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Suggest Treatment For Night Sweats In A Person With Dementia
Question: My Mother is 88 with dementia. 15 mg Mirtazapine helped her anxiety for 18 months but all of a sudden she started getting sweats at night which disturbed her sleep and increased her anxiety - she was hyperventilating and sobbing a lot during the night. The anxiety spread to worsening her daytime anxiety as well and she started to develop 'sundowning' but I believe it's more related to the fear of not being able to sleep. A trial of 30 mg Mirtazapine appeared to make her sleep and anxiety worse. One month back to 15 mg didn't make any huge differences. Put back up to 30 mg since a week ago. Sleep disturbance come back and anxiety off the show. Also takes 4 mg melatonin since 3 months ago. Wondering about Memantine/very low dose Lyrica/tricyclics? She reacts badly to benzodiazapines - memory gets a lot worse, unsteady on feet, gets delirium easily. Wondering if there is a 'sleeping aid' that might do the trick? Should we avoid antipsychotics? Thanks
Brief Answer:
Lyrica or Zolpidem can be tried.
Detailed Answer:
HI
Greetings from Dr.Divakara.P
Thanks for posting your query.
I went though your query and i cn understand your concern. Well Lyrica is a good option but low dose may not work . She may require somewhere like 150mg every night.
As of Tricyclics is concerned it is not a good drug to be used in elderly people. Memamtine is used for dementia but it shall not be useful for sleeplessness. In fact it can cause Insomnia.
Also I recommend she can try Zolpidem , though it is similar to Benzodiazepines , it doesn't have most of the side effects of Benzodiazepines. So you can give it a try.
If possible avoid caffeinated drinks after 5 p.m , avoid her from sleeping in noon or afternoon, avoid heavy dinner, play a soft music while she goes to bed , make sure there are no disturbing noises around.
Hope this information was useful to you.
Any clarifications feel free to ask.
Regards.
Lyrica or Zolpidem can be tried.
Detailed Answer:
HI
Greetings from Dr.Divakara.P
Thanks for posting your query.
I went though your query and i cn understand your concern. Well Lyrica is a good option but low dose may not work . She may require somewhere like 150mg every night.
As of Tricyclics is concerned it is not a good drug to be used in elderly people. Memamtine is used for dementia but it shall not be useful for sleeplessness. In fact it can cause Insomnia.
Also I recommend she can try Zolpidem , though it is similar to Benzodiazepines , it doesn't have most of the side effects of Benzodiazepines. So you can give it a try.
If possible avoid caffeinated drinks after 5 p.m , avoid her from sleeping in noon or afternoon, avoid heavy dinner, play a soft music while she goes to bed , make sure there are no disturbing noises around.
Hope this information was useful to you.
Any clarifications feel free to ask.
Regards.
Above answer was peer-reviewed by :
Dr. Yogesh D
Brief Answer:
Yes use in combination with Mirtazapine.
Detailed Answer:
HI
First reduce the dose of Mirtazapine to 15mg and in addition start Lyrica 150mg . She may experience littel drowsiness or dizziness in the initial few days but if it is very significant then you need to stop Mirtazapine.
But if this dose doesn't give her good sleep then you can increase the dose of Mirtazapine to 30mg .
It would be better if she doesn't take alcohol in future .
Regards.
Yes use in combination with Mirtazapine.
Detailed Answer:
HI
First reduce the dose of Mirtazapine to 15mg and in addition start Lyrica 150mg . She may experience littel drowsiness or dizziness in the initial few days but if it is very significant then you need to stop Mirtazapine.
But if this dose doesn't give her good sleep then you can increase the dose of Mirtazapine to 30mg .
It would be better if she doesn't take alcohol in future .
Regards.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr Divakara
I am wondering if when one becomes elderly/has dementia whether an intolerance to a drug can develop some way down the path of taking it and side-effects start to come on which didn’t come on before. I am wondering if the original night sweats that started four months ago were in fact a reaction to the Mirtazapine and whether instead of increasing it we should be taking her off it. What do you think?
