@tomrennie he has been in alot of pain yesterday and today. The lactulose is not working right now. Sleep is getting more difficult, good nights are few and far between. I will look up the article you suggested I appreciate the resources that this has provided as resources are in short supply. I thank you for your response, I am hoping to figure out how to relieve his immense pain that he is in right now. His pain medicine helps usually but this time he is even moaning in his sleep.