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Thread: Night time care

  1. #1
    Senior Member
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    Night time care

    So, we've been lucky for a long time. For several years in fact. Husband has always slept flat on his back all night. He isn't able to move on his own, but was always fine. Sometimes he'd wake me to raise or lower the bed or move a pillow.

    But at the beginning of Sept. he developed a Stage 2 pressure sore. And thus began the every two hours rolling all night long. And a serious reduction in time in his chair. The sore has healed. We have (again, cause he got rid of the first one a while ago) an alternating pressure air mattress overlay. He thinks that means we don't have to roll him all night long anymore.

    We are limiting his chair time, though honestly from where the sore is, we are sure its from the bed and not the chair.

    He didn't "qualify" for the fancy bed that rolls you on its own.

    Am I right? We still need to continue to re-position him during the night every two hours? How do people manage this?
    Rebecca
    Wife and Caregiver, husband has Secondary Progressive MS, wheelchair bound, unable to work, MS still progressing.
    Mother of 2 active boys!

  2. #2
    You will probably hear lots of ultraconservative responses on here but my experience is as follows. I develop my first pressure sore on my coccyx (from J active cushion) over a decade ago, granted it was only mild but ever since then I have been on an alternating overlay, lying flat all night without problems. When I say laying flat I mean on my back as I have an electric bed to raise the head and legs. Needless to say I haven't had any follow-up issues but it would always be prudent to check the skin of a morning. Make a judgement upon his skin condition and hopefully enjoy a full nights sleep. That's my $.02 worth.

    Cheers

  3. #3
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    i'm the wife of a c4/c5 and have been doing the 2-hour nightly roll for 15 years. we've never had a pressure ulcer.

    most of the time, i'm not fully awake when i do the turns. i assume this was the only way my body could cope with the interrupted sleep pattern. it's not easy. yes, i'm tired a lot and some days i'm exhausted. i've had to come home from work because i was so tired. the interrupted sleep pattern is beginning to take its toll on me as i've gotten older.

    i'll be interested in seeing what other responses you get to your post.

    fyi: i've done some research about the lal & pressure reducing mattresses and found a clinical study from 2005 which indicated that rolling once every 4 hours on one of these mattresses is equivalent to the 2 hour rolls on a standard mattress.
    Last edited by chris45; 10-02-2012 at 06:50 AM. Reason: add additional information

  4. #4
    Alternating pressure pads are not particularly effective. In fact the moisture buildup by the plastic surfaces can contribute to pressure sore development. Low air loss mattresses are a better choice. For more than a year I have been sleeping on one side on a lal mattress without a problem. That said, I am also a C-7 quad and do shift my position a couple of time during the night if I wake up.

    I assume the sore was in the tailbone area, which is a common place for bed-caused wounds. However, sores may also start from sheet burns caused by sliding. I have also seen sores develop in that area from sitting if the tailbone gets pressure from pressing against the seatback. They can then be aggravated by tight pants. Those are things you should check out.

    I think you could go longer between position changes with a lal mattress. I would increase the time gradually with close monitoring.
    You will find a guide to preserving shoulder function @
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    http://cccforum55.freehostia.com/

  5. #5
    This is also an issue I worry about.

    When my father left the hospital, his doctor basically said turning was the most important thing..... more important then the bed/overlay, as none of us could afford the best bed options anyway. What they recommended was starting with turns every 2 hours, and that over time, his skin might build up more tolerance for more time before turns. We quickly moved to turning every 3 hours to every 4 hours. We would check his skin before the turn to see how red, and as long as the redness faded within 15 minutes or so, then that was a "safe" amount of time.

    We moved to maybe one turn a night, and he started to be able to turn himself. But I admit that now this is quite unreliable as he cannot always remember to turn himself. He also does not remember to check his skin himself, and lives alone much of the time. I worry a lot and check his skin when I can.

    We also had a 3" memory foam overlay on his bed, but now he took it off. I have tried to talk him into buying a Sleep Number Bed over the years, but he always refuses.

    I don't think I could survive turning him every 2 hours. I admire you for doing it.

  6. #6
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    I should also add that over the years he's lost weight so he's only 121 lbs and he's 6'3". So not much muscle tissue over the "bony prominence". The sore was near the tailbone/butt crack on one side.

    The air mattress is what we are being given by home health, so its whatever they think he needed I guess.

    I don't do all the turning.... no way I could manage it. He's very hard to move because his body goes into spasms and "fights" the movement sometimes. So some nights our caregiver comes in and does it. But now I can't sleep in our bedroom because it disturbs me every two hours. And then there are the nights when he's complaining that his position is bad after one hour, etc.
    Rebecca
    Wife and Caregiver, husband has Secondary Progressive MS, wheelchair bound, unable to work, MS still progressing.
    Mother of 2 active boys!

  7. #7
    I'm a c5/6 who enjoys hunting ALOT...gotta pressure sore last yr from tooo much huntin, had ta get a flap procedure on my lower back..dr. put me on a clinitron bed, i really enjoyed the bed but as soon as the sore healed yea uno the insurance wouldnt pay for it anymore..i have been in a chair 36 yrs. w only 4 pressure sores..i have almost always slept on a waterbed.. was gonna go back to it, then went to a bed center to get a new waterbed, the guy asked if i had ever tried a temperpedic bed i replied no, my motto is if it aint broke dont fix it..he said he understood but 2 other ppl in chairs were like me (w/the waterbeds) but tried the temperpedic and loved 'em..He said try it for 90 days if ya dont like it, no problem i'll get ya the waterbed, YES I love it..firm enough so that i can turn myself at night, yet soft enough no problems have i had even getting red from sleepin all nite..might try it...wish you the best..Coy

  8. #8
    Senior Member zillazangel's Avatar
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    I never do every 2 hours, I'd literally lose my mind. I prop him up off the sore with TONS of pillows (and we have a temperpedic bed), go to sleep and about 7 hours later I'll turn him (or sooner if I can wake up). During the day, I turn him more often just because I'm awake.
    Wife of Chad (C4/5 since 1988), mom of a great teenager

  9. #9
    The most important thing to help with healing a pressure ulcer is to keep the pressure off the area. I would recommend that he NOT lie on his back. You could work on getting his turns slowly up to every 4 hours, one side and then the other. I would start at every 2 hours, then try 2 1/4 hours. If the skin is ok, you can move him up to 2 1/2 hours, etc. Give each turn time a night or two.

    Each mattress out there claims to be the answer. I would agree that the low loss air tends to be the one that works best at home for many people. However, each one of us is different.

    Please, Please, Please keep the pressure off that area. That goes for sitting, also. Really minimize it, unless you can get all of the pressure off it.

    CKF

  10. #10
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    I would think you could work up to more than 2 hours, but I want to point out, that NONE of that time should be on the recently healed area,
    T7-8 since Feb 2005

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