Updated 9/14/17
We Know Better, So Let’s Do Better
As I noted in We Know Better, the FDA issued a black box warning stating any type of antipsychotic (new or old) is not safe for people with dementia.
I also said when we know better, we do better. The FDA warning was issued in June 2008, so clearly we know better. Now, how do we do better?
Why Does This Happen?
First, it’s useful to understand why people with dementia are put on antipsychotic medications in the first place. The top three most-cited reasons I hear are “The doctor said…”
- “This medication is for dementia.”
- “It will make him stop having behaviors.”
- “She’ll sleep better.”
One of the big problems with treating dementia effectively is that doctors typically get one 50-minute class on depression, delirium, and dementia in medical school.
Yes, you read that right: one class combining all three topics, lasting less than an hour.
Once in practice, doctors see their patients with dementia for about 15-20 minutes in the course of an office visit. If you’re the primary care partner, it’s likely you have more experience with the day-to-day ins and outs of dementia than the doctor does.
Let’s look at the top three reasons, check the facts, and explore alternatives.
“The doctor said this medication is for dementia.”
Currently, there are only four medications approved for treatment of dementia: Aricept (donepezil), Exelon (rivastigmine), Razadyne (galantamine), and Namenda (memantine).
Any other drug is NOT approved for the treatment of dementia.
“The doctor said this will make him stop having behaviors.”
Because dementia-related behaviors are attempts to communicate, it’s much more effective to identify the cause of the “behavior.” Then you can fix the underlying cause. See Behavior=Communication: Learn to Speak Alzheimer’s, Fast! for more details and tips.
“The doctor said this will help her sleep.”
Instead of using an antipsychotic to achieve sleep, try the following ideas. And please, don’t use a sleeping pill! They have a “hangover” effect on people living with dementia and increase the risk of falls with injury. On top of all that, sleeping pills (even the over-the-counter kind) work against what the dementia medication is trying to do.
Cut down on nap time
Is your person getting so much sleep during the day that sleeping during the night is difficult? If so, start gradually reducing nap times by 5-10 minutes until they’re about 30-60 minutes long.
If a person doesn’t feel a sense of purpose or have something to look forward to during the day, daytime sleep can become the default mode and disrupt nighttime sleep.
Establish a bedtime routine and stick to it.
Allow extra time to get through the bedtime routine. That’s about one and a half to two times as long as it would take you. Also be sure to provide cueing and assistance as needed.
Check the environment.
Is the temperature comfortable? Yet another way dementia affects people is by breaking their internal thermostat. Knowing they’re often (usually) colder than we are, make sure there’s an extra comforter on the bed.
Try soft music as a background noise, or use a sound machine. And introduce a nightlight for an added sense of security.
Full days lead to good sleep.
Several things create a full day: exercise, household chores, leisure pursuits, and more. Be mindful, though, of the difference between a “full” day and an overstimulating one. Overstimulation, just like understimulation, will lead to nighttime sleep difficulty.
What’s your experience? What do you think helps with sleep? Let us know in the comments section below!
Christy Turner is the founder of DementiaSherpa.com and has enjoyed the privilege of working with 1,123 people living with dementia and their families. Follow on Facebook, Google+, Instagram, Pinterest, Twitter, and YouTube. Content varies across platforms.