Do you have ADHD and want to know how to get a better night’s sleep? If so, you are not alone. Many people with ADHD have sleep problems or sleep disorders related to ADHD; indeed, those with ADHD are more likely than people in the general population to have sleep issues. (CHADD, 2015).

The Connection between ADHD and Sleep Problems

The relationship between ADHD and sleep problems in adults is complex. Sleep problems are often a symptom of adult ADHD. Another possibility is that sleep problems exist on their own but ADHD makes them worse. Conversely, sleep problems may make the existing ADHD worse.

Researchers aren’t completely sure of the precise relationship between ADHD and sleep, but they are certain beyond doubt that one exists. If you have difficulty sleeping, you don’t need research to tell you what you already know. If you have ADHD and can’t sleep, try the tips below for getting a good night’s sleep.

Tips for Getting a Better Night’s Sleep with ADHD

From the National Sleep Foundation, the Harvard Medical School’s Division of Sleep Medicine, and other ADHD and sleep experts come tips for ADHD and getting to sleep and staying asleep. Start with just one or two, and add more as necessary.

• Establish a regular schedule where you go to bed at the same time each night and wake up at the same time each morning, every day of the week.
• Avoid all sources of anxiety-inducing caffeine starting in the late afternoon through the night.
• Use your bed and bedroom for sleeping only (for example, don’t work in your bedroom or do hobby activities during the day).
• Avoid watching TV, playing video games, using phones, or doing any other screen activities at least 30 minutes before bed (the more time between these activities and bedtime, the better).
• Create a bedroom environment conducive to sleep: make it dark, cool, quiet (with white noise like a fan if you prefer), and comfortable. Remove the TV and video games.
• Exercise during the day, but not beyond three hours before bedtime, as endorphins will prevent sleep.
• Don’t eat anything other than a light, healthy snack before bed.
• Create a routine that you do every night. Have wind-down, calming activities that you do and a regular pattern of preparing yourself for bed. Doing this nightly will help you relax, and your brain will come to associate the routine with sleep.
• Keep pets where you want them: out of the bedroom if they disturb you, in the room if they help you sleep better.
• If you can’t fall asleep or you wake up in the night, avoid tossing and turning. If you can’t sleep after approximately 20 minutes, get up, leave the bedroom, and do something calming. Return to bed. Repeat as necessary.
• Decrease stress. If you are dealing with a stressful situation, write it down and put it away until morning. Allowing yourself to have a break from it while knowing you won’t forget about it will help you sleep.
• Stay away from social media. So much is negative or increases negativity within. Ruminating over things you see online can keep you up.
• Play a game with a reward. Challenge yourself to be in bed by a certain time (with ADHD, it’s easy to get off track and end up getting into bed an hour or more after you wanted to). When you do, reward yourself and let yourself listen to music or read a book in bed for 30 minutes.
• Create a structure to help you stay on track. Make and write down your routine. Use gentle alarms to let you know it’s time to get off the computer, turn off the TV, etc. Some adult ADHD apps or alarms help you move through the steps of your routine without losing track of the time (How to Manage Your Time and Stay on Schedule with Adult ADHD).
• Help your circadian rhythm regulate by getting a lot of light first thing in the morning and by dimming your lights in the evening. Some people find success with using a lightbox for approximately 30 minutes every day, preferably in the morning.

A note about ADHD and sleep medication. Medications affect everyone differently, plus they interact with other medications. Sleep medication, prescription or over-the-counter, isn’t always safe or effective for people with ADHD. If you are wondering about sleep medication for ADHD, a visit with your doctor will help you know your options.

The tips on the above list will help you improve the amount and quality of sleep you get, despite the sleeping challenges caused by ADHD. Soon you’ll be sleeping well at night so you can function well the next day.

Being quiet and listening are the keys to helping a suicidal friend or loved one.

If someone is feeling depressed or suicidal, our first response is to try to help. We offer advice, share our own experiences, try to find solutions.

We'd do better to be quiet and listen. People who feel suicidal don't want answers or solutions. They want a safe place to express their fears and anxieties, to be themselves.

Listening - really listening - is not easy. We must control the urge to say something - to make a comment, add to a story or offer advice. We need to listen not just to the facts that the person is telling us, but to the feelings that lie behind them. We need to understand things from their perspective, not ours.

Here are some points to remember if you are helping a person who feels suicidal:

What do people who feel suicidal want?

