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Anxiety at Bedtime

Anxiety at Bedtime

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Even on good days, my mom becomes extremely anxious at bedtime. She "can't get comfortable," no matter what. Sometimes she says she's dying, and wonders if I know who to call in that event. Frequently she doesn't want me to leave her, which isn't characteristic of her daytime behavior.

Her shrink suggested Lorazepam aka Adavan (sp?) (a small dose -- given my mom's size (under 90 lbs.)). It was also suggested that she take the pill half an hour before bedtime, so it would kick in by then. Still, bedtime is often a time of high anxiety.

Any home remedies or suggestions for getting a PWP relaxed?

Much appreciated.

P.S. Since going on the antidepressant Effexor, my mom's daytime moods have perked up. Where once she didn't have the patience to read, she is again enjoying short stories.

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I'd be sure your mom is getting plenty of calcium and magnesium; these affect the nervous system in many ways, and people with PD are often somewhat deficient in one or both. Your mom probably needs 1200 mg calcium and 350 mg magnesium daily, though possibly less in view of her small size. However, she may not be eating enough to get sufficient amounts of these minerals, and multivitamins do not supply very much of either. Her physician should refer her to a registered dietitian who is experienced in PD for counseling.

Calcium-fortified orange juice is a good choice -- it contains 300 mg calcium/8 oz and the calcium is very well absorbed. Calcium citrate supplements are good also, and I would consider crushing the tablet and mixing it with her food or juice, as that will be easier to absorb.

Another possibility is a deficiency of B vitamins, which is also fairly common with PD. An RD can determine whether a B-complex would be a good idea. I often recommend this daily for a week or two, then 2-3 times per week for maintenance. If she uses Sinemet, she must take a B complex separately from Sinemet by about 2 hours, as the B6 will prevent the levodopa from working.

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in the words of someone who's been there for along time, your Mom is "sundowning". When the sun drops the dementia comes up like the sun. The ativan should help "bring her down" but it's a tricky med. and there's a level between a calming drug and one that just makes the person totally zombie. My heart goes out to you as to all of us dealing with pd dementia. My husband went thru this 4 years ago and we were able to bring him back for 3 pretty good years after a two weeks stay in a psych ward, drug holiday, etc. Now he has given up and is sunk deeply into dementia, hardest to bear. Keep after the doctors to try to stabalize her and do whatever it takes. If she can still read and understand during the day, she may be able to be brought back for awhile. I wish you luck.

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My thought was sundowning. Very common, even without PD. This often happens in a nursing home or hospital, but can be the case at home too. You could try the small dose of Ativan, but also consider what kind of calming pre-bedtime routine is possible. I read that the old remedy of warm milk really works! How about soft music? reading to her for awhile in bed? soft but adequate lighting--they say that helps if one is disoriented by darkness. Think of her as being like a small child who is scared of the dark--what would you do then?

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My husband has had PD fifteen years too, and has experienced some episodes at night of similar nature - but I haven't looked at it as dementia, but an aging person facing an uncertain future with a body that is more and more unresponsive. We have a routine of messaging legs, backs, etc, - talking frankly about the reality of the situation (inability to change the bed if can't get comfy - change positions, etc). He uses Lorazepam once in a great while, not routinely, and hot showers, t.v. , etc helps.

I realize your mom's situation may be very different, but I lean toward persuits of natural means rather than increased mixes of medications, if at all possible. Since she enjoys short stories, have you tried "talking books" at bedtime?

Best wishes in this never ending struggle for quality of life for all, you included....

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My mother is similar to your description. Although my mother is now in the late stage of PD, she has had to deal with this for quite a number of years. Her doctor has had her on Lorazepam for at least 5 years now and it is the best med we've used for the anxiety.

Many PDers (I think it is about 40%) have depression and/or anxiety at some level. There is an interesting questionaire for determining the likely hood of having depression or anxiety on the APDA web site. My mother does get depressed once in a while (who wouldn't?), but the psychiatrist says she does not believe she has depression, but clearly experiences the symptoms of anxiety. Therefore she is not on any antidepressents. (We've tried them but didn't get much response.) However, the lorazepam is a life saver for her and as far as we know, we have not had any bad reactions to it over the years. My mom is small (100 lbs) and is sensitive to meds. She takes .5 mg regularly with her bedtime meds and can take an additional .5 if needed during the day. It also has helped her to manage the pain she expereinces with the PD muscles tightening up in her abdomen . It doesn't actually relieve the pain, but it increases her ability to "cope" with it and not make it worse by stress.

Just a warning, we DID have trouble with a previous med called Xanax. Basically she became dependent on it and kept needing to add more and more and then when the docs wanted to take her off, it was a terrible withdrawal experience. Apparently, lorazepam does not have this issue. Thank God!

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Warm milk helps sometimes. I heard t.v. helps too and since the person probably sleeps in another room , the caregiver won't heard it. Books on tape also helps.

We have a remote for the lamp. The lamp is not near my eyes, but is just enough (40 watts) to put light in the room if i want it. Also, dim enough so that it does not wake anyone up. We can both then feel a sense of control.

Lorazepam eventually worsened my vision and my body got to use to it, so we all decided to stop it. Plus it didn't agree with the anti-depressant.

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