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Caregiving Questions

Latest Questions and Answers
I take Ambien CR for a sleeping problem, which started after five abdominal surgeries that I had during a period of 18 months. I find myself tired all day everyday and wonder if Ambien is interfering with my REM sleep. My memory and reactions to things are poor and would like to know what is wrong with me. I have been a full-time caretaker of my mother, who has Alzheimer’s disease. I know that depression is a possible cause of my symptoms, but I am more concerned about my REM sleep. Is there research concerning Ambien’s affect on REM sleep? [ 02/24/10 ]

Several studies on the effects of Ambien on the different stages of sleep have found that there is a tendency toward reduced REM sleep and increased deeper stages of non-REM sleep. But whether this shift in sleep stages has any bearing on your memory is another question which is not easily answered. The role that sleep plays in learning and memory is still being unraveled. Different types of sleep (REM, non-REM) have been found to be beneficial for consolidating different types of learning, so the absence of REM sleep may be detrimental to one type of memory or learning but may have no impact upon another type of memory that requires the deeper non-REM sleep stages.

More likely than not, with all of your caregiving demands and surgical ordeals, you are probably overworked and over-stressed, which can certainly affect your sleep. Try talking to your doctor about adjusting or changing your sleep medication. Please also talk about exercise and other strategies to manage stress and depression during your visit—these can go a long way toward encouraging good sleep without any of the side-effects caused by sleep aide drugs.


My father is 57 and has just been diagnosed with Alzheimer’s disease. Although it has been evident for years that something is wrong, he is mostly in denial. His wife is younger and has three small children. He is becoming increasingly agitated and I constantly worry about his safety as well as the well-being of the children. He is not sleeping and will get up and leave the house without telling anyone. He does come home, but if he does not take his cell phone, there is no way to contact him. I need some guidance on how to handle each new situation that comes up without hurting his dignity. I personally do not feel it is safe for him to drive but his doctors have not recommended that he give up driving. This is all so new and I am the only daughter. I am 35, but in his eyes I am still a little girl and it is difficult to tell him not to drive or go anywhere by himself. However, as his only child, I am sure that I will have a huge part in his caregiving in the future. [ 02/16/10 ]

You are right to be concerned about both your father's and his family's well-being. Even though it may be emotionally difficult, it is usually best if all of you—you, your father and his wife—sit down together and discuss his diagnosis and what it means for your family and the future. You all need to have a realistic idea about how caregiving responsibilities will be divided, financially and practically, so that hopefully there will not be any unpleasant surprises down the road. More than likely, this will be a discussion that needs to be periodically revisited as time goes on and new issues arise. What you decide today may change in the future, but that does not mean that you should not at least have an overall plan for your father's care. He may have strong opinions against, for example, having a home health aide or respite caregiver help with his care at home. But these types of arrangements may be necessary if his wife has her hands full with other home childcare responsibilities, and therefore it is best to try to persuade him now to keep an open mind about different caregiving options for the future. Now is also the time to make sure that your father's legal and financial documents—such as his will, living will, titles and deeds, etc.—are current and in order.

As for your father's wandering behavior and his driving, remind your father that your concern is not intended to cause him indignation or restrict his freedom, but rather your concerns are for his safety and the safety of other motorists. You can read more about the subject of driving and about wandering behavior on our website.

In the meantime, you may want to consider joining an Alzheimer's support group. You can search for Alzheimer's caregiver support groups in your area by visiting our "Resources" section, such as under the Caregiving and Caregiver Support heading in "Helpful Organizations."


Are there any Medicaid and Medicare benefits for caregivers of individuals with Alzheimer's disease? [ 02/15/10 ]

Although Medicaid and Medicare sound as if they are related, they are actually separate programs and have different eligibility requirements. Medicaid, for example, is a state-run program designed to help lower-income individuals, whereas Medicare is a federal program for persons over the age of 65 receiving social security benefits.

Depending on what program(s) the Alzheimer patient qualifies, the caregiver may be able to receive benefits in the way of assistance with caregiving responsibilities. For example, Medicare can cover some of the expenses related to the care of a patient having Alzheimer's disease. For more caregiver information, please visit the Medicare website. There are also several agencies under the Helpful Organizations heading that you can contact and that can help you to identify sources of aide appropriate for your situation.


My husband was diagnosed with Alzheimer’s disease 6 years ago. He has just started exhibiting an unusual behavior that baffles me and seems to agitate him greatly. When he sees his reflection in a mirror, he becomes angry and insists that "that man" get out of our house. I have covered the mirrors and have even taken down the mirror in our bedroom. This did not help because he just pulls the coverings down. Is this a common symptom? Is he suffering from hallucinations, delusions or both? Thank you. [ 02/12/10 ]

It is not uncommon for Alzheimer's patients to report seeing strangers in reflective objects, when in fact it is their own image they see. This phenomenon is referred to alternatively as self-misidentification, mirror sign or mirror delusions, and it is basically the inability to recognize one's own reflected image. This behavior is often more disturbing for the caregiver than it is for the patient, although as you indicated, the patient can certainly become agitated over the “intruder” in the reflection.

If cloth coverings have not worked, the only real recourse is to remove the reflective objects from the home altogether. If the mirrors are permanent structures or too difficult to remove, it may be possible to apply a self-adhesive vinyl covering (which is non-permanent and can later be removed) or, if you do not mind a permanent change, spray paint the mirrors with a frost finish designed for glass surfaces. Check with your local hardware or design store for more options.


