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Mom is 86 with vascular dementia. She stays up all night talking with people who aren't there. She holds actual conversations with them, sometimes calling out to me to come and help. I have tried playing along by "running them out of her room" and negating what she thinks she sees as well. I don't really know what to next. She is already taking antipsychotics. I have tried light therapy, which seemed to work at first, but no longer. She is confused as to time/space, we moved in with her because we thought it would be easier for her than taking her to a different home. She continuously asks the same questions about deceased relatives. She is one of 17 children, only one other survivor, whom we do not hear from. It gets old, but I can handle it during the day. Any suggestions for helping her sleep better? Melatonin works occasionally, but not always.

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If your state allows, apply for a medical marijuana card for her and a caregiver card for yourself. Our neurologist preferred cannabis over melatonin. He said that it acts in the same manner so don’t give both. My husband takes the tincture prior to going to sleep and usually sleeps quite well.
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AliBoBali Dec 2021
Not a bad idea to try, but THC is correlated with psychosis symptoms. If it were other mental health symptoms -- depression, anxiety -- I think it could be more helpful, and less risk. It could help; it could cause heightened delusion.

*I'm not a doc, just an observation about the potential risk. I've thought about trying the THC tincture at my local smoke shop to see if it helps my sleep issues.
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You either need a much stronger sleeping pill to make her quiet and sleep the night or your lives will be shot to hell. I think you have to face the fact she is gone and should be placed. Please don't wait - do this now. This is only going to get worse.
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Eat dinner early and discontinue fluids after the meal as much as possible to avoid indigestion and bathroom trips. Add occasional roasted turkey dinners (it does actually help make you sleepy - and provides leftovers for days so it is very economical (both for time and money)).

If possible, help her take a warm shower after the evening meal/snack as a wind-down. If this is too difficult, bring her warm wet towels, like “finger towels” for clean up and give her a quick hand or foot massage.

if tolerated well, use aromatherapy. Depending on her preference, use plug ins or scented lotions such as products from Bath and Body Works or Aveda. You can also use essential oils from a health food market (but mix-in/dilute with other products as they can be strong. A little goes a long way.

Introduce soft music or a pleasant (to her) television show, such as Lawrence Welk, as a bedtime “falling asleep” ritual. The end of Lawrence Welk had a “good night” song and dancing that my mom found very calming. Get complete series on DVDs or download from YouTube.

Relaxation videos or cooking shows may be helpful in calming her. Play “nature sounds,” “relaxation,” “meditation,” or “spa” background music using an Echo Dot or similar “Alexa”-type device.

Make sure her bedroom is warm and comfortable.

When all else fails, sit with her and listen to the conversations. Is she speaking to a deceased relative? Bring in a notebook and ask her questions during the conversations. Take notes. During my experience as a caretaker I did this and later learned that many of the tidbits from these conversations held truth. A relative was pregnant (even, it turned out— before she knew it herself). Another relative was hospitalized (no one in the family knew at that time). The conversations with deceased relatives actually were not ramblings after all, but a bit of a miracle to me, as a confirmation of my faith (that had been waning).
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I know what you mean about them staying up all night. It seems to be part of dementia. Talking in the sleep (I mean conversations) and acting out things they use to do in past – (our case driving log truck, hurdling cattle, etc.). Maybe we didn’t get the light therapy right as well so also gave up that one. Same questions over and over. It also seems part of dementia. Is mom sleeping as one example? Yes, she is resting (mom is deceased and so is his dad, mom, sister, and a brother that he asks about quite often). Is it raining outside? You just asked me a few minutes ago. Roll your transport chair over and look out the window. Over and over and over lol. Other times I will repeat the question he asked me over and over and I got looked at like I’m a nut or he will say stop that.
 
I have tried so many brands of melatonin. Some caused stomach upset and others did nothing. The only brand that is half-decent (at least so far but still at times hit or miss) is Spring Valley Adult Gummy Melatonin. I still have to try and get the timing right. Many other prescriptions caused insomnia so get the help of your doctor to see if your loved one can be taken off any med that you find from research that can cause insomnia and is not absolutely necessary,
 
