My husband has gone from relatively easy to deal with, to quite difficult. He has been on Risperidone for several weeks as we slowly worked him up to a 1 mg a day dose (divided into two doses). But he is now also on Lorazepam (Ativan) as needed. I need help with strategies.
Originally I was told to give him either half a 1 mg pill or a whole one as needed. I've been told I can go up to as much as 4 doses of half a pill each a day. But what I've done so far is not working.
Yesterday he was tired and wanted to go to bed around 7:00. I let him. In the past he would stay in bed until around 6 am. But lately he has been getting up about an hour after he goes to bed and get dressed for the new day. Yesterday I could not just turn him around and get him back to bed again. Instead he insisted he was "going out", "going home" and just getting out of my house. Please note, not our house, because he thinks this is my house and not his too.
I gave him a second half pill yesterday, and spent half an hour trying to keep him in the house, and then he just gave in and went back to bed and slept unto 7 am with no problems.
Today I tried to keep him up longer, but around 7:30 the fight to keep him in the house started up. I gave him a third half pill (I'd already given him the second half pill) and it literally was a fight. It got physical at several points. He did not hit me, although he threatened me with it, but he went to the front door and began unlocking the locks. I put myself in front of the door and locked them as quickly as he unlocked them. I managed to keep him in the house.
I finally managed to distract him and after that helped him get ready for bed. He was in bed by 8, which was earlier than I wanted him to be, but I'm tuckered out. It is now half an hour later, the sun is down, but it is not full dark yet. I'm just hoping he stays in bed for the night because I don't know if I'm up for round 3 of the battle.
So, for those of you giving Ativan or Lorazepam (same drug) to your LOs, how much are you giving them? And when?
starling so sorry you are having the leave the house syndrome. its very frightening. you should go ahead and have the deadbolts if you can. its better than him getting up in the mid nite and leaving with you sleeping. you cant trust them to stay down. and they are lightning fast as maneuvers like getting out. its also a concern hes threatening to hit you. not good . i would go to the full dose the dr says you can if hes non compliant and aggressive. if that doesnt work and redirection doesnt you may need to call dr and get a new rx. take care you are out of harms way if he gets overly aggitated. divvi ps i only gave half of one pill and it zonked DH out so i cant imagine giving all that and hes still going. maybe its not the med he needs -
The question is: what is going thru their minds that makes them want to leave?
Have they become frightened or disorientated to their current surroundings, no matter how long they have lived there? Are they somehow trying to communicate with us after they loose language skills?
Are they trying to tell us they feel lost or they are looking for something they have lost?
Do they need to eat, go to the bathroom, or something else but are lost as to where?
Maybe something stimulated them too much like too much conversation (all could have been earlier), TV, noises of us doing dishes, ??? Maybe they had a thought go thru their mind and are reacting to it. Or something went thru their mind that scared them.
Are they bored or restless? that makes a lot of sense
I read where they could see something familiar like coats, brief case, or other things they use to use in a routine and flash back to that.
And why do they call it wandering when most move very fast? We called my FIL a 'runner' case he took off fast. To me wandering is a slow, meandering walk.
Starling, I am sorry you are having to go thru this. I do pray you find a way to calm him soon, for your own health.
Starling, have you thought that the risperidone could be causing him to be this way? I have found that my DH is very sensitive to medications. We have tried Exelon Patch, seroquel, trazadone, zyprexa and he had bad reactions to all of them. I took him to a Geropsych Feb.11th and he was there 13 days. They were to evaluate his medications because of the sundowning. He went in walking and talking and came out zonked out. He was constantly having to pee and was so unsteady on his feet that I thought he was going to fall. After all kinds of crazy behaviour, falling out of bed and having 911 come and get him back to bed, getting up in the middle of the night and getting into all kinds of trouble and telling me often that he was going to knock the hell out of me I took him to the ER. They found nothing they thought could be causing the problems.Our family doctor took him off the trazadone and zyprexa and we went back to pamelor. He said the zyprexa was causing the constant peeing. It took about 5 days and he was back to the new normal. Needless to say I am not a fan of this Geropsych Clinic and we did not go back for the follow up appointment. I'll stick with our family doctor.
OMG, I'm going through this same thing! DH is on Risperidone also, for the past month. This up and down all hours of the night is killing me physically and mentally. I'm lucky to get 3-4 hours of sleep a night and this has been on going now for the past week and a half. We went to the Dr today and I have a new medication, suppose to be the best on the market with no side effects, gosh I can't remember the name off hand. Very, very pricey and most insurance don't cover it. In addition, it's one of those perscriptions you have to take on going for some time to help build up in the system. At this cost, I'm not sure I can continue. Dr did placed an order for Butte Home Health to come out, they have a dementia program. Medicare covers it. Not sure exactly what they will do but I'm open to anything and I mean anything I can get. I'm so tired of being told, you need to to this, you need to call your doctor, you need, you need you need but not one person has met my need for HELP. I'm at the end of my rope, pretty soon, I'm going to drop.
my DW tried the resperidol and could not take it cause it caused extreme nausea. she has been on ativan for over 1 1/2 years now and after aboout the first six months we changed the dosage from .5 to 1 mg. she takes up to 4 per day and always two at bedtime. usually i give her one in the morning and if needed one about 2 p.m.. but i always give her two at bedtime. this allows her to sleep soundly thru the fight usually getting up in the morning about 10 a.m. she is also on namenda and lexapro. this combination seems to be the best for her. it keeps down the mood swings and allows her to feel fairly normal during the day. she usually has to take at least a 2 hour nap in the afternoon which is ok because she gets to tired to function. hope this helps.
