Soliciting advice: Meals schedule

kkl1943

Hi everybody! I have gained a lot by reading your discussions for a few months (thanks!) but this is my first post. My question is: how important is it to keep a fixed schedule of meals for a PWD? I understand the answer may be very personal, so this is our background info.

My DW was diagnosed with dementia ("probably AD" as her doctor states) about 20 months ago (by my layman's estimates, she is somewhere between stages 5 and 6 now), but in hindsight, the first significant symptoms could have been noticed about 5 years ago. One of them was overeating: before I noticed the problem, she put on some 20 lbs in less than 24 months. After I had stopped going out for work and took over our meals about 3 years ago, we were able to shed all these extra pounds just by staying away from continuous snacks. For the last 12 months, her weight is reasonably stable, so I am pretty sure I do not keep her hungry.

However, recently she started to go to bed and get out of bed earlier and earlier, and as soon as she is up, she asks for breakfast. So far I have managed to convince her waiting until our usual 6 am, but this convincing becomes harder and harder, creating additional mental stress for her and myself.

My major concerns about complying with her requests are two-fold. First, I am afraid that this would return us to her overeating problem with all possible health consequences. Second, having a free meals (and hence bedtime) schedule would turn our (already pretty nightmarish) everyday life into a full round-the-clock nightmare.

Any advice would be highly appreciated.

M1

Welcome kk, glad you posted.  First thing that comes to mind--I wonder if the underlying problem is sleep fragmentation (the getting up earlier and earlier).  Have you discussed this with her docs?  Medication that helps her sleep through the night might help both of you and solve the meal schedule problem, at least as far as breakfast is concerned.  Seroquel worked really well for my partner when she started to not be able to sleep through the night.  But there are lots of choices--trazodone, mirtazepine are others that are commonly used.  Worth a discussion or a phone call at least.

kkl1943

Dear M1, thanks a lot for your advice! My DW is already on seroquel (it helps a lot) but so far I am giving her only a half a dose recommended by her neuropsychologist. (Did not want to sedate her without need.) Maybe I will just go to the full recommended dose now. Thanks again!

Rick4407

Hello KKl1943.  My DW has been on Seroquel for about 4 years now.  We started and 12.5 mg (1/2 of the smallest pill) and slowly worked up to where she is now.   Fifty mg late afternoon and another 50 mg an hour before bed.  

Seroquel was started for delusions but now I think the sedative effect is the real benefit.   She goes to bed about 7:30 and sleeps until about 4-4:30  when she gets up.  At that point I feed her breakfast and then she immediately goes back to bed until 8 or so.  The schedule seems to work well for her,  Lunch at 11 and dinner at 4:30.  She very occasionally will nap during the day, maybe 30 minutes.  I pretty much keep her schedule though I stay up until 10 -11 at night to get some time alone.   

If she wants a snack during the day I give her sugar free Jello or a banana.  The sedative effect of the Seroquel allows me to adjust as needed though she seems to consistently need / want at least 12 hours of sleep.  Rick

M1

KK, that's exactly what I would do, go on up to the full dose and give at bedtime, see what happens.  There's a wide dose range on Seroquel.  You can easily increase by 12.5-25 mg increments, and if needed add more than one dose a day--some dose as often as three or four times a day.  Of course I would do this with input from her doc, but don't be afraid of it, it may help a lot.

kkl1943

Dear Rick, thank you very much! (And M1, thanks again for your new input!) My DF's seroquel prescription was 25 mg twice a day. Again, so far I was giving her just one of these pills at bedtime. After your input, I will probably double the dose and see what would happen.