• Someone to listen - Someone who will take time to really listen to them. Someone who won't judge, or give advice or opinions, but will give their undivided attention.
• Someone to trust - Someone who will respect them and won't try to take charge. Someone who will treat everything in complete confidence.
• Someone to care - Someone who will make themselves available, put the person at ease and speak calmly. Someone who will reassure, accept and believe. Someone who will say, "I care."

What do people who feel suicidal not want?

• To be alone - Rejection can make the problem seem ten times worse. Having someone to turn to makes all the difference. Just listen.
• To be advised - Lectures don't help. Nor does a suggestion to "cheer up," or an easy assurance that "everything will be okay." Don't analyze, compare, categorize or criticize. Just listen.
• To be interrogated - Don't change the subject, don't pity or patronize. Talking about feelings is difficult. People who feel suicidal don't want to be rushed or put on the defensive. Just listen.

Ignorance appears to be one reason for stigmatizing people with AIDS.

One in five Americans has an unfavorable attitude toward people living with HIV infection, according to a large-scale survey published in the Dec. 1 issue of the CDC's Morbidity and Mortality Weekly Report.

"It is important to understand that stigma surrounding HIV infection still exists -- it has not gone away, and it is something we need to continue to address," says CDC deputy AIDS chief Ronald O. Valdiserri, MD, MPH.. "We may be three decades into the epidemic, but we are still at a level of stigma that is unacceptably high."

The survey enlisted almost 7,500 adults from all parts of the country. In return for agreeing to participate in weekly surveys, they received Internet access via television. Of the more than 5,600 people who responded to the HIV stigma question, nearly 20% agreed with the statement, "People who get AIDS through sex or drug use have gotten what they deserve."

"That is a fifth of the population -- if 20% of people still think that, our battle against irrational hatred is not yet won," says Mindy Fullilove, MD. A professor of clinical psychiatry and public health at Columbia University, Fullilove has long worked on the problem of HIV transmission in high-risk communities.

This stigmatizing attitude was most frequently expressed by men, whites, people age 55 and older, people with no more than a high school education, people with an income of less than $30,000, and those in poor health. Blacks were far less likely to hold this attitude than other racial groups.

Ignorance appears to be one reason for stigmatizing people with AIDS. People who did not know that HIV cannot be transmitted by a sneeze or cough were twice as likely to stigmatize AIDS patients as those who did know. An appallingly high proportion of those surveyed -- more than 41% -- think a person could catch AIDS from a sneeze. This is only a little better than in China, where 49% of people believe this fallacy, according to a Peoples University of China survey reported by Reuters.

University of California at Davis psychology professor Gregory Herek, PhD, has conducted nationwide surveys of AIDS attitudes and knowledge for more than 10 years. "Notions that HIV can be spread by casual contact are closely linked to stigma," according to Herek. "To the extent people can be put into categories, people whose misinformation is based on distrust of what the government says tend not to be angry or disgusted with AIDS patients, but just worried that they themselves might get infected. For another group there is a condemnation of gay men and intravenous drug users that leads to punitive attitudes -- those are the ones who say it is their own fault. It's not a clear and simple thing."

"It is a human response to react negatively to what we can't understand and can't relate to," Valdiserri says. "We need to deal with that -- not only because it is the right thing to do, but because this has a significant impact on public health. If people are afraid to even admit they are at risk, then how can prevention work? Society has a real stake in addressing these issues."

The CDC already is planning to act. "We are conducting research to understand these attitudes, and we continue to work with faith communities -- which we feel are very important as stigma often has a moral or judgmental aspect," Valdiserri says. "The CDC also is working with White House Office of AIDS Policy to begin an advertising campaign to reduce stigma. It is scheduled to begin next spring. Also beginning next spring we will start up a training program of local HIV service providers. We have to teach the kinds of practical steps health providers can take to reduce stigma around HIV and AIDS."

CDC figures show that a third of the 4-5 million Americans with HIV infection do not know that they carry the AIDS virus. All of the experts contacted for this article stressed that AIDS stigma makes it hard for people to admit they are at risk of infection -- and keeps them from seeking the HIV testing, counseling, and treatment that can save their lives and keep them from spreading the disease.

