Medicine induced insomnia ? Posted: 03-22-08 00:02am
My Dad (80 years old) just got out of the
hospital due to difficulty breathing due
to fluid in lungs (5 week stay - 2 in
hospital, 3 in Transitional Care Unit). He
has advanced heart failure, COPD and
osteoarthritis, bad kidney function
because of all the diruetics he has taken
for approximately 5 years, and also
chronic gout. His ejection fraction on his
heart is 15% which means that his heart's
pumping ability is very bad and he is
almost immobile. Prior to his hospital
stay, his only prescribed drugs were
Diovan for hypertension, allopurinol for
gout, demedex diuretic, cardura diuretic
for urinary/prostate, prescription
potassium and darvocet for pain, and a
daily aspirin. Now my Dad's list of meds
include: Coreg (beta blocker), Plavix,
Lasix (diuertic for fluid in legs and
lungs), Digoxin (to improve pumping
ability of the heart, magnesium oxide,
daily aspirin, darvocet for pain, Diovan
for hypertension, Allopurinol for gout,
Flomax for prostate/urinary, Miralax for
constipation that is caused from all the
drugs, Megace for appetite stimulant
because some of these drugs will reduce
appetite, Breathing Treatments -
Spiriva/Brovana, Duoneb.
My questions are concerning his total
demeanor that changed drastically from the
beginning of his hospital stay until the
present day. He has been home for about
2-1/2 weeks now. From the onset of being
given these new meds in the hospital, he
has been unable to sleep through the
night, only napping very lightly during
the day. He is totally miserable, freezing
cold all the time (electric blanket
sometimes won't even get it), pulling
covers up and then off, having to have the
pillows he sits on "just a certain way,so
as not to put pressure on his tender
backside", readjusting constantly the
pillows, blankets, up and down constantly
to the bathroom because of the diuretics
and not being successful half the time. He
is very unconcerned about watching TV
programs he enjoyed before entering the
hospital or even reading the paper -
really he doesn't want to do anything but
just sit. He does not see the point in
doing the least little physical therapy to
keep him slightly mobile - doesn't see the
point because he doesn't see the necessity
in it. Will not take a chair bath until
absolutely necessary (every 2 weeks is
okay with him) - this is because he claims
the water freezes him although the
bathroom is so hot like a sauna and the
washcloth is blazing hot - it all still
"feeezes" him and he says that he is half
dead now and why should he do something
like that if it is not totally necessary.
Also, he goes through periods of time
where what he says makes no sense at all -
pure gibberish. But at times, it is like
he is aware of what he just said that made
no sense. He will also use curse words
when he is ridden with anxiety about his
coldness and also when he is uncomfortable
on his backside - then he has had
outbursts with us, his daughters only, no
one else so far, where he says things
like, "I can't live like this, I'd rather
be dead" and "i'm no good to anyone like
this", and I wish I had just died" and I'd
rather be dead and "I'm just going to kill
myself". These comments are very much NOT
like anything my Dad would say. His mind
was extremely good up until his hospital
stay. He also will say if we will let him
go home (to his house alone and he is a
widower and would be alone there) then he
could get warmed enough there and would be
more comfortable and one time he said that
he would go there and just kill himself.
Well, he is living with me, his daughter,
and I have made every effort for his
comfort and warmth - if he could only know
what efforts my family have made to have
him with me as he cannot go home and be
alone, not in his condition, doctor's
orders is that someone has to assist him
on his walker at all times. The minute it
hits midnight, if he has napped late,
every night he does this - he awakens and
starts going back and forth to the
bathroom, turning the electric blanket on,
pulling it on him for about 5 minutes and
then throwing it off and turning it off,
adjusting the pillows constantly,
wandering around throughout the night with
little and no sleep throughout the night
and during the day, he naps very little -
maybe 30 minutes maximum. Quite honestly,
he has not had a full night's restful
sleep in about 8 weeks now. I frankly do
not understand how he is even making it as
well as he is with no proper rest for that
long. I have to be attentive to him most
every minute of the day, as he is
constantly wanting me to pull his blankets
around him to his back and keep his
pillows adjusted accurately, etc. When I
take him for a Doctor's appointment, he
presents himself outside the home as if he
is just okay, and the minute I get him to
my home and he gets in the house, he
starts to get irritated with something -
anything and displays, verbally, his total
unhappiness with his situation - sometimes
he gets so agitated that I feel that he
could become violent and fear what he
might do. One day, during an agitated
event, he said that he thought he was
loosing his mind and that we could just
put him in the state psyciatric hospital.