Is it normal for an Alzheimer’s patient to be completely helpless just like a baby? My mother was able to walk, go shopping and take a bath by herself 3 weeks ago; however, after a week-long hospital stay, she cannot talk, walk, lift an arm, open her eyes or focus in the morning. She is unable to function normally until around 1 p.m. and the cycle begins again the next morning. Could you explain why this happens? [ 02/01/10 ]

If your mother received anesthesia while in the hospital (such as for an operation or other procedure requiring her to be sedated) it is possible, though not proven, that this could have made the Alzheimer's disease (AD) worse. Similar instances have been reported for other AD patients who were relatively fine prior to an operation, and then were reported to have more severe symptoms following a procedure requiring anesthesia. Scientific studies have had mixed conclusions as to whether anesthesia can affect the disease or disease course, so it is not clear whether this could be the cause of your mother's recent behavior if she did have anesthesia.

Even if your mother did not have any anesthesia while in the hospital, AD on its own can in some cases cause a patient to experience a very sudden decline in their functioning. It really depends upon the area and extent of the brain affected by the disease. Please talk to your mother's physician about the recent changes in her condition, emphasizing that this deterioration has only happened within the last few weeks. There may be another medical reason for this, but her doctor would have to perform an examination to determine other such causes.

It is also possible that your mother is depressed, which is not uncommon for AD patients. This may explain why it takes her so long to “wake up” in the morning. Or perhaps your mother is not sleeping well at night, which may be why she wakes up disoriented and unable to function properly for some time. Again, her doctor should be consulted about this new behavior, as there could be a medical explanation apart from AD that is causing her to behave in this manner.


My dad was diagnosed with Alzheimer’s disease 8 years ago, and is taking Aricept and Namenda. He has started humming randomly (no tune, just a constant monotone). Is this behavior associated with final stages of Alzheimer’s disease? [ 01/30/10 ]

Constant humming (or singing, chattering, muttering, or other noise-making) has been reported in patients suffering from Alzheimer's disease and other types of dementia, but this behavior has not been formerly associated with any particular stage of the disease. Typically, patients who display this behavior are recognized as being at least in the second stage of Alzheimer's.


My mother has advanced dementia and for the past few months she has been moving and jerking continually. She does "pelvic thrusts" while sitting or lying down. What is the cause of these movements? [ 01/28/10 ]

About a third of Alzheimer's patients have been reported to develop a condition called myoclonus, which is similar to the sudden involuntary jerks and muscle twitches you may experience when falling asleep. The muscle spasms themselves are not painful, and if your mother already requires constant care, then they probably are not as debilitating as they would be to someone who is still mobile (i.e., muscle spasms can interfere with activities of daily living or could cause a person to fall and injure herself). Even though there are medications that can help reduce muscle spasms, there are always side effects to consider when introducing any new drug. Please consult with your mother's physician for further advice.


I am concerned that my 84-year-old mother-in-law may be showing early signs of Alzheimer’s disease. She never seems to remember anything that I tell her, appears depressed, does not want to do much of anything of late, appears confused about what day it is, has a vacant look and can drop off to sleep easily during the day (but says that she cannot sleep at night). I am not sure if these symptoms are related to old age or if they are related to something more serious. Any advice would be helpful. [ 01/26/10 ]

As people age, their memory may decline, but this is completely normal. However, normal aging does not necessarily explain the confusion, apathy, depression, and sleep problems you noted your mother-in-law to have. It is therefore possible that the symptoms you list are indicative of another condition.

For that reason, it would be wise to get your mother-in-law examined by a physician who can help to diagnose what the cause of her symptoms may be. Your mother-in-law may be depressed, for instance, which alone can lead to memory impairments, confusion, apathy, difficulty concentrating, and sleep disturbances. Or the diagnosis may be something more serious, such as dementia. Besides Alzheimer's disease, there are several causes of dementia in the elderly that can be treated and even reversed. For example, memory impairments and confusion consistent with dementia can be the result of hormonal imbalances (thyroid hormones in particular), vitamin deficiency (such as vitamin B12), or infections of the brain (such as meningitis)—all of which can be treated. So a doctor's evaluation and diagnosis can be particularly helpful to help figure out the cause of her symptoms and possibly even treat them.

Even if your mother-in-law were to be diagnosed with mild cognitive impairment (MCI) or probable Alzheimer's disease (AD), this diagnosis can be useful too. Taken early, the medications currently available for the treatment of AD can help to slow the debilitating effects of the disease. A proper diagnosis, whatever it may be, can also help to prepare your mother-in-law and your family for deciding which course of action to take for the future; particularly should your mother-in-law be found to have Alzheimer's dementia or another such degenerative disease.


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Disclaimer: The information provided here is a public service of the BrightFocus Foundation and should not in any way substitute for the advice of a qualified healthcare professional; it is not intended to constitute medical advice. Please consult your physician for personalized medical advice. BrightFocus Foundation does not endorse any medical product or therapy. All medications and supplements should only be taken under medical supervision. Also, although we make every effort to keep the medical information on our website updated, we cannot guarantee that the posted information reflects the most up-to-date research.

Some of the content in this section is adapted from other sources, which are clearly identified within each individual item of information.

Last Review: 04/29/13


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