"As long as we have a politics that says we respond to an epidemic only when we like the people who are sick, we have a grave threat to public health," Fullilove says. "It is disastrous health politics. Because the AIDS epidemic has been perceived as an epidemic of undesirables, it has been hard to get the kind of funding for education and treatment from the beginning. This has made it hard to teach people how to manage their lives in a new era of sexual behavior."

Read: AIDS phobia: Do you know someone who has it?

next: AIDS Phobia

Not only do Alzheimer's patients wander but they also easily become lost. It's a serious and troubling symptom of Alzheimer's disease.

Many people with Alzheimer's walk around or leave their homes. This can be worrying for their caregiver, and can, at times, put the person in danger. But it is important to find a solution that preserves the person's independence and dignity.

If the person with Alzheimer's starts 'wandering', the first step is to look at the reasons behind their behavior. Alzheimer's patients usually wander because they're disoriented, anxious, restless or stressed. Once you identify what the person is trying to achieve, you can start to find other ways to meet their needs, reducing their desire to walk alone.

It can be very troubling for a caregiver when the person they are caring for starts to walk about in an apparently aimless way. A person with Alzheimer's might get up and leave the house in the middle of the night. Or they might knock on the neighbors' doors at inconvenient times of the day. Occasionally, people get lost and are discovered, confused, miles from home. This can make the caregiver feel very anxious and concerned for the person's safety.

Some caregivers find it reassuring to know that this type of behavior does not last - it seems to be a phase of the condition that people go through. In addition, most people with Alzheimer's retain their road sense and are rarely involved in traffic accidents.

What can you do?

The first thing to consider is why the person might be doing this, so that you can find ways to deal with the situation. Think about why people generally choose to go for a walk:

• Walking helps us to keep fit and to sleep better at night.
• It is a good way to relieve tension and stop us feeling 'cooped up' inside the house.
• It can be an enjoyable way to see what is going on in the outside world.

For many people, whether they have Alzheimer's or not, walking is a lifelong habit. A person with Alzheimer's who has always walked a lot for the above reasons may find it very difficult to remain in one place for long periods of time.

The Mayo Clinic also suggests other reasons for wandering:

Too much stimulation, such as multiple conversations in the background or even the noise in the kitchen, can trigger wandering. Because brain processes slow down as a result of Alzheimer's disease, the person may become overwhelmed by all the sounds and start pacing or trying to get away.

Wandering also may be related to:

• Medication side effects
• Memory loss and disorientation
• Attempts to express emotions, such as fear, isolation, loneliness or loss
• Curiosity
• Restlessness or boredom
• Stimuli that trigger memories or routines, such as the sight of coats and boots next to a door, a signal that it's time to go outdoors
• Being in a new situation or environment

Retaining independence

It is very important that people with Alzheimer's are encouraged to remain independent for as long as possible. Some degree of risk is inevitable whatever choices you make as a caregiver. You need to decide what level of risk is acceptable in order to maintain the person's quality of life and protect their independence and dignity.

The steps you take to safeguard the person will depend on how well they are able to cope, and the possible reasons for their behavior. You will also need to take the safety of the person's environment into account. There is no such thing as a risk-free environment, but some places are safer than others. If you live on a busy main road with fast-moving traffic, or in an urban area where you don't know your neighbors, you might need to take a different approach to someone living in a peaceful rural area where the person is well known within the local community.

Feeling lost

If the person has recently moved home, or if they are going to a new day center or having residential respite care, they may feel uncertain about their new environment. They may need extra help in finding their way about. They may also be more confused about the geography of their own home when they return.

This disorientation might disappear once they become familiar with their new surroundings. However, as the Alzheimer's progresses, the person may fail to recognize familiar surroundings, and they may even feel that their own home is a strange place.

Memory loss

Short term memory loss can lead a person with Alzheimer's to go walking and become confused. They might embark on a journey for a specific purpose, with a particular goal in mind, and then forget where they were going and find themselves lost. This can be particularly distressing.

Alternatively, they may forget that you have told them that you are going out, and set out to look for you. This may lead to extreme anxiety, and they will need plenty of reassurance. In the earlier stages, it can help to write notes reminding the person where you have gone and when you will be back. Fasten these securely in a place where the person will see them, such as near the kettle or on the inside of the front door.

Sources:

• U.S. Office on Aging - Alzheimer's brochure, 2007.
• Alzheimer's Association: Steps to Understanding Challenging Behaviors: Responding to Persons with Alzheimer's Disease, (2005).
• Alzheimer's Society - UK, Carers' advice sheet 501, Nov. 2005

Suggestions for Alzheimer's caregivers in dealing with aggressive or agitated behaviors.

