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Medical Forum / Diseases and Disorders / Alzheimer's / May 2008Brother-in-law
Hello, He sleeps most of the day, complains he is very tired. But he stays up most of the night. We cannot get him to stay awake during the day. I visited my daughter about 50 miles away and when I came back, it seemed like he had aged so much. Maybe it is my imagination. He seems to hallucinate a lot too. I wonder if this is very common. Thank you for listening. Bri Bri, I'd suggest it is in everyone's best interest to work on getting him to stay awake and active during the day, so he sleeps at night. Getting days and nights mixed up is very common, and it can become a HUGE burden on the caregiving family. Looking after someone with progressing AD is hard enough, never mind trying to tackle it when you are sleep deprived. Everyone's coping skills go right down the sink when they are exhausted - your fuse is shorter, your tolerance is lower etc. To get him back into better habits, I'd start by not letting him sleep in. Get him up and moving at the same time every day. Try not to let him nap - and if he does, limit it to an hour or less and make sure that its prior to 3 pm. Snoozing in front of the TV. TV is deadly - in my mother in law's AD ward, they actually banned TVs other than for group movie nights, because residents who had sets would just zone out in front of the set all day instead of being up and and around, participating in activities and socializing - and then they'd be up all night. I know that won't be easy to keep him busy and awake - but its something you have to do. If your sister can't tackle it, then she should sign him up for daycare or other program that will keep him moving around during the day, or hire someone to come up with things for him to do, take him for walks, whatever. You can apply the same strategies you would use for improving the sleep habits of a toddler. Routine is important - to try to get the person into a groove that is the same every day in terms of wake up time, evening rituals and bedtimes. Nighttime should be as boring as possible. If the person is really off cycle, you can try gradually getting them back on track by moving wake up time or bedtime back or forward by a given number of minutes per day (i.e. even 5 or 10 minutes change per day can let you "walk" their hours slowly onto the desired pattern). M Mary, Thank you for your suggestions. We have tried so hard to keep him awake. We take him for drives and to the mall but he falls asleep in his wheelchair. Yesterday, he grabbed my sister by her hair and hit her about 9 times. He accuses her of letting him poop in his pants and she doesn't do that. Why would she allow that if she has to clean him? I wish she would take him to a day care center but he won't go and will scream while he is there. Bri >Bri, I'd suggest it is in everyone's best interest to work on getting >him to stay awake and active during the day, so he sleeps at night. [quoted text clipped - 30 lines] > >M > Mary, > Thank you for your suggestions. We have tried so hard to keep him awake. [quoted text clipped - 6 lines] > day care center but he won't go and will scream while he is there. > Bri Brianna, he might carry on or fuss in the beginning, but after going there a few times he will adapt. There are some things that are characteristic of the illness that actually can work in a caregivers favor. I am speaking of their forgetfulness. He will forget very quickly that he didn't like the daycare center or that he didn't always go there. Evelyn I think that you at least somewhat are still thinking of him the way he was. He's not rational, or capable of rational thought. so of course he accuses her of things that make no sense. Its no different than if he were accusing her of being an imposter or trying to poison him. He's not in his right mind, period. If he continues to be aggressive, your sister MUST get a doctor to prescribe something to tone him down - she can't continue to be hit when he's agitated or frustrated. And she can't put up with screaming and other verbal abuse. He needs anti-agitation meds if he is continue to have these outbursts. She should also not ask his opinion about the daycare, or ask for his permission to send him. Don't ask him if he'll go. Get him on something to settle him down, sign him up, take him, and leave him there during the day. If she can't get a doctors help with him, I strongly suspect he'll have to be institutionalized sooner rather than later. Mary G. >I think that you at least somewhat are still thinking of him the way >he was. He's not rational, or capable of rational thought. so of [quoted text clipped - 17 lines] > >Mary G. Hello Mary, Thanks for writing again. The strange part of the agression is he does it only when they are both alone. He waits until night time to curse and call her all kinds of filthy names. When their son or I am around he is just a different person. We think he knows what he is doing and saying because he is careful not to say the ugly things when people are around. I will print the e-mail from you and have my sister read it. I know she needs help but she just cannot put him in a nursing home. If she does, then she will be there all the time. Sometimes, I feel it is a lost cause. Bri >>I think that you at least