With increases in the steroid dose, unfortunately, can come several side effects in particular that can make things challenging for the caregiver.

Mood/personality changes: Some---not all---patients experience a worsening of their mood or negative changes to their personality as the steroid dose goes up. Typical may be impatience, rudeness, sarcasm, childlike behaviors, possessiveness of the caregiver's time, and sometimes aggression. Decadron-induced psychosis may have the patient suspecting his or her caregivers of mistreatment of some kind. Some patients have believed that their caregivers are spies, for instance, or are "working on some kind of a deal" with the doctors.

Insomnia: Decadron perks a person up...but sometimes more than a caregiver can keep up with. When a patient finds it hard to fall asleep, or stay asleep, at night, the caregiver who is busy all day might now find that there's a night shift as well. Some caregivers have found that using a baby monitor or sleeping on a sofa in the room where the patient stays up to watch TV has worked to meet both of their needs. It's not ideal, but especially in cases where a patient might be prone to wandering in the night, it's important to make sure this can be heard before a fall occurs.

Atrophy of the leg muscles: As the steroid dose is raised, keeping the legs moving becomes even more important, in order to keep a patient mobile for as long as possible. In a patient who is still getting up and around on his or her own, this may mean maintaining that leg strength. In those who need help with transfers from bed to chair, this may mean that the patient is still able to help by supporting his or her own weight while assisted. In those who are bedridden, this becomes harder, as inactivity accelerates this loss of muscle. Exercise can be done with a great deal of help by the caregiver, if the patient is willing to. While the patient is lying on his or her back, the caregiver can take one leg at a time and guide it slowly toward the patient's chest, for a count of 5, then carefully guide it back down. Repeats of 10 on each leg, even if done with very little of the patient's voluntary movement, still work the muscles. Never push a patient to exercise who isn't interested in doing so. It might be possible to encourage him or her or to explain the benefits---the stronger a patient is, the more independent he or she can be!---but it is never appropriate to exercise a patient who is asleep or unwilling.

Increased appetite: Many patients on "higher" doses of Decadron experience a great increase in their appetite. This may create more work for the caregiver whose help is required for preparing food or feeding the patient. In patients who are experiencing insomnia, there is now more time to eat. It's important that, in order to limit weight gain, low-fat snacks are provided throughout the day. As patients gain excess weight and lose mobility, the physical strain on a caregiver increases.