If you can find out what may be upsetting the person with Alzheimer's you may be able to reassure them or you may be able to find ways of making situations less distressing. Try to obtain advice from other caregivers or from professionals. If appropriate:

• Reduce demands on the person if they do not seem to be coping, and ensure that there is an unrushed and stress-free routine.
• Explain things, wherever possible, calmly and in simple sentences, allowing more time for the person to respond than they would formerly have needed.
• Find tactful ways to offer help without seeming to take over. Guide or prompt the person and break down tasks into easily-manageable steps so that they can do as much as possible for themselves.
• Try not to criticize. Hide any irritation that you feel. Avoid situations where the person is set up to fail. Praise any achievements and focus on the things which the person can still do rather than on those which are no longer possible.

In addition:

• Watch out for warning signs such as anxious or agitated behavior or restlessness and offer more reassurance, if appropriate.
• Avoid sharp voices and sudden movement. Too much noise or too many people may add to their confusion.
• Avoid confrontation. Try to distract the person's attention if they seem upset. You might find that it helps if you leave the room for a few moments.
• Find activities to stimulate the person's interest . Make sure that they take enough exercise.
• Make sure that the person has regular health checks and consult the GP immediately if they seem to be ill or in discomfort.

Prevention is the best solution for aggressive behavior but it will not always work. If this type of behavior occurs, don't blame yourself. Concentrate instead on handling it as calmly and effectively as possible.

At the time:

• Try to stay calm and do not enter an argument however upset you feel. A heated response will probably make the situation worse.
• Take a deep breath and count to ten before you react. Reassure the person and try to distract their attention. Leave the room if necessary.
• Try not to show any anxiety as this may increase the person's agitation. Of course, this is easy to say and much harder to do if you feel threatened. You might be able to plan some strategies in advance which you could use in such situations.
• If the person is physically violent, give them plenty of space. Closing in on them or trying to restrain them, unless absolutely necessary, can make matters worse. You may need to leave them until you have both calmed down. You may have to call for help.

Afterwards:

• Do not try to punish the person by, for example, withdrawing a treat or ignoring them. They are not able to learn from experience and will probably forget the incident very quickly. However, they may feel a general sense of unease for some time. Try to behave as normally and reassuringly as possible.
• If aggressive incidents are frequent or worrying discuss them with a professional such as an old-age psychiatrist or a community psychiatric nurse. They may be able to offer support and suggest other ways of handling the situation.
• Generally, it is best to avoid treating aggressive behavior with drugs. These can suppress behavior without addressing its cause and may also add to confusion. However, if it seems impossible to avoid using such drugs, the doctor will want to prescribe the minimum dose and to review the treatment very regularly.

Your own feelings

It is important to remember that, although much of the aggression may be directed at you, it is not personal. It is simply because you are the person who is there. However, any such incident will probably leaving you quite shaky. For some people it is helpful to have a chat or share a cup of tea with a friend, relative or neighbor. Others will like to spend time quietly alone.

Don't feel guilty if you do lose your temper. You are under great stress. But do discuss things with a professional or another caregiver who may be able to suggest ways of handling such situations more calmly.

Don't bottle up your feelings or resentments. Talking things over with a friend, a professional or within a caregivers group may help.

Sources:

Special Care Problems: Aggressive and Violent Behavior, by Kenneth Hepburn, PhD. Department of Veterans Affairs Medical Center, Minneapolis, Minn.

Alzheimer's Society - UK

Detailed information on Alzheimer's and aggressive behaviors including triggers for aggression and reasons for aggressive behavior.

Sometimes Alzheimer's or dementia patients seem to behave in an aggressive way. They may be verbally abusive or threatening, for example, or kick or pinch, or they may lash out violently at people or property. If such behavior occurs, you will probably feel distressed and anxious about the best way to cope.

Here are some possible explanations for the aggressive behavior:

• A person with Alzheimer's disease or dementia may react in what appears to be an aggressive manner if they feel frightened or humiliated, or frustrated because they are unable to understand others or make themselves understood.
• Someone may also become aggressive if their judgment and self-control have been eroded by dementia. They may be no longer be restrained by inhibitions learned in early childhood and forget how to behave appropriately.
• Aggressive behavior sometimes seems to take the form of an over-reaction. The person may shout or scream or become very agitated as a result of what appears to be a very minor setback or criticism.
• Any form of aggression is upsetting but it is important to remember that the person is not being aggressive deliberately. They will probably forget the incident very quickly, although the emotion which caused them to behave in that way may persist. You may take longer to forget the incident than they do.

