunnygirl's suggestions - making wake-up time something pleasant and soothing gradually changes the mind's perception to wake up anticipating that pleasantness rather than having to get out of bed and go through another day.

I'm going to start practicing these myself. I recall there were times when I didn't want to get up and face a lot of the problems that had to be resolved so I thought about art work, or mentally created a new garden plan. Then I could develop enthusiasm for starting the day.

I think we alll can use a mental boost occasionally; we just need more boosts as we get older.
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When you awake her earlier than what she is used to, I might try to talk of something that interest her. I'm not sure how much she comprehends, but if your voice is upbeat, there is lively music playing and the house seems to be bright with activity, it might entice her to be more alert and stay awake. It's a tricky thing, but feasible. Good luck.
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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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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.
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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.
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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.
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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:

https://www.nlm.nih.gov/medlineplus/ency/article/002332.htm

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.
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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.
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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.
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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.
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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.
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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.
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