I have also read that Mirtazapine can suddenly stop working, also that at doses over 15 mg the sedative properties reduce. What do you think?
We are 10 days into the three-week trial but she is so distressed at night, awake more than asleep, calling my brother and I frequently on the phone. The nursing home has asked us to go in on quite a few occasions because she has been in distress. When I go in to sleep, she sleeps better because when she wakes in panic and calls out ‘help, help’ I said ‘it’s ok Mother, I’m here – go back to sleep’ and she often does.
Is there anything we could use to help her sleep better in the trial period?
Thank you
I am wondering if when one becomes elderly/has dementia whether an intolerance to a drug can develop some way down the path of taking it and side-effects start to come on which didn’t come on before. I am wondering if the original night sweats that started four months ago were in fact a reaction to the Mirtazapine and whether instead of increasing it we should be taking her off it. What do you think?
I have also read that Mirtazapine can suddenly stop working, also that at doses over 15 mg the sedative properties reduce. What do you think?
We are 10 days into the three-week trial but she is so distressed at night, awake more than asleep, calling my brother and I frequently on the phone. The nursing home has asked us to go in on quite a few occasions because she has been in distress. When I go in to sleep, she sleeps better because when she wakes in panic and calls out ‘help, help’ I said ‘it’s ok Mother, I’m here – go back to sleep’ and she often does.
Is there anything we could use to help her sleep better in the trial period?
Thank you
Brief Answer:
Get her a counselling from Psychiatrist.
Detailed Answer:
HI
As the age progresses human brain starts shrinking and the ability and efficiency of the brain starts declining. The same happens in an accelerated process in case of Dementia.
The medicine ( Mitrazapine, Benzodiazepines , Tricyclics ) all these affect on the cognition of the brain. Initially their effect may not cause any problem in normal people but in elderly and in dementia patients the affect on the cognition will be more as the cognition have already been impaired due to age or dementia. So the use of these medicines will cause cumulative affect on the cognition and hence these patients develop intolerance after few weeks or months of medicine use.
Coming to night sweats I personally don't think it is due to Mirtazapine. As narrated by you it could be just Anxiety, fear or even Nightmares ( which are quite common in dementia ).
Mirtazapine stopping to act all of a sudden is not possible ( at least I have not come across ) Its effect can gradually wear off over time but not stop suddenly.
Lyrica is a good option but also I would recommend a counselling from a Psychiatrist. She might be in fear of something that might be causing all these problems.
Family support and indulging her in some family sctivities might be of some help to her.
Hope this information was useful .
Any clarifications feel free to ask.
Get her a counselling from Psychiatrist.
Detailed Answer:
HI
As the age progresses human brain starts shrinking and the ability and efficiency of the brain starts declining. The same happens in an accelerated process in case of Dementia.
The medicine ( Mitrazapine, Benzodiazepines , Tricyclics ) all these affect on the cognition of the brain. Initially their effect may not cause any problem in normal people but in elderly and in dementia patients the affect on the cognition will be more as the cognition have already been impaired due to age or dementia. So the use of these medicines will cause cumulative affect on the cognition and hence these patients develop intolerance after few weeks or months of medicine use.
Coming to night sweats I personally don't think it is due to Mirtazapine. As narrated by you it could be just Anxiety, fear or even Nightmares ( which are quite common in dementia ).
Mirtazapine stopping to act all of a sudden is not possible ( at least I have not come across ) Its effect can gradually wear off over time but not stop suddenly.
Lyrica is a good option but also I would recommend a counselling from a Psychiatrist. She might be in fear of something that might be causing all these problems.
Family support and indulging her in some family sctivities might be of some help to her.
Hope this information was useful .
Any clarifications feel free to ask.
Note: Get a consultation booked to know more about aging related medical issues. Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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