Triggers for aggression and dementia in Alzheimer's patients

If you look carefully at the situations in which the person with Alzheimer's becomes aggressive and the events that lead up to the outburst, you may be able to identify the trigger and gain some understanding of what might be troubling them. Of course, it is not possible to analyze such a situation until it is over. But, once the heat of the moment has passed, you may be able to think about what happened and why.

If there seems to be no pattern to the behavior and it is becoming very difficult to manage, seek professional advice.

Possible reasons for a person with Alzheimer's or dementia behaving aggressively include situations in which they:

• Feel frustrated, under pressure or humiliated because they are no longer able to cope with the everyday demands of life. It takes longer for a person with dementia to process information and respond to a situation - in words or in actions. It is therefore common for them to feel pressured.
• Feel their independence and privacy are threatened because they are forced to accept help with intimate functions such as washing, dressing or going to the toilet. These are areas of life which have been private since childhood. It is not surprising that these situations become particularly stressful.
• Feel they are being judged or criticized because they have forgotten something or made a mistake in completing an everyday task.
• Feel bewildered or frightened because there is too much noise or too many people around them or there has been a change in a familiar routine. All these things can be hard for a person with dementia to manage.

The person may also react aggressively in situations where they:

• Feel anxious or threatened because they are no longer able to recognize certain places or people. They may be convinced that they are in the wrong place or that a relative is a stranger who must have broken into their home.
• Feel frightened because of a sudden noise, sharp voices, abrupt movements or a person approaching them without warning from behind.
• Feel discomfort, pain, boredom or thirst.

Sources:

Brian Willie, Caring For An Aggressive Alzheimer's Patient, Jan. 24, 2008

Alzheimer's Society - UK

Separation anxiety in relationships is an excessive experience of fear and worry, a collection of emotions, thoughts, and behaviors that can be crushing when two people must be apart. It can begin even before the person who is going away departs. Anticipating being apart can cause distress for both partners. During the separation, anxiety can spike as one or both partners develop heightened worries. Separation anxiety in long-distance relationships, whether the time apart is for days, weeks, or months, can contribute to unhealthy emotions, thoughts, and behaviors.

Separation Anxiety in Long-Distance Relationships: What It’s Like?

How does anxiety affect relationships? Long-distance relationships and separation anxiety can affect someone’s whole being. People can respond with negative emotions to the separation. Depending on their level of anxiety as well as their outlook about the separation, people respond in different ways. Some experience only a few of the following reactions—and those only mildly—while others deal with many of them and more and do so intensely.

One or both partners can react negatively to the parting. Anxiety in long-distance relationships contributes to

• Despair
• Depression
• Detachment for self-protection
• Loneliness
• Anger
• Acting out (protests, irritability, crying spells)
• Guilt
• Jealousy
• Mind-reading (assuming the worst about what the other person is thinking and doing)
• Over-attachment, clinginess through excessive texts, calls, and social media behavior

Separation anxiety can cause physical symptoms, too. It can be felt in any part of the body. Headaches, digestive troubles, respiratory problems, aches and pains, and fatigue can make people miserable. This physical manifestation of anxiety makes being apart all the more difficult to experience.

These effects of anxiety and long-distance relationships don’t have to bother you for the duration of your separation. You can keep the time you’re apart from negatively impacting your relationship.

Managing Separation Anxiety in Long-Distance Relationships

Working both together and independently, you can reduce separation anxiety and the hold it has on your relationship.

Perspective is important. Viewing this time as a challenge you both can handle helps you work on positive ways to get through it. You will still miss each other and even feel some separation anxiety from time to time, but that anxiety won’t control you or dominate your relationship.

Rather than forming unhealthy attachments and dependence, dealing with the separation and creating healthy, positive ways to navigate through it will decrease separation anxiety and bring you closer to each other despite the distance.

