Mom is 92 and in nursing home. She has dementia, maybe stage 6 but not sure. When I am there from 10 am to 2 pm daily shes usually funny and talkative and eats a good lunch prior to getting really tired and going down for a nap at 2 when I leave. Yesterday was one of her best days lately, alert etc. But she didn’t want to take a nap, which was very unusual. I left her in the care of an aid, since something seemed a little "off" and I didn’t want any more wheelchair falls. Today was awful. I was told she didn’t sleep at all since yesterday, she was talking but not making any sense, spit out breakfast. I played some soothing music, got her to eat lunch and she seemed more relaxed and sleepy and wanted to lay down. She was awake but nodding off when I left. The LPN who is very good told me that she "often gets like this at night, due to sundowning." This was the first I've ever heard she has these episodes at night, so obviously I was pretty upset, since I’ve been assuming she has "normal" afternoon/evening, like she is at lunch. LPN feels that small 1 mg dose of melatonin at night might help her sleep better at night (she’s 90 lbs) Evidently it’s a pretty commonly used over the counter drug there, and she thinks it would good to try, but I would need to have her NP write an order for it, who seems reluctant. Does anyone have experience using this and does it help? Can it make them too tired during the day or does it wear off by then? Thanks!
Because it is not a medication that comes under the FDA, it has not been studied to determine ideal doses or timing of doses, etc. (It is a supplement.)
My experience with melatonin was trying it for my husband when he had dementia (it didn't help his sleep) and trying it at two different times myself for my sleep disorder. It was a psychiatrist specializing in sleep issues who had my husband try it. My doctor is a sleep specialist.
I like that that the LPN who suggested you try it suggested a half of 1 mg. Some people take 5 or even 10 mg and according to my sleep doctor, there is no evidence that more is better. (My dose was a half a pill, too.) From what I've read and heard from doctors, there is very little risk involved. If the NH suggested this for my mother, I would go along with a small dose. If it doesn't help, it can be discontinued.
Obviously, I am not a doctor and I don't even play one on tv. I'm just relating my own experience.
If Mom's NP is not familiar with the use of melatonin, perhaps they could ask some colleagues.
I would do an online search for drug interactions and dosage required. I personally feel that is a safe sleep aid but would want to know if there are drug interactions, maybe if there is the problem drug might have a sister drug without interaction. I have also found my pharmacist much more knowledgeable then my Dr about safe natural options. If your research doesn't reveal any issues for mom taking I would question the Dr thoroughly about his hesitation.
I'm sorry that the care home has kept you in the dark about your mom's struggles, I get the same stuff or I get he does blah blah blah as though it is an everyday occurrence when in fact it happened once.
I pray that your mom finds peace for her evenings and the sundowners syndrome goes away.
Update. Mom had been awake for 40 hours, when she finally went to sleep at 1 am Monday morning. We just let her sleep Monday, only waking her for some ensure and ice cream at noon, then back to sleep. Tuesday she was up, dressed and better. Not great, but better thankfully. I spoke to tbe RN floor manager about sundowning and the various methods we had researched to deal with it and she was very receptive to implementing some for Mom and the residents who exhibit this. She is from an ER environment and not familiar with these behaviors. She agreed with the melatonin, got the NP to write the order and we started Mom on 5 mg last night. She also will have the aids play her Simple Music Player for her at night. I loaded it soothing music for sleep and removed all the peppy big band tunes it came with. (This is a wonderful devise for people who enjoy music but can’t operate a radio/ player easily) We will try some more tactics like room lighting etc. Hopefully there will be some improvement, but at least I’ll feel like we’re doing something. Thanks for all your suggestions.
Mom doesn’t have a neurological psychiatrist. Hardly. She has a NH doctor to flys in and out of her room, once a quarter, a Nurse Practitioner on site 2 days a week who handles her general health & scripts, and the LPNs and RNs on her floor. And me on Google. The NP previously suggested melatonin, but now she’s resistant since she feels Mom would sleep all day, and she wants her to be alert for my visits. But if this issue is worth pushing/insisting I will. That’s why I requested some opinions. If there are any other suggestions for minimizing sundowning, I'm all ears. I definitely was blindsided by the revelation today that Mom gives them problems at night. Ignorance is bliss so they say. Thanks!
thesleepdoctor.com/2017/06/06/understanding-melatonin-melatonin-can-help-sleep-bio-time/