Which medication can help manage my dad’s sleep issue at 86?

Question

Hi doctor,

This query is for my father, who is 86 years old. He is currently bedridden and suffering from the following conditions:

Parkinsonism.
Primary hyperparathyroidism.
Chronic kidney disease.
Hypertension.
Rheumatoid arthritis

He takes the following medications daily, with chemical compositions within brackets:

Stamlo 5 mg (Amlodipine besilate 5 mg).
Ivabradine 5 mg.
Syndopa Plus 125 (Levodopa and Carbidopa).
PTH 30 mg (Cinacalcet).
Silodol 8 mg (Silodosin).
Rantac 150 mg (Ranitidine).

He usually does not sleep through the night or cooperate with his caregivers. Given that he takes medicines for heart conditions, kidney conditions, and hypertension, along with other conditions listed above, I wanted to ask if one or all of the following sleeping aids would be appropriate for him.

Massage a magnesium lotion on his foot and lower legs before bedtime.
Taking Melatonin 5 mg.
Can any low dosage of sleeping prescription medicine be given to him without causing any harm with his current medications? If so, which medicine?

Kindly help.

Answer 1

Hi,

Welcome to icliniq.com.

I understand your concern.

I hope his medical conditions listed above are under control with the listed medications he is taking. Lack of sleep and not cooperating with caregivers is very common in old age, too, with Parkinson's. Waxing and waning of symptoms despite medicines are hallmarks of this condition.

He lacks sleep, as he is bedridden and remains in one place all the time; his mental and physical orientation to day and night (which is called circadian rhythm in medical terms) is disturbed. This is further worsened by his multiple other medical conditions.

Some medications may help, but need evaluation in person for consideration for prescription.

I hope this information will help you.

Thank you.

Answer 2

Hi,

Welcome back to icliniq.com.

I understand your concern.

To start with, please go ahead with magnesium lotion rather than Melatonin. Although low-dose Melatonin is alright, you may defer it to see how he responds to each medicine and for any possible side effects.

His current medication has minor interactions with Melatonin, but you may see a little more waxing or waning of symptoms when it is given with Syndopa (Levodopa and Carbidopa) in a few patients.

I hope this information will help you.

Please feel free to reach out in case of further queries.

Thank you.