Dad has gradually gone from 15 prescriptions to a sugar pill morning, half of a 300 mg Full Spectrum CBD Gummy noon, and escitalopram an hour or so before dinner. I'll also add during the night if I happen to wake up and see him tossing a 5 or 10mg melatonin gummy. But I’m still testing because it seems if given late it keeps him awake more than helping with sleep. But so far with this last regimen, one speaking of, (fingers still crossed) no more bad sundowning, agitation, or having those conversations and acting out when should be sleep. He sleeps just enough now that I don’t have to be overly concerned.
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Are you familiar with CBD products? They do not contain THC that gets one 'high' but these natural plant compounds work with the body's own chemistry; some are formulated with relaxing herbs as well to ensure good sleep/relaxation.Check with the doctor so there's no potential risks/interference with current pharmaceutical medications. There are many highly regarded producers of CBD products now; ask around, shop around; and more and more intriguing parts of both the Hemp and Cannabis plants are being discovered all the time with great healing potential. CBD comes in liquid tinctures, even rub-on salves (and some smell heavenly, as with Rose, etc.) Between the brain changes with dementia and stress hormones, the body's chemistry is distorted; CBD could help restore some balance since the body has natural opioid receptors as any doctor will confirm. These are Not opioid drugs (oxycontin, etc.) which are highly addictive and problematic, but plant-derived compounds that the body recognizes, can utilize, and have helped many people.
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My mother is 95 next month with advanced dementia. She too continuously asks about the deceased relatives (she's the last living sibling out of 8) and insists they've 'abandoned her'. She never sleeps through the night; nothing helps. In fact, all medications make her much WORSE. Melatonin, which everyone swears by, can, in fact, CAUSE nightmares and night terrors in people who are sensitive to it. My mother is sensitive to EVERYTHING and all medications make her dementia much worse. The wellbutrin doesn't seem to bother her, but she's taken it since 2011.

Nowadays she's confabulating wild stories about the Memory Care staff taking her out to different restaurants for dinner and then to a show afterward. Then they drive her home in a different car, and all sorts of other complicated scenarios that she feels are 'scams'. She's now 'losing little little baby teeth' at least once a week, so as you can see, the delusions and delirium is ramping up quite a bit all of a sudden.

No, she doesn't have a UTI either.

She's just been accepted in hospice so I'm curious to see what they'll give her, if anything, to calm her or help these delusions she's having. They're already taking her off of all supplements & vitamins which they feel is contributing to her chronic stomach issues and vomiting.

Her sleeplessness has been an ongoing issue for ages; Ambien was a very bad idea for her and caused her to sleepwalk and break her foot back in 2009. So yeah, sleep issues and dementia go together like peanut butter and jelly. I don't know that there ARE any iron-clad fixes for it either. Some elders get their circadian rhythms mixed up and wind up sleeping during the day & staying awake at night.

I particularly like bevthegreat's suggestion about 'letting her stay up all night' if she doesn't want to sleep. Uh, how about the rest of the household? Bet you'd all like to sleep so you can get up and FUNCTION the next day, huh? Just a hunch. Naturally you should speak to mom's MD about ideas for better sleep, but throwing more meds at VD can be a tricky thing, I know.

Wishing you the best of luck.
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Does she nap a lot during the day? Sleep late? Even as I ask, I am wondering if the dementia is too far advanced for these things to even matter?

While she's up all night talking, I'm guessing that she's keeping you up all night too. This is not good for YOU. And you need to be your first priority. You need good sleep, every night. I would hire someone (with mom's money) to sit with her at least a few nights a week so you can be off duty and sleep. Put on a sound machine, let the helper help and sleep!
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I see others mentioned brands of melatonin -- so I'll add that I use SwansonVitamins.com - dual-release 3 mg.
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Daizy,

I'm experiencing the same thing with my mother. She's on 4 prescribed meds, including a "sleeping pill". It's very rare that she sleeps through the night. She does full conversations with all / different voices, and often she yells and screams. (I call it "dinner theater" in my head.).

Fortunately, this doesn't happen every night, but it happens most nights. It's very disruptive, as you know. And it's the same thing - a combination of deceased relatives, invisible people that no one else has ever heard of, miscellaneous babbling. Actually, it was worse a few months ago, because she was cursing, too. At least that has stopped. I think that the improvement came when we made sure that she got ALL doses of her meds, even if that meant waking her up to take them. It's still nowhere close to perfect.

I wish I could tell you something helpful.

I just want you to know that you're not alone.
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Your mother needs help from a psychiatrist that specializes in dementia. They take a bit to find, but can medically help. Not sure anyone in a chat group is qualified to gelp your mother at her stage of illness.

If medication she is taking is not working, it should be changed. Rarely is a General Practioner going to have the specialized knowledge to help her.
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