Try these tips for healthy ways to cope with your long-distance relationship separation anxiety:

• Plan ahead. Before you or your partner leaves, create a plan with times for talking and video chatting. Also plan things you can do “together,” like taking walks at the same time and sending pictures of what you see.
• Tune in to your emotions. Be aware of negative emotions like anger, loneliness, sadness, and guilt. When you catch them before they grow out of control, you can use coping skills to manage them.
• Recognize your thoughts and feelings for what they are. They relate to the separation rather than you, your partner, or your relationship.
• Let go of expectations and the way you think things “should” be. Catch yourself thinking this way, and then sit or stroll in mindfulness to return to the real world, not the imagined one.
• Regularly practice relaxation, using your favorite techniques to reduce anxiety.
• Communicate with each other often. Texting and video chatting are great ways of connecting. The phone isn’t always helpful because interpreting tone and words without body language to help can lead to negative assumptions and jumping to conclusions.
• Share your feelings for each other. Also, it’s important to address concerns and misunderstandings. Such conversations are uncomfortable, but in the long run, they decrease anxiety rather than increasing it.
• Keep printed pictures of each other nearby. Texting pictures of yourselves helps maintain the connection, too.
• Share your day with each other. At the end of the day, text or video chat about what you did and share stories of what was good and not-so-good.

Separation anxiety in long-distance relationships can be uncomfortable at best and devastating and debilitating at worst. Even though it impacts both partners in multiple ways, you can manage it and remain close despite the distance.

article references

Explanation of delusions and how to help the person with Alzheimer's suffering from a delusion.

Definition of delusion: Delusions are ideas that are not based on reality, but which are thought to be true by the person with Alzheimer's or dementia. Their content can often be centered on people stealing money or other possessions, or they may have fixed ideas about people intending to harm them.

A person with Alzheimer's may sometimes become rather suspicious. This is usually because of their failing memory. They may accuse someone of stealing from them when something has been mislaid, for example. However, they are often reassured when the object is found.

With some people this suspicion goes much deeper and they may develop distorted ideas about what is actually happening. The person may become convinced that other people want to harm them, for example, and no amount of evidence to the contrary will persuade them otherwise. This kind of belief is called a delusion and can be very distressing both for the person with Alzheimer's and for those who care for them.

Common delusions that people with Alzheimer's have are:

• Their partner is being unfaithful
• Their partner or a close relative has been replaced by an impostor who closely resembles them
• Their home is not their own and they do not recognize it
• Their food is being poisoned
• Their neighbors are spying on them

A person with Alzheimer's has these odd ideas because of the changes that are occurring in their brain. However, sometimes these ideas may be created by hallucinations.

There is little point in arguing with the person as only cause further distress to both of you.

Tips for helping the Alzheimer's patient with delusions

• Try to reassure the person that you are on their side and want to help them.
• Distract them with other activities.
• Ask for advice from your doctor.
• Medication can sometimes be helpful, particularly if the person is becoming aggressive. This type of medication needs to be reviewed regularly. Ask your doctor.

Explaining behavior

It is important to explain any unusual beliefs or behavior to anyone who comes into contact with the person with Alzheimer's. If they understand the situation, they will be more able to reassure or distract the person as appropriate.

Sources:

• Alzheimer's Australia
• Alzheimer's Society - UK - Carer's Advice Sheet 520, Jan. 2000

Caring for an Alzheimer's patient, many Alzheimer's caregivers forget or set aside caring for their own needs.

Looking after yourself

When you're caring for someone with Alzheimer's, it can be all too easy to ignore your own needs and to forget that you matter too. But it's much easier to cope if you look after your own health and wellbeing, and there is lots of support available.

Your emotional wellbeing

Every caregiver needs support and people with whom they can discuss their feelings. You can get different types of support from:

• Friends and family
• Understanding professionals, such as family doctors, counselors and psychologists
• A local support group where you can chat to others who have had similar experiences and who really understand what it's like. (For details of local support groups, contact your local social services department or the Alzheimer's Association.

Time to yourself

Make sure you have some regular time to relax or do something just for you:

• Put aside some time each day for yourself - to have a cup of tea and read the paper, listen to some music, do the crossword or go for a short walk.
• Get out every week or so to meet a friend, have your hair done, pursue an interest or take part in church activities, for example. It is important to do something that you find enjoyable and that keeps you in contact with the outside world.
• Take regular weekends away or short breaks to recharge your batteries.

There are plenty of options to help you meet your own needs without compromising the needs of the person you're caring for.