My husband was given one of the anti-depressants to help him SLEEP at night. It had the opposite reaction on him! After the second night of his being up MORE, I flushed the down the toilet. The doctor then let us try Ambien. He gets four straight hours of sleep, sometime five. And I get four straight hours of good sleep. Sometimes five.
After my husband got out the back door a couple of times and we saw him go to the bathroom in the back yard, I quickly got the deadbolt key-only locks and everyone who comes in the house and especially me, keeps the key on their person (in the pocket, on a bracelet or on a necklace) so that it is second nature to us and a part of opening the door now.
This is typical AD symptoms to have the Sundowning and restless nights and trying to leave the house. It drove me bananas, and I was so sleep deprived until the Ambien was finally prescribed. We tried four other drugs and they didn't work on him before Ambien. I can't stress enough that some medications that they think will work on our spouses, don't.
Try what the doctor gives you and see if it works - and if it doesn't, tell the doctor and let him try something else until you find the drug that helps your husband sleep. And you sleep.
The sundowning itself we have to live through until that stage passes...
He has been on resperidone (same as resperidol) for about 12 weeks starting with a very small dose and working up. I think it has smoothed him out quite a bit, and isn't responsible for the napping he has been doing because he was doing some napping well before we started the drug. So I don't think that drug has caused any problems. I think it is helping.
The atavan (lorazepam) also helps. You can literally see him get calmer as the drug starts working. He sits forward with this arms on his knees when the anxiety starts and gets very pale. When the drug starts working he sits back, watches the tv, even smiles a bit if something on the TV set appeals to him. Then the anxiety comes back again.
One thing that did work late yesterday afternoon was that I managed to distract him. I suggested that he needed to shave and he went into the bathroom and ran the electric shaver over his face. At one point he tried to shave off his eyebrows, but I put it back on his chin and that didn't happen again. I think that my focusing on his wanting to "go", by which I mean he wants to go outside and go home, is a mistake. I need more distractions. But outside of putting the TV set on around 3, there hasn't been anything distracting in our lives for him. He wasn't interested in anything.
Faye, I am thinking that Seroquel is something to give everyday not on an "as needed" basis. At least that is how my husband took the drug years ago. It might help put him on a more even keel...
starling, so sorry you are in this "living hell". DH had sundowning syndrome and was so very difficult to deal with. Psych doctors used Ativan initially, but Ativan wears off (after 6-8 hours) and needs to be readministerd versus the meds (like Seroquel) which build up in the system. I agree with Sandi*, seroquel should not be used on an as needed basis. We have keyed deadbolts (we hide the keys and keep one on us at all times) and I have installed alarms from Walmart that ring whenever the door is opened in case someone should forget to lock the door. DH is now on 300mgs of seroquel/day and 0.5 mgs of clonopin each afternoon to help with the sundowning. I can give an additional clonopin anytime durin the day if I notice increasing agitation. My heart is with you-sundowning and constant "motorization" is a difficult phase.
So approximately how long does this Sundowning stage go on before it passes? I looked at the perscription bottle of the new medication the doctor perscribled for sleeping, it's called Rozerem. DH went to sleep around eleven last night and slept through till about 6:30 this morning, I'm happy with that. Not sure if it was the medication or the fact that my daughter and I had him out quite a bit and he was just exhusted. On a good note, he was able to take a nap this afternoon for about 2 hours, at which time I too took a nap. Gave it to him again tonight and he's already in bed and sleeping. I hope this continues, it so it's a life saver for me!
My understanding is that you use Seroquel the way the doctor has my husband on risperidone. He chose to use risperidone first because it is so much cheaper since it is a generic. It does help. He gets that twice a day.
We are using Ativan on a as needed basis. As much as 4 half pills, each as a separate dose. Since I'm not giving it to him all day long it does tend to build up a bit as we get to bedtime.
I've ordered the MedicAlert SafeReturn bracelet. This morning as a matter of fact, while he was in the room. He was clueless, which shocked me. He is already registered and they have a recent photo of him (took it Wednesday). The bracelet will be here next week. I looked at a closeup of the clasp. He will not be able to get it off.
starling both ideas are good. if hes a runner its a necessary safety fact.
good for you. the safealert has the hardest clasp i have ever worked. it took the ER a very long time to get it off for an xray once. i couldnt do it myself. DH wore his for over 5yrs without ever taking off. they are longlasting and well worth it. divvi
Starling: I am so sorry that you are having to go thru this and I know exactly how you feel. The neuro/dr put my DW on Seroquel for sundowing and it helped a great deal. Several months later, when she was in the hospital of an 'evaluation', the Dr there took her off of Seroquel and put her on Zyprexa with she is still on and seems to be working well.
The Seroquel is very very expensive if you have to buy it. I paid over $800.00 for a 30 day supply before our Dr told me that the mfg. Astrazanica (or something like that) would help with the costs. I filled out a form on line and paid $25.00 for the next presc. You might want to ask your Dr if that help is still available. Goodness knows, we need it.
On the Atavan, we used a 1mg table every 4-6 hours for a total of three per day. I was sure to give her one about an hour befor bedtime. Worked well. I think this is a wonderful drug. When my DW had to have a blood transfusion last month, the hospital gave her 1mg every 4 hours. Otherwise, she wouldn't (or couldn't) stay in the chair and wouldn't leave the IV's in her arm.
When my husband was on the Ativan, he was getting a 1/2 tablet 4 times a day morning, noon, dinner and right before bed. It did make him very groggy but he wasn't acting out. My rule of thumb was his safety, the safety of those caring for him and if the first two are doing well, then lets talk about lowering drugs. He went through about a year where he was very agitated.