Tinsley is the easy-going man with a warm personality during the day. He smiles often and laughs with me and his guests. He is happy to see us. During the day he engages with other residents in community activities. He likes sing-alongs, trivia games, or watching Hallmark Christmas movies. He doesn’t express anger or resentment toward me anymore. It is a joy to spend time with him when he is the sweet man we’ve all known. But when night comes, he faces his biggest challenge. He can’t sleep and becomes a man I don’t know.

When the sun sets, the sundown syndrome kicks in. He becomes more agitated, irritable, and impulsive. When he starts to feel unsettled, he becomes a difficult resident. He starts to pace the facility. Sometimes he stays in his wing, and sometimes he wanders down other wings. And he doesn’t just wander through hallways. He has a strong tendency to open doors and walk into other people’s rooms without notice. This has happened at 2AM in the morning, and he’ll start rummaging through their drawers or closets. When staff tries to redirect him out of a room that’s not his, he resists. There are some nights that they have to lock the doors of residents to keep Tinsley out.

Several weeks ago during the evening shift, he barged into the nurse’s station. He grabbed some pill bottles sitting on a counter and started to run with them. He announced that the pills were his and resisted two nurses who caught him and pried the pills out of his hands. Two weeks ago, he noticed a staff person assisting another resident who didn’t want her help. Tinsley heard the resident express displeasure, so he grabbed the staff person and pinned her to the bathroom wall. He thought she was hurting the resident. She screamed for help so that other nursing staff could remove Tinsley.

There is nothing normal about these behaviors. It makes me sad that he can’t help it. Since his admission, the medical staff has adjusted his medication three times over the last three months to help him sleep at night. They added Melatonin to his medication line-up and added Ativan on an “as needed” basis. I see him mostly in the evenings because of my work schedule, so I see his personality change after he gets his last round of medications. Last Sunday evening, I came over to watch Sunday Night Football with him. He was enjoying my company while holding hands. The nurse gave him medicines at 9PM, and as the evening progressed, I could see a distinct change in his personality emerging. It was like a switch turned on. His agitation became evident. He announced that he “needed to go.” He got up and started walking through the hallways while I followed. As soon as he reached for a door handle that was not his room, I’d have to tell him “we can’t go in there because this isn’t your room.” Yet he’d still reach for the handle and try to enter the room.

He didn’t appreciate my redirection. He had not slept for three nights in a row, so his tiredness was starting to show in his gait. When he walked, he started to stagger as if he was drunk. So a nurse and I each took a hand of his and guided him to his room. As soon as we reached the doorway, he refused to enter. We tried to gently pull him in, but he wouldn’t budge. So the nurse decided to let go of his hand and deal with him later. But Tinsley chose to grab my free hand, and then he tried to pull  me down to the floor. When that didn’t work, he attempted to swing me around in the hallway. He was getting physically aggressive with me, and I finally said, “Tinsley, we’re only trying to HELP you. You’ve been without sleep, and we think if you’ll lie down, your body will rest.” That was too logical! You can’t reason with someone who has Alzheimer’s. He did NOT want to stay in his room.

The latest physician visit occurred on December 18^th, which seemed like an eternity since the last visit on November 20^th. Before the doctor evaluated Tinsley, I shared my concerns with her over the phone. It’s been four months, and we still can’t seem to help him sleep. He only sleeps when his body finally crashes, or when staff administers Ativan to knock him out. It appears that his medication regimen isn’t working. She spent an hour with him that afternoon and then called me to give her report.

First, she noticed that his weight dropped off again. He lost fourteen pounds in four weeks, which concerns her. The staff believes this is happening because he can’t sit still long enough to finish the meal in front of him. He’ll get up and leave for no apparent reason and then maybe revisit his plate later. Though this is plausible, the doctor is still concerned, so she ordered weekly weigh-ins to monitor this.

Second, she shared a different approach to deal with the lack of impulse control that is causing so much havoc during the evening hours. She is not a fan of anti-psychotic medications to address anxiety and lack of impulse control. She ordered a new drug, Depakote, which also works well with controlling anxiety and managing impulses.

Third, she changed the time when the staff gives him Melatonin. She wants to stagger his evening meds instead of giving it to him all at once.

Finally, she helped me understand that Tinsley is not in the “moderate” stages of Alzheimer’s. She said he’s in the severe stage of Alzheimer’s. When I asked why she thought that, she said, “The biggest indicator is the loss of language skills. We often see this in the severe stages of this disease.”

I share this update with you because I need you to keep praying for him. I know many of you are already doing that, but I wanted you to have a clearer picture of what is happening, especially during the nighttime hours. I invite you to join me and pray in agreement for the following:

1. That the Lord will grant him a sweet sleep every night. (Proverbs 3:24)
2. That the Lord will restore the joy of his salvation in this new chapter of life. (Psalm 16:8-11)
3. That the Lord will give the physicians “generous portions of wisdom” in managing his medications. (James 1:5)
4. That the Lord will remove all anxiety in Tinsley as far as the east is from the west and fill him with the peace that surpasses all human understanding. (Phil 4:6-8)

May you have a very Merry CHRISTmas!

Blessings,

Lee Ann