If the person you are caring for can't be left alone, ask friends or family whether they could pop in for a short time, or whether they could come and stay with the person for a few days. Find out what support services are available in your area, such as home care, day care or respite residential care, and what they cost.

Family and friends

Even though you may be coping well now, caring for a person with Alzheimer's may gradually become more demanding, both physically and emotionally.

• Try to involve other family members right from the start so that the responsibility doesn't all rest with you. Even if they can't offer day-to-day care, they may be able to look after the person while you have a break. Or they might be able to contribute financially to the cost of care.
• Always try to accept help from friends or neighbors when they offer it. If you say you can manage, they may not think to ask again.
• Suggest ways that people can help. Maybe ask them to stay with the person for an hour, or to go for a walk with them, so that you can get on with something else.
• Tell people that you value their support. Remind them what a difference it makes when they pop in for a chat or phone regularly to see how you are.
• Explain to your family and close friends how Alzheimer's can affect a person's behavior. Tell them what life is like for you, and for the person you care for. This will account for apparent contradictions in the behavior of the person, and will help them understand how much you do.

Source:

Booklet SD4 'Caring for someone?' - The Northumberland Care Trust Health Development Service (UK)

Physicians use these guidelines to help patients manage the sexual side effects of antidepressants.

Causes

1. Medication Induced Sexual Dysfunction
2. Tricyclic Antidepressants
3. MAO inhibitors
4. Selective Serotonin Reuptake Inhibitor (SSRI)
   1. Fluoxetine (Prozac) (54% Incidence sexual dysfunction)
   2. (56% Incidence sexual dysfunction)
   3. Paroxetine (Paxil) (65% Incidence sexual dysfunction)

Management Approach

1. Observe for 4 to 6 weeks for adverse effects to subside
2. Adjust current Antidepressant dosing
   1. Decrease Antidepressant dosage
   2. Alter timing of daily dose
   3. Consider 2 day drug holiday
      1. Paroxetine (Paxil)
      2. Not effective for Fluoxetine (Prozac)
3. Consider adjunctive therapy (see below)
4. Substitute another Antidepressant
   1. Minimal to no sexual dysfunction
      1. Bupropion (Wellbutrin)
      2. Mirtazapine (Remeron)
   2. Low risk of sexual dysfunction (10-15%)
      1. Fluvoxamine (Luvox)
      2. Citalopram (Celexa)
      3. Venlafaxine (Effexor)

Management: Adjunctive therapy to improve sexual function

1. Approach to specific sexual dysfunction problems
   1. Orgasm: all of the agents below
   2. Libido: Amantadine, Buspar, Periactin, Yohimbine
   3. Erection: Amantadine, Buspar, Periactin, Yohimbine
2. As Needed dosing
   1. Sildenafil (Viagra) 25-50 mg PO 0.5 to 4 hours before
      1. Numberg (2003) JAMA 289:56-64
   2. Amantadine 100 to 400 mg PO prn 2 days before coitus
   3. Bupropion 75-150 mg PO prn 1 to 2 hours before coitus
   4. Buspar 15-60 mg PO prn 1 to 2 hours before coitus
   5. Periactin 4-12 mg PO prn 1 to 2 hours before coitus
   6. Dexedrine 5-20 mg PO prn 1 to 2 hours before coitus
   7. Yohimbine 5.4-10.8 mg prn 1 to 2 hours before coitus
3. Daily Dosing
   1. Amantadine 75-100 mg PO bid to tid
   2. Bupropion 75 mg PO bid to tid
   3. Buspar 5-15 mg PO bid
   4. Dexedrine 2.5 to 5 mg bid to tid
   5. Pemoline 18.75 mg PO qd
   6. Yohimbine 5.4 mg PO tid

References

1. Montejo-Gonzalez (1997) J Sex Marital Ther 23:176
   http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search&db=PubMed&term=Montejo-Gonzalez [AU] AND 1997 [DP] AND J Sex Marital Ther [TA]
2. Moore (Jan 1999) Hospital Practice, p. 89-96
3. Labbate (1998) J Sex Marital Ther 24:3
   http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search&db=PubMed&term=Labbate [AU] AND 1998 [DP] AND J Sex Marital Ther [TA]

Source:Family Practice Notebook. The author of the Family Practice Notebook, is Scott Moses, MD, a board-certified Family Physician practicing in Lino Lakes, Minnesota.