somewhat are still thinking of him the way >>he was. He's not rational, or capable of rational thought. so of [quoted text clipped - 33 lines] > > Bri Bri, I know how you feel. I feel so sorry for your sister, but she REALLY needs to get him on meds. It has been suggested several times here, but you haven't replied about it. Is there some reason your sister or yourself may be against medication? Doesn't her doctor help at all? This is an illness that really needs a little "help" and few are gentle enough to go through it without needing that assistance. My mother in law did just fine with merely taking Zoloft for a long time. It was only when her delusions got really difficult that our doctor gave her Risperdol. I have no idea how we would have ever gotten through it without medication. They get violent, have delusions, are angry and confused. Caregivers often get the brunt of it. Meds help that.  SignatureBest Regards, Evelyn “Like the light of the sun moon and stars, may the love, compassion and wisdom shine forth. May they strike every single living being and dispel the darkness of ignorance, attachment and hatred that has lurked for ages in their being. When any living being meets with another may it be like the reunion of a mother and child who have long been separated. In a harmonious world such as this may I see everyone sleep peacefully to the music of non-violence. This is my dream.” -- 17th Gyalwa Karmapa Orgyen Trinley Dorje >>>I think that you at least somewhat are still thinking of him the way >>>he was. He's not rational, or capable of rational thought. so of [quoted text clipped - 17 lines] >They get violent, have delusions, are angry and confused. Caregivers often >get the brunt of it. Meds help that. Hello, No, my sister is not against medication. I don't understand why she doesn't tell the doctor about it but at the same time, she cannot talk to the doctor when he is in the room. Then he accuses her of having an affair with the doctor. They took his driver's license away because of what the doctor said in the report to the DMV, so he accused her of having an affair with the doctor so they could take his license away. So my sister would have to write the doctor a letter and not let him know she did that. This is a very difficult situation. I wish she would do something about it, he is driving her to an insane asylum. Thank you, Bri >>>>I think that you at least somewhat are still thinking of him the way >>>>he was. He's not rational, or capable of rational thought. so of [quoted text clipped - 14 lines] >Thank you, >Bri Oh, one more thing. Sometimes she does give him a tranquiler so he can settle down but it makes him so sleepy that he cannot get up to urinate and pees all over himself. That's her fault too. >>>>>I think that you at least somewhat are still thinking of him the way >>>>>he was. He's not rational, or capable of rational thought. so of [quoted text clipped - 25 lines] > and > pees all over himself. That's her fault too. Brianna, I feel so sorry for your sister. She is still operating as if he was in his full and right mind. I think she needs to go to see the doctor on her own, even if she has to lie about where she is going...... or else write a letter to the doctor. Paranoid feelings (like saying she is having an affair with the doctor) is quite typical of the illness. My mother in law had a lot of those kinds of feelings as well. We had the exact same thing with the tranqulizers, they made her too tired to function well, and of course then she became more incontinent. What really WORKED for my mother in law was Zoloft, an anti-depressant. If she tells the doctor he is angry and depressed (and truly, who wouldn't be depressed if it looked to them, like they were losing their mind, and they were fearful and paranoid!) Hopefully the doctor might put him on an antidepressant. But first and foremost she has to communicate to the doctor what is really and truly going on, the violence, the rage, the paranoia. All those things are serious and could really become impossible for her. SignatureBest Regards, Evelyn “Like the light of the sun moon and stars, may the love, compassion and wisdom shine forth. May they strike every single living being and dispel the darkness of ignorance, attachment and hatred that has lurked for ages in their being. When any living being meets with another may it be like the reunion of a mother and child who have long been separated. In a harmonious world such as this may I see everyone sleep peacefully to the music of non-violence. This is my dream.” -- 17th Gyalwa Karmapa Orgyen Trinley Dorje Bri, is there any way for you to communicate to the doctor what is going on with them? He really needs to know so he can give your sister some help. Gwen >>>>>I think that you at least somewhat are still thinking of him the way >>>>>he was. He's not rational, or capable of rational thought. so of [quoted text clipped - 25 lines] > and > pees all over himself. That's her fault too. Brianna, I feel so sorry for your sister. She is still operating as if he was in his full and right mind. I think she needs to go to see the doctor on her own, even if she has to lie about where she is going...... or else write a letter to the doctor. Paranoid feelings (like saying she is having an affair with the doctor) is quite typical of the