SLEEP AND SLEEPLESSNESS
Some people have difficulty sleeping. A change in one's sleep pattern, much more of it or much less of it, is a classic sign of depression. Little sleep and a very high activity level while awake could be a sign of mania. If you see this, report it to the appropriate health care professional so a complete evaluation can be made.
Due to daytime fatigue in advanced HD, some folks accidentally fall into a cycle of napping during the day and then being unable to fall asleep at night. You can usually find the right balance between conserving energy during the day and being tired enough to sleep through the night. Try to help them maintain their "rhythm of life".
Certain people with HD persistently scream for reasons that are not readily apparent to their caregivers. Since they're unable to simply say why they're screaming, it's a challenge to their caregivers to figure it out. it could be a need that's been overlooked and gone unmet.
They could be in pain or panic; hallu-cinating or heartbroken. They might be frightened, anxious, grieving or hurt and have just one way to express all these different feelings... screaming! In the most advanced stages of HD, it may be related to medication or the cramps that come with the changes in their muscle tone.
Try to figure out exactly what triggers the screaming. This will mean systematically trying one approach after the other, asking other caregivers and the family for ideas of what may be causing it.
Some folks may also make frequent unusual sounds as they encounter problems coordinating their breathing: gasping, sniffing, grunting, slurping sounds, etc. Since these sounds are not under their control, caregivers should graciously tolerate them.
EXCESSIVE SWEATING, TEMPERATURE, AND THIRST
People with HD may be more comfortable in surroundings that are cooler than typical, perhaps as low as 18° Celsius. This may be related to some aspect of the disease that affects metabolism. They may also have episodes of excessive sweating. In some cases this may be related to certain medications.
Others may have a compelling thirst. Those who drink an excessive amount of liquid per day should consult their physician regarding potential problems with electrolyte imbalance and kidney function.
FREQUENT URINATION AND CONSTIPATION
He will have more and more difficulty thoroughly emptying his bladder, as his muscles become progressively uncoordinated. Increased thirst may lead to increased fluid consumption. This often causes him to sense the need to urinate more often than usual.
Problems controlling impulses, coupled with the increased urges to urinate, often lead to him demanding to go to the bathroom over and over, often after just having urinted. Do not remind him that he just went to the bathroom. Do not ask him to wait. He may have an accident or only be further antagonized.
Constipation is a common problem in the more advanced stages of HD. Filling up on high-calorie low-fibre foods to keep weight on, the loss of some fibre in altered texture diets, and an increasingly sedentary lifestyle can all add to the problem.
After a thorough assessment, constipation is often treated with increased fluids, more frequent position changes, and a regimen of stool softeners.