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Grandfather is not sleeping for a week
78-year-old male, post hip fracture surgery 6 days ago. Since surgery, he is not sleeping properly at all—only 1–2 hours total in last 6 days. And in last 48 hours he didnt sleep even for a minute.
He is confused, having hallucinations, talking irrelevantly, and very restless, especially at night.
He keeps calling people constantly and is not settling. He has history of Stroke and is on
Levera.
He used to take 2*Avil25 tablets daily before surgery to get sleep. But we stopped after surgery as orthopedic dr said it can make his hallucinations worse and instructed us to contact a general physician.
Current medicines include painkillers, calcium, antibiotic, and acidity medicine.
We need safe medication to help him sleep and reduce agitation/hallucinations.
Answers (21)
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First, do serum electrolytes, urea creat, cbc, crp, malaria ict (if at risk)
Rule out dyselectrolytemia, sepsis or any infection.
If all reports are normal it's most likely post hospital delirium which is common at this age.
In that case give melatonin 6 mg at night.
And low dose olanzapine(5mg later 10mg if not improving ) at night bed time .
Give these for atleast 5-7 days.
And most importantly talk with him, reassure, reorient him the time , place. Expose to sunlight, allow a calm environment at night. Allow meeting with family members.
And yes, if the symptoms don't improve , better to do a CT brain to rule out any cerebral cause.
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Need to investigate more about electrolyte profile so that we rule out the metabolic impairment and consult for further diagnosis and management
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Please consult with your Doctor who did the hip surgery. It is only 6 days since he got operated.
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This situation requires urgent medical attention. Please do not attempt to sedate him with over-the-counter sleep aids at home.
Your grandfather is likely experiencing Post-Operative Delirium. This is a common but serious condition in elderly patients following major surgery like a hip fracture repair. It is a state of acute confusion caused by the body's reaction to surgery, anesthesia, pain, or potential electrolyte imbalances.
1. Immediate Steps
In-Person Evaluation: He needs to be seen by a physician immediately. If he is at home, he should be taken back to the hospital or seen by his primary consultant.
Safety First: Since he is restless and has had a recent hip surgery, ensure he is supervised at all times to prevent a fall, which could dislodge the surgical repair.
Orientation: Keep the room well-lit during the day, keep his glasses or hearing aids on (if he uses them), and have a familiar family member talk to him calmly to help "re-orient" him to his surroundings.
2. Why "Sleep Medicine" is Complicated Here
Avil (Pheniramine): Your orthopedic surgeon was correct to stop this. Antihistamines can worsen delirium and hallucinations in the elderly.
Seizure Risk: Since he is on Levetiracetam (Levera), any new sedative must be checked for interactions to ensure his seizure threshold isn't lowered.
Pain Management: Sometimes, delirium is triggered by uncontrolled pain. The doctors need to review if his current painkillers are sufficient or if they are contributing to the confusion (certain high-strength painkillers can cause hallucinations).
3. Necessary Investigations
The medical team will likely need to check:
Urine and Blood Culture: To rule out a hidden infection (like a UTI), which is the #1 cause of delirium in seniors.
Electrolytes: To check for sodium or potassium imbalances.
Oxygen Levels: To ensure his brain is receiving adequate oxygen post-surgery.
Summary Advice:
Delirium is a medical emergency. Please contact his treating physician or a General Physician immediately to discuss starting low-dose, safe antipsychotic medications (like Quetiapine or Haloperidol) specifically used to manage delirium, rather than standard sleep tablets.
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Looks like post surgery delirium confusion, no sleep, hallucinations.
This needs urgent doctor review please do not delay or give sleep medicines on your own.
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Dr. Manisha Mallavarapu
Consult Now
Endocrinology, Metabolism And Diabetes Specialist
7 yrs exp
Rajahmundry
Could be delirium .. plz do consult a GP asap.
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"I am sorry to hear about your grandfather's condition. Based on the symptoms you've described—acute sleep loss, confusion, irrelevant talking, and hallucinations following surgery—he is likely experiencing Post-Operative Delirium. This is a common and serious condition in elderly patients, especially those with a history of stroke. The 'sundowning' effect (worsening at night) is very characteristic. While Avil was being used previously, it should definitely be avoided now as it can further cloud his mental state and increase the risk of falls."
Next Steps
Since he is extremely restless and has a history of stroke, immediate clinical intervention is needed to prevent further complications:
Rule out Infections: Please check if he has any fever or painful urination, as UTIs (Urinary Tract Infections) are a major trigger for delirium in the elderly post-surgery.