illness. My mother in law had a lot of those kinds of feelings as well. We had the exact same thing with the tranqulizers, they made her too tired to function well, and of course then she became more incontinent. What really WORKED for my mother in law was Zoloft, an anti-depressant. If she tells the doctor he is angry and depressed (and truly, who wouldn't be depressed if it looked to them, like they were losing their mind, and they were fearful and paranoid!) Hopefully the doctor might put him on an antidepressant. But first and foremost she has to communicate to the doctor what is really and truly going on, the violence, the rage, the paranoia. All those things are serious and could really become impossible for her. SignatureBest Regards, Evelyn "Like the light of the sun moon and stars, may the love, compassion and wisdom shine forth. May they strike every single living being and dispel the darkness of ignorance, attachment and hatred that has lurked for ages in their being. When any living being meets with another may it be like the reunion of a mother and child who have long been separated. In a harmonious world such as this may I see everyone sleep peacefully to the music of non-violence. This is my dream." -- 17th Gyalwa Karmapa Orgyen Trinley Dorje Hi sweetpickle, Yes, I can communicate with the doctor. He is a cardiologist and is my doctor too. I have an appointment with him in June. I could probably tell him what is happening but I don't think he will give me advice that my sister should be hearing. I will talk to him and see what happens. Thanks, Bri >Bri, is there any way for you to communicate to the doctor what is going on >with them? He really needs to know so he can give your sister some help. [quoted text clipped - 27 lines] >and truly going on, the violence, the rage, the paranoia. All those things >are serious and could really become impossible for her. > Hi sweetpickle, > Yes, I can communicate with the doctor. He is a cardiologist and is my [quoted text clipped - 6 lines] > Thanks, > Bri Bri, that is wonderful! It's great that he is your doctor also. Your sister really needs help getting the doctor to understand. You will be doing her a great favor. SignatureBest Regards, Evelyn “Like the light of the sun moon and stars, may the love, compassion and wisdom shine forth. May they strike every single living being and dispel the darkness of ignorance, attachment and hatred that has lurked for ages in their being. When any living being meets with another may it be like the reunion of a mother and child who have long been separated. In a harmonious world such as this may I see everyone sleep peacefully to the music of non-violence. This is my dream.” -- 17th Gyalwa Karmapa Orgyen Trinley Dorje You can tell the doctor he doesn't have to say anything - he just needs to listen, and you tell him what is going on at your sister's house. Alternately, you or your sister can write him a letter, explaining the situation, giving as much detail and as many concrete examples as possible. He must be made aware there is a serious problem - he can't help with what he doesn't know about. I think there is a real possibility of your sister being in physical peril, never mind the emotional distress. I have known of a number of couples where the male partner developed dementia, and no matter how reasonable or gentle they were before, they began to act out physically with their wives (hitting, shoving, pinching and worse). Particularly if they are physically strong and able to get around, and paranoid, you just can't know what they are capable of. Does your sister not have a family doctor or a neurologist attending to her husband? M >>>>>I think that you at least somewhat are still thinking of him the way >>>>>he was. He's not rational, or capable of rational thought. so of [quoted text clipped - 25 lines] > and > pees all over himself. That's her fault too. Brianna, Hippa laws probably do not allow you to get information from the doctor. But it does not prevent you from calling the doctor and informing him/her of the paranoia, depression and rage your brother is displaying and the impact on the caregiver. Say your sister cannot say these things when the brother is present for fear of her own safety (which I think, from your comments, is true. But if not, say what is true). You can say your brother's sundowning, paranoia and rage are exhausting your sister, having an impact on her health. My husband did not do this with his father, trying to respect his mom's "I've got it all in hand" attitude. But it was a mistake. They wound up in crisis - FIL refused to take his cardiac meds and wound up in hospital. Doctor finally realized how compromised FIL was and refused to release him to home, only a care facility. One that was open didn't handle his psychiatric meds well and he wound up in the psych ward for eight weeks until another facility opened (after allegations he assaulted a patient). It was awful. The last care facility was wonderful (but extremely inconvenient). Sadly, FIL only lived three or four more months because of complications from a broken hip. So much time was wasted. Their lives just didn't have to be as miserable as they lived. If only MIL (or my husband) had been less 'respectful' and more pro-active. Adelle |
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