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Safe sleep aid for alzhiemer/dementia residents

Geriatric   (11,306 Views | 33 Replies)

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CapeCodMermaid has 30 years experience as a RN and specializes in Gerontology, Med surg, Home Health.

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Restoril.....old drug...major side effects.....higher risk of falls....Beer's list

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BrandonLPN has 5 years experience as a LPN.

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Maybe my facility is out of date, but we use restoril for many of our elderly residents. Other residents can get PRN benedryl.

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CapeCodMermaid has 30 years experience as a RN and specializes in Gerontology, Med surg, Home Health.

2 Followers; 6,073 Posts; 60,615 Profile Views

Maybe my facility is out of date, but we use restoril for many of our elderly residents. Other residents can get PRN benedryl.

If you're routinely using Benadryl and Restoril, you are, indeed, out of date.

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With restoril there imay be problem with monthly supplies because at least in Il medicaid paid only for 2 weeks supply in 30 days. I do not know why.

Similar to and more frequently used in LTC is ambien 5 mg ( U could even give half dose prn). Zyprexa and seroquel are also used frequently.

But before all these U should first try to change this resident sleeping habits. Do not let her sleep in the morning or maybe try to get her up early, and do not let her get too long naps in the afternoon/evening. It may take week or so. You should talk to Your MDS / Care plan cordinator and ask him/her to discuss this issue with the family during the next careplan conference or even to make the meeting early. Maybe there was some routine that she used to do before going to sleep. Disturbing other residents is very bad because there probably are some other dementia patients and when they will be awake, they will be many more problems then one resident who takes sleeping pill. Maybe she needs some sleeping aid only for few weeks until the sleeping habit will change.

Somebody should discuss it with the family first and inform them that You are going to ask doctor for sleeping aid for few weeks to see if this will help. If doctor agree , U put the resident on fall risk list - low bed, bed alarm, frequent checks.

This is what I did or would do in Your situation. I really feel Your pain because I had to deal with many dementia /alzheimer patients and many of them were Russian / Greek/Polish/ Spanish/ Korean/ Ukrainian.

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One of MD's at my facility LOVES melatonin 3mg. She prescribes it to everyone with insomnia first then moves up from there. my cart alone goes thru 200 pills of it a week.

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VivaLasViejas has 20 years experience as a ASN, RN and specializes in LTC, assisted living, med-surg, psych.

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Except in cases when there are adverse behaviors---like when a resident goes into other rooms and starts hitting people, or is combative with staff---antipsychotics are overprescribed in the elderly, IMHO. These drugs are pretty heavy-duty and they carry their own dangers, and the side effects (such as EPS) can be permanent. They should NOT be used just to make a resident sleep!

Trazadone is usually pretty effective, although the dose often has to be titrated up because the person gets used to it pretty quickly. The jury is still out on melatonin.....sometimes it works, and I know a couple of people who swear by it; but it does tend to lose its effectiveness after a few weeks. But the bottom line is, we can't just drug people because they don't sleep at night---like some of the other posters have said, there are plenty of reasons why some residents are up at night.

I once worked in a SNF where one of the residents was a 101-year-old retired RN. She worked nights throughout her entire career and never changed back to a daytime rhythm. She used to go on my rounds with me at night and check off names on her clipboard as I looked in on the other residents. Yes, sometimes it was a drag because she was so slow, and sometimes I had to remind her that I was the nurse in charge but would report the "patients'" conditions to her if I observed any problems. (I never did, of course......there was that pesky HIPAA thing, you know, and she usually got tired and went to bed halfway through the 0200 rounds.)

We also had one fellow who used to wander during the night and try to crawl in bed with female residents. He didn't do anything else that was inappropriate, but of course we had to make him stop disturbing the ladies. Turned out he had been a piano player in a bar who worked evenings, and though he never married, he was quite the ladies' man and had several whom he "visited" on a regular basis (this was told to us by his nephew). Fortunately, there was a piano at the facility that we asked to be moved to the dining room so he could play to his heart's content without disturbing anyone. Oftentimes we'd find him asleep on the piano stool after he'd been playing for awhile. It didn't solve the problem entirely, but it did give him something to do that made him happy, and we were able to avoid medicating him.

Not every resident is going to sleep at night, no matter what we do to/for them. When someone is psychotic because she hasn't slept in a week, it's an equine of an entirely different hue and that's when medication becomes appropriate, and even desirable. But medication shouldn't be the first-line treatment for a resident who's merely up wandering around at night.

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370 Posts; 8,611 Profile Views

Viva, I couldn't like your post enough (although my phone won't let me like it at all.).

Sometimes with Dementia residents, they will flip their sleep cycle.

Unless there it's an extreme behavior that is causing s/s of sleep disturbance in either that resident or others, and they are getting enough rest throughout the day, there really is no reason to medicate them just to make them sleep when we think they should be sleeping.

Give them a quiet activity to do like washing "dishes", washing the tables, or folding. Some still read or color.

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MauraRN has 14 years experience.

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you could try having someone who speaks her dialect of Portugues (there are several) use a digital tape recorder and record some words or phrases that will be easier for you to remember and speak them to your patients. I did that a few years ago because I knew a few phrases of Brazilian Portuguese but I was working in a predominantly Azores Portuguese area.

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Before you suggest any med changes to the family or Dr, be sure to discuss it with your DON. A few of the med suggestions here would not be allowed in our nursing home.

There is a huge push against antipsychotics in dementia residents and surveyors are looking for it. Not saying it's never allowed for hallucinations, severe behaviors such as physical aggression, etc. but if one of my nurses suggested a Dr. order Seroquel for insomnia I would hit the roof.

First thing I would check is if she has any pain symptoms. She might not be able to tell you but why not try some Tylenol at bedtime or when she awakens and see if it helps? Pain is woefully undertreated in our dementia residents.

Then-after ensuring all behavior interventions are exhausted--- I would try the antidepressants, we use Remeron rather than Trazadone and it works for some people. Depression is also undertreated in the elderly. It requires monitoring like other psychotropics but it is indicated for use in many nursing home patients. Another med we have been using recently is Namenda as it has been shown to help with alzheimers behaviors as well as slowing down progression of memory loss.

Stay away from prescription sleep meds and benzodiazepines. They cause falls and are habit forming. If she is causing severe issues on your shift, especially if a lot of other residents are complaining, write up each episode and leave messages for your DON social worker and Administrator to follow up on. They should then find her an Alzheimers unit where she can wander when she wants and sleep when she wants in a safe environment.

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