Progression or Something Else?

Bentley6

My mom has had dementia since 2016 and currently in a nursing home.  She is dependent on aids to dress, feed, etc.  She was on a low dose of morphine 25mg in the morning and at bedtime for arthritis pain for 3 months.  I noticed that she was more sleepy and last week asked that they stop giving it to her and just give her Tylenol.  For a few days she was very alert and not sleepy.  Then about 4 days later very sleepy again.  I am not sure if she is not sleeping well at night and will ask for them to do a sleep log.  I read that morphine can cause insomnia.

She also seems to talk gibberish when she is tired and pockets food so I asked that they only give her purée.  I also noticed that at times she will zone out and not answer me and then a few minutes later answer me.  Could this be from Morphine withdrawal or something else?

She does have an under active thyroid and takes medicine for it, but 3 months ago when I  asked that they check her levels they were high.  Her thyroid doctor told me that the test results tell him her medicine was not given to her properly.  I immediately contacted the nursing home and they assured me that they will make sure she gets the med in the morning.  We have checked it every 30 days, numbers have been getting better but still a little high.  They are checking again tomorrow. I want to make sure this is not causing her sleepiness.

I am aware this disease does progress and this could very well be a progression, but I need to make sure it’s not something else.  It’s like pulling teeth to get this nursing home to run bloodwork.  All they tell you is that it is the progression of the disease.  I have heard this one too many times and each time before they were wrong and I was right, it was something else causing her symptoms.  

FreakingOut

I can't believe they took her off the morphine cold turkey.  I can't attest to whether or not these are progression symptoms, but do you know how awful withdrawal is?  Yikes!

I know it is common for dementia patients to sleep a LOT, for what that's worth.  Do you have a doctor you could ask about this?

Rescue mom

In general, an over-active thyroid (or med levels that are too high) cause insomnia. Being too low will cause fatigue and “sleepiness.”

One problem with thyroid meds is that so much can interfere with absorption—caffeine especially, and taking with food, along with some other things. Giving the meds at the right time is super-important, it demands individual attention and control, those meds can’t just be handed out with breakfast. 

But if her levels are too high, that usually means she is getting too much thyroid medication, and the dosage should be reduced. And even more complicated, thyroid blood work numbers can be very confusing and counter-intuitive. For example, a “high” test number can mean there’s not enough”thyroid production” going on. In other words, a high number—just the number itself—can mean she is low on thyroid.

But I would not be at all surprised if staff is not giving the meds at the right time and conditions. It’s a hard thing to keep up with.

And as said, stopping that morphine dose suddenly, without weaning her off gradually, is likely to cause all kinds of problems. 

M1

Bentley, thyroid levels can be confusing to understand. If she’s getting too much medicine, the lab called T4 will be too high but the one called TSH will be too low. Conversely, if she’s not getting enough medicine, the TSH will be too high and the T4 too low. So be sure which is which…however, lots of older folks can run a slightly high TSH when their levels are really okay.

Morphine typically causes sleepiness if anything-hence the term narcotic. I would also be careful about withdrawal if she’s been on it a while. It may be actually one of the safer ways to treat endstage arthritis. 

Is she eligible for a hospice evaluation? 

Bentley6

Thank you for the responses.  I was a little confused when they told me they could stop giving mom the morphine cold turkey because the 25mg dose 2 x a day was a low dose.  I had to fight to get them to run blood work, finally they will do a CBC, thyroid test and potassium level.