Safe sleep aid for alzhiemer/dementia residents

[beatrice1]

Could you all give me some examples of Sleep aids you use at your facility to help your resident's rest/sleep when all other interventions do not work.

ex. We have a Portuguese speaking dementia resident who sundowns and starts to wander in out of other residents rooms "looking for her husband" when there is no Portuguese speaking CNA on, she is very difficult to redirect. We have tried many non-pharmacologic interventions that are not working. she wanders around sometimes till 12am-1am, waking up the other residents and getting them upset.

The House MD at our place seems to have a liken to Trazodone. This is what he ordered for her. (which isn't working)

Isn't Trazodone an antidepressant? maybe drowsiness a side effect but not what it should be used for.

I would love some input from experienced Nurses who work with Dementia patients. What are some successful interventions you have used.

And Is there a safe sleeping aid for elderly as a last resort?

Thank you,

Bea

[SuesquatchRN, BSN, RN]

Oh, for goodness sake. You were quite clear that you wanted her quiet because she was disturbing the other residents. How you got from that to eating one's young I don't know.

Personally, I don't have a problem with sedating someone for the greater good. However, Medicare and any state surveyor will. And there is no such thing as anonymity on the internet.

[chrisrn24]

My problem with your request is that you are looking for a chemical restraint. Think long and hard before doing that - or at east don't post about it on a message board.[/quote']

So no one can use any kind of a sleeping pill?? That's ridiculous!! Please think before you write.

[BostonFNP, APRN]

I use trazadone first line pharmacological in all my patients over 65 even though it is off-label. That's after all the non-pharm interventions have failed and the patient is symptomatic from sleep loss, not just because it's more convenient (of course).

Benadryl, benzos, and barbs are all BEERs list drugs.

[SuesquatchRN, BSN, RN]

So no one can use any kind of a sleeping pill?? That's ridiculous!! Please think before you write.

I did not say that. So much for reading comprehension.

That's after all the non-pharm interventions have failed and the patient is symptomatic from sleep loss, not just because it's more convenient (of course).

Thank you.

[ClearBlueOctoberSky]

In my facility, we do "sleep studies" on anyone being prescribed a sleep aid. If they get at least 8 hours in 24 hours, no go.

You need to advocate for your resident. Try other things to keep her occupied. Snacks, fluids, if you are able, walk with her. Tell her her husband is at work and will be home later. If you have a male Portuguese-speaking employee on another unit at the time, have her "call" him, have him tell her he will be home later and to not wait up. Role play into her reality.

My point is, just because she wanders at night, doesn't mean she needs a sleep aide. If she is being "loud", be creative to redirect her. Just telling her her husband isn't there and to go back to bed won't work. It will cause her to become more anxious and loud. You need to reassure her that he is okay and is "out".

I understand wanting to keep the unit quiet set night, but sometimes, you just have nights where everyone is up.

[ktwlpn, LPN]

And sleep disturbance is very typical of alzheimer's patients, in fact it's one of the top 3 reasons why families seek long term care along with incontinence and unsafe wandering. We have used trazadone with varying results. A sleep study is a great idea and I'll suggest that on my unit. We have had several family members come in to visit during the of the day to discover their loved one is sound asleep after being active throughout the night. We have residents who nap periodically through 24 hours with intermittent bursts of intense activity and some who have their days and nights reversed.The best intervention (after toileting,snacking and OTC pain med) is letting them do what they want to do within the secure environment and keep them well hydrated and well nourished.Educating the family is KEY-a lot of them think their loved one is"doped up" sick.I'ts the disease-dementia impacts the natural circadian rhythm

[workinmomRN2012, BSN]

I did not say that. So much for reading comprehension.

This quote is exactly why there is a culture of "nurses eat their young", you are obviously part of the problem! this is just plain RUDE!!!

[SuesquatchRN, BSN, RN]

And you have been polite to me? I was blunt. You and other have been rude.

[CrunchRN, ADN, RN]

How about focusing on suggestions to help with the issue instead of doging and sniping? It is a big issue if it disturbs the whole unit. I wonder if a translator could give you some phrases that might help such as "your husband will be here in the morning and wants you to rest" or something like that?

Sleep aids are not evil if they are not getting enough sleep which leads to deprivation and hallucinations and you do have to think of the other residents.

I think it is AWFUL that people would make such negative comments to someone who is trying to find ways and ideas to provide better care for this and all her other patients.

I am really surprised by some of the people making them too. Not the usual I see from y'all. She is clearly not just wanting to drug/restrain the patient for her convenience. I know there are some that do, but i do not get that sense of the OP at all.

[CapeCodMermaid, RN]

1. I am a bad sleeper now so I assume I will be one when I'm old(er). Please give me something other than hot milk to help me sleep.

2. Trazodone is NOT a chemical restraint. It's an antidepressant with sedative properties. It is far safer than Benadryl or Ativan. People who don't sleep well for days on end can become psychotic and then will get prescribed an antipsychotic ....which is a chemical restraint.

[Soon2bFNP]

I have been following a NP that works in the NH and have noticed that she has ordered Restoril has a sleep aid before. Maybe you can inquire about that with the Md.

[BostonFNP, APRN]

I have been following a NP that works in the NH and have noticed that she has ordered Restoril has a sleep aid before. Maybe you can inquire about that with the Md.

Tough drug in the elderly even at a half dose.