Environment: Keep his room well-lit during the day and quiet at night. Use familiar objects and family members' presence to help re-orient him.
Medication Review: His current painkillers and Levepra (Levetiracetam) need to be reviewed by his treating doctor or a geriatrician. Sometimes, low-dose antipsychotics or specific sleep aids (not antihistamines like Avil) are required to manage agitation safely."
Health Tips
Do not attempt to give him any over-the-counter sedatives at home. Given his restlessness and hallucinations, please consult his orthopedic surgeon or a General Physician immediately for an in-person evaluation. They may need to check his electrolyte levels (like Sodium/Potassium) and adjust his medications to help him sleep safely without increasing the risk of another stroke or fall.
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The symptoms described—acute onset of confusion, hallucinations, sleep-wake cycle reversal, and restlessness in a 78-year-old post-hip surgery patient—are classic indicators of Postoperative Delirium (POD). This is a medical emergency in the elderly and requires a systematic approach to identify the underlying "trigger."
1. Immediate Diagnostic Workup
Delirium is often the first sign of an underlying physical issue. I recommend the following:
Rule out Infection: Urinalysis and culture (UTI), and a chest X-ray (pneumonia).
Metabolic Screening: Check electrolytes (specifically Sodium), renal function, and blood glucose levels.
Oxygenation: Check pulse oximetry to rule out hypoxia or silent pulmonary embolism.
Review Levera: Levetiracetam can occasionally cause neuropsychiatric side effects; this should be reviewed by his neurologist or attending physician.
2. Medication Management
Antihistamines (Avil): The surgeon was correct to stop this. Anticholinergic drugs like pheniramine are major triggers for delirium and increase fall risks in the elderly.
Sedation: If the patient is highly agitated or a risk to himself, low-dose atypical antipsychotics (e.g., Quetiapine) are generally preferred over benzodiazepines, which can cause paradoxical agitation in this age group.
3. Non-Pharmacological Interventions
Reorientation: Ensure the patient has his glasses/hearing aids. Use a clock and calendar in the room.
Sleep-Wake Cycle: Keep the room bright and engage him during the day; keep it dark and quiet at night.
Mobility: Encourage supervised sitting or walking as per orthopedic clearance to help "ground" the patient.
Next Steps
Kindly request for consultation if symptoms don't improve
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It may be due to post operative stress, anxiety, pain, senile dementia, electrolytes imbalance, any one or more of these causes.
Please check with a physician offline.
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Consult superspecialist immediately. U can try clonazepam 1.0 mg +quitipine50 one at 9.0 pm
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Consult general physician immediately
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Insomnia
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This looks like acute postoperative confusion, most consistent with Delirium — very common after hip fracture surgery in elderly patients.
On Levera → can sometimes increase irritability/agitation
For elderly delirium, avoid antihistaminics like Avil — they worsen confusion.
For sleep and agitation, low-dose quetiapine 12.5–25 mg at night (or low-dose haloperidol if severe) may be considered under supervision. Non-pharmacological measures like reorientation, day–night cycle maintenance, and hydration are equally important. Urgent in-person review advised."
Next Steps
Because he hasn’t slept for 48 hrs, in-person evaluation today is strongly recommended
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Dr. Chaithra H
General Physician
5 yrs exp
Bangalore
Psychiatrist
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Dr. Gaurav Jaiswal
General Physician
6 yrs exp
Jhansi
Kindly do connect and consult
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Dr. Ravi Kumar Nadella
General Physician
18 yrs exp
Hyderabad
Keep him hydrated
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Dr. Suraj Sharma
General Practitioner
4 yrs exp
Jaipur
Do consult
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Dr. Sasikumar M
General Physician
5 yrs exp
Tirunelveli
The cause for the altered sensorium of your father to be find out and to be treated accordingly, he need In-patient treatment at present.
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Dr. Dipankar Das
General Physician
3 yrs exp
Kolkata
It may be due to stress post operative Or Senile causes for Insomnia .
Melatonin 5 is one without hallucination.
Supplement him with Vit D
Next Steps
Consult any physician
Health Tips
Take care of him n remove any thing which causes stress for him
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Dr. Vetsa Sri Krishna Chaitanya
General Physician
7 yrs exp
Rajahmundry
Need a few more details please consult for further evaluation and treatment
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