So he is aware sometimes that something is
terribly wrong with him These actions are
so very unlike the way I have always
remembered him and certainly was not him
immediately before entering the hospital.
He was always a very calm, collected,
sedate, gentle, kind and caring man with
not ever very many harsh words that I can
remember. He is now very irrational for
most of the time and makes no sense when
he says thing (almost like Alzheimers),
then to turn around and then make perfect
sense - just like Dr. Jekyl and Mr. Hyde.
While in the hospital, when we saw he was
not sleeping, as we stayed with him 24/7,
they gave him Lunesta to sleep and he
didn't sleep a wink at night and became
extremely irritated and agitated and mean
at night saying things like "I am going to
jump out that window" - then it was
changed to Resterel another sleeping pill,
same thing there, then it was changed to
Ambien with the same results. Absolutely
no sleep until about 6:00 a.m. and then he
would sack out with a swollen bottom lip
head hanging for several hours. Then they
thought he was depressed and gave him an
antidepresnt Celexa and it didn't help to
relax him at all - same problems. I will
have to say that since we are out of the
hospital that the magnitude is not as
great as it was in the hospital, however
the same patterns and events still exist.
I was told that these things happen to
people that stay in the hospital that
long. I can believe that somewhat,
however, after looking up all the drugs
that he is now taking, I am finding that
almost each one of them can cause anxiety,
insomnia and mental changes. Well, all I
can say is that he is one very miserable
man and that if taking him off all of the
medicine will bring back my Dad to the
person he was born to be, then I believe
that I could opt to have quality of life
over quantity of life. I truely hope that
I can get a good response as to the cause
of these problems and some clues as to
what to do about them as I don't know if I
will be able to deal with him like this.
How could anyone change so drastically
just by being put into the hospital. The
only thing that I believe would be the
cause of his behavior changes are these
drugs - am I right? I think I am.
Thanks in advance for any time anyone
could afford me.
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CarolDiane
Supporter
Joined: 23 Sep 2007 Posts: 2401
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Posted: 03-22-08 14:58pm
This is what we call in medical terms
"Failure To Thrive". That means when
someone for any reason gives up hope and
does not care anymore about themsleves or
even go on living. This usually does
happen at his age and after a long
hospital stay or finding out you have a
fatal desease. Most common in patients
with termenal health issues. They feel
that they are going to die anyway, so why
try. Which is so not the truth. Just the
oposite. You dad could live to be in his
90s.
Now comes the hard part. Convincing him of
that. I would suggest even if he objects,
turn on that TV, sit around and joke and
laugh. You and you family have to try to
bring his want to live back. He has given
up on himself and this is so common in
many of our elderly population. My mother
was diagnosed 2 years ago with lung cancer
and it has moved from the left side to the
right plimph node now. But, she has not
givin up. She refuses any treatment but
she gets around the best she can and she
is not letting it rule her life. I have
had her at least a year longer then I
thought I would. My point is, Failure To
Thrive does not have to be a death
sentence. This is like I said the family
has to intervein and try to bring him back
to reality of the Quality Of Life theme.
Get him to laugh, smile and talk. This may
be a hard road, because your dad feels he
is worthless right now and that what the
heck, I ain't gonna be around much longer
anyway. NOT! At his nex B'day, I would
celebrate it like you never have before.
Give him a great bash. It's all about
lifting up his spirit to want to live
again.
Wishing you the best on this road,
Carrie
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kajcomp
New User, Becoming EHEALTHy
Joined: 22 Mar 2008 Posts: 2
Carrie Posted: 03-22-08 16:20pm
Thanks so very much Carrie for your
response - and yes, we have been trying so
very hard to encourage him so far -
nothing doing for him - maybe some more
time will help his emotions. I really
can't help but think that a lot of his
confusion, anxieties and sleeplessness is
due to the current medications he's on.
I appreciate your time in your response
and will keep those thoughts up front in
my mind always.