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My mother is 87 years old and has full blown dementia. She cannot be left alone and requires daily assistance. She is awake a good part of the night and recently she has developed panic attacks. Every time I leave she wants to know if she can come with me. Since I work full time this is usually not an option.  She is being well cared for by her caregivers.

I know she can’t control her behavior- and that her lack of sleep doesn’t help. Her doctor suggested melatonin for the sleep, but that did not help. What can I do to keep her calm and keep the panic attacks to minimum?  Marla H., Miami, FL

Caring for a loved one with dementia can be very challenging and emotionally draining.  As you are learning, the disease is not just about memory loss: It also involves personality changes and impaired reasoning so that independent daily living is severely limited.  

To learn about the options available to your mother for her insomnia and anxiety, I contacted Dr. Leslie Kernisan, a geriatrician in the San Francisco Bay area and the physician behind the excellent website, Better Health While Aging. In her email response to my question, she described your mother’s situation as “tricky” to manage;

“There’s no easy and safe way to keep her calm,” she wrote.  “Commonly prescribed tranquilizers such as Xanax or Ativan pose risks for older people with dementia as they can increase the chance of a fall and even make patients more confused. They are also habit forming and it can later be very hard to wean people off these types of drugs.”

Dr. Kernisan recommended that you explore non-drug ways to manage your mother’s anxiety;

“Keep her rested, relaxed and as emotionally healthy as possible so that she’ll be less likely to panic when she’s faced with a stressor such as your departure,” she said.

“For example, to help her sleep better, try one of the techniques I write about in depth in this article: How to Manage Sleep Problems in Dementia. These include making sure she gets enough exposure to sunlight and fresh air during the day. Exercise has also been shown to help dementia patients improve their sleep.

“Music therapy or another pleasant activity can help during those times when you have to leave her."

“If you have exhausted non-drug approaches and want to discuss medication options with your mother’s physician, an article I recently wrote about 5 Types of Medication Used to Treat Difficult Dementia Behaviors, should help you understand the benefits and risks. It describes the approach I take when considering medication for behavior problems in dementia. For example, I would first make sure that your mother isn’t experiencing chronic pain or constipation, which can make people with dementia irritable or more reactive.

“With a little effort and creative thinking, it’s often possible to reduce the anxiety and distress of a person with dementia, without resorting to chemical restraints,” Dr. Kernisan said.  “Consider them if it seems absolutely necessary, and talk to the doctor about using the very lowest doses possible.”

As a footnote to this column, you may find information on Dr. Kernisan's website very helpful.  Her podcasts on Safer Treatments for Insomnia and Drugs for Difficult Dementia Behaviors are well done and well worth the time to listen to.