What to do when days and nights don't make sense anymore?

slm7880: People that have been diagnosed with macular degeneration actually need light, not dark, to be able to see. They do need to always wear there sunglasses while outdoors when the sun is shining. 

Luvme2, I'm anxious to see answers to this as my husband has only recently begun to exhibit this behavior. Not the yelling, but the refusal to move.

It sounds like Sundowner's to me.

Very frustrating issue but common. My father's neurologist prescribed high dose of melatonin for sleeping (10 mg) which helped a bit, and suggested getting a light box which simulates sunlight, and using it twice a day for 45 minutes each..Found that trazadone and seroquil did not help at all for sleeplessness..Some people have suggested hiding the shoes so at least maybe they won't go out..
Also, a geriatric psychiatrist recomended depakane for agitation, which is an anti-seizure drug that has shown to be helpful with alzheimer's patients. Good luck..it is a very hard issue..

Lots of good suggestions here, so I won't repeat. I wonder if you have an Adult Day Care or Adult Day Health program somewhere in your area? I used to work at a few several years ago, and over the years we heard from many families who said their loved one slept better at night and some of the undesirable behaviors were reduced because they'd be "too tuckered out" when they got home to get up to any trouble! :)

Agree with the suggestions of schedule for mother who can't tell night from day. Daycare or specific TV programs provide schedule for someone who is living alone. Also you can phone or visit regularly around specific times. My father calls me several times a day to check on what day it is, what's on his calendar (although it is always available on the counter to him) and what he should be doing. Once in awhile something happens to throw his rhythm off and though he doesn't always believe me, he usually accepts my answers. You won't win a logic argument, so don't worry about it. I go over every day to open the shades and make sure he has eaten/taken his meds. Have someone else come over every night to do the same. For the moment it works, but he panics a little if he can't get a hold of me. I have to work with his world.

I understand that pain is one of those things people with dementia can't grasp so they can't always tell you if they are in pain or define where and how much. So I would certainly talk to his doctor about this to see if he needs to be looked at. If he is not in pain, try the distraction technique when you are moving him. In our own case, my father is afraid of losing his balance if he doesn't do it his way and doesn't quite trust me to catch him.

over the past 3 weeks my dad with advanced Alzheimer and dementia. refuses to stand or let you help him. Like moving from bed to chair or chair to toilet. Tried everything,he just pushes against you and stiffens up and get this, screams at the top of his lungs like your killing him. This is the entire time you are trying to get him to move. It has been taking me hours to try to coax (sometimes loudly, sorry but I have to over his screaming) him into moving and I always have to end up physically lifting and pivoting him while he screams in my ears. By the time its over my spirit and my back are broken and my dad hasn't a clue to what has just happened. Would sun downer cause this? He is already on seroquel at night to help quiet his yelling at night. By the way, I get my boyfriend to help me whenever he can, he is very strong so he can lift dad easily but even so, dad still screams. If you ask dad if your hurting him , he will say no every time.. I've been trying not to even think about putting him in a facility, I thought I could keep him home till the end but now I am not so sure.

I find keeping to a routine helps. Mom is bedridden so that is a factor, but I make sure to tell her what each meal is, breakfast, lunch, or dinner, when I bring her her tray. She watches certain shows in the morning. After lunch she gets a nap. I also tell her when my husband has left for work and when the nurse and aide are coming. They come at about the same time so that helps too. I have also found that turning on a lightbulb that simulates daylight during the day helps too. I don't know how long this system of having a routine will work, but for now it really helps.

I have the same problem with Mom. She goes into the bathroom, and when she comes out she asks, " is it time to go to bed, or time to get up?". She no longer seems to understand the difference between day and night! Same for meals, she will have breakfast and then ask, " was that our dinner?". Sometimes she goes into the bedroom in the afternoon, and puts her nightie on. When I ask her why, she simply says " I don't know". I think it's just the disease. All you can do is learn to accept it.

All of the above ideas and suggestions show how much love and care we devote to our family members who have dementia.And how frustrating it all gets when nothing works, or only works for a short while. Visitors help, day care helps, but my husband had periods when he slept all day AND all night to times when he did neither and wandered in the house and garage. With my spouse, only risperidone helped. it is an antipsychotic and calmed whatever fears he was experiencing which made him avoid them by sleep or stay awake to "protect" himself.

One more comment I just thought of. Another thing that helped us was to keep a strict schedule. I can't say that we didn't break it every now and then but a schedule helped. Although, I'm not sure if this is just for those with brain injuries. The schedule helped keep my Dad from getting confused.

One word - Patience. My father had Sundowners. Every afternoon around 3:30-4:00 he would go into a place far away. No matter what I said or did he didn't believe me. Luckily enough he trusted me and knew I wouldn't let any of the bad things in his head actually happen. In the beginning it was battle after battle of me trying to convince him it was daytime or that I didn't move the house. Then I realized that his logic and my logic were no longer the same. Usually what I did was try to distract him or generally just talk to him. With my father it didn't matter if it was day or night, in his mind it was what it was. Sometimes soothing music helped until it passed. I still think that the bottom line is that we have to have patience and work with their reality not ours. Does it really matter which is day or night?

I guess they all do that. My mom stayed up all night and slept all day. So she kept me up yelling about her hallucinations that she thought were real all night. What a nightmare. For both of us. She is in a home now, and I think they have her on a sleeping schedule, she is awake and has eaten breakfast when I get there around 9:00. But she keeps falling asleep the whole time I am there. If she is quiet at night, I would just let her sleep whenever she wanted if it fits in with your schedule. Eventually, she may need someone to watch her. It may not be ok to leave her home by herself. My mom used to fall a lot.

Sometimes the type of lights used for seasonal affective disorder (SAD) can help. You may need a prescription, but the Alzheimer's doctor could give you one if he/she thinks it would help.

Otherwise, you can get daylight bulbs. If you put those around the house and use them when things are dark during the day you may have some luck with your mom. This isn't a magic cure for the sleep/awake problems of AD, but it does help some.
Take care,
Carol

I had this same situation with my aunt who I was caring for. As the days shortened and it was dark at both 5 o'clocks. Plus she was dosing throughout the day which didn't help her confusion. But she couldn't do much with arthritis in her knees and hands, and vision and hearing problems. She would wonder why "they" kept "changing the days all around now". I am not sure how we really handled it, mostly with changing the subject I think. It gets very tricky. Your Mom seems a little more mobile than my aunt was. Slm7880 has some good suggestions. If she is tired for bed earlier, maybe let her unless there is a problem with waking in the night unsupervised. This time of year I am ready for bed earlier myself. If I sit to watch TV I am out. Good luck with all.

If your mom lives with you, try encouraging a short nap, in her bed, after breakfast and lunch. During the day, keep the blinds open, you can put shears up if the glare hurts her eyes. Many adults develop macular degeneration, and the glare is uncomfortable, so they keep the shades/blinds drawn. It's OK to keep the TV off--often times folks with dementia confuse what they see on TV with reality anyway. Try giving her some word puzzles or regular (large piece) puzzles to work. Or other activities. If you visit the Alzheimer's Association website, they should have some suggestions. As the day wears on and the sun starts to set, close the blinds and turn up the lights in the house. This may help with 'sundowning' behaviors/issues. If she is ready for bed at 7pm, that's OK. Get her ready and let her lay down in her bed.
One thing that is important to know is that depression is very common in folks with dementia. Has she seen her doctor for depression? If not, take her to her primary care doctor as soon as possible. A SSRI medication (i.e. Celexa, Zoloft or Lexapro) are good medications to use.
I hope this helps!! Good luck!