How do I deal with sundowning?

Here a a few techniques to try:
1 - Make sure she gets most of her sleep at night. Make sure naps during the day are brief so she will be tired at night. This may cut down on the "confused time" with Sundowner's.
2 - Make sure she gets into the sunshine, but avoid 10 am - 2 pm when the rays are more concentrated to cause skin cancer. Sunlight helps to regulate the circadian rhythm.
3 - Put on more lights in the evening and afternoon. It appears that lengthening shadows are related to more confusion. More light helps things to "look normal."
4 - Redirect her attention as much as possible. Have her make a salad for dinner, set the table, select a movie or tv show to watch, select a radio station... Dance with her to music you both enjoy. The idea is to engage her brain in another thought or activity so "the looking for the children thought" isn't triggered.
5 - Be patient. That "watching for the children" thought is a very strong pathway right now, but will diminish with time.
6 - If her persistent thought/behavior causes her anxiety or "acting out," please notify her doctor. Anxiety and frustration is usually the cause of "acting out." especially when the world doesn't seem to make sense. She might benefit from a mild anti-anxiety medication.

Can you tell her...any of the following..
**They called and went to a movie and wont be in until later, they said to go ahead and ...(insert something here)..eat dinner, go to bed, watch TV...
**They called and decided to watch the game at "Bobby's" house.
** "Sue" asked if they could spend the night so they won't be home.
**They already came home and went to bed. They came in the back door

The sun going down, changing light and reflections can be troublesome.
There are shadows that you see that make things different.
Make sure that inside the house is brightly lit. I would switch to LED bulbs in a brighter lumen.
Pull blinds or drapes so that windows do not act as mirrors and it looks like people are outside.
Place a dark entry rug in front of the door. Often people with dementia will not cross a dark rug thinking there is a hole in the floor. (works for some not for all)

I controlled my mom's sundowning with daily walks. I also gave her coffee in the morning and early afternoon. I would keep her occupied to keep her awake. She slept all night. Her Alzheimer's also became extremely severe--yet she generally slept all night BUT I worked hard to keep her up during the day, and only let her take very brief naps. I ended up having to get a $700 upright walker but it kept her walking in the park for 5 years. She was able to do 1/4 a mile every single day and I LOVED walking with her. It was like paradise being with my mum taking her for walks. She loved it! If she got the "crazies" during the day it's another walk in the park and when done she was perfectly relaxed. Exercise is more important than pills.

If they sleep all day you will have a severe problem at night.

Be careful using medications because that predisposes to falls and more confusion. Many narcotics will also cause impaction...I never used those meds for my mom. Other than routine stuff she took all her life for her blood pressure and insulin-dependent diabetes. Mom lived to be 90 years, 3 months and was bed ridden the last 3 months of her life because she literally forgot how to stand and could not do it. Complications of kidney and liver disease from her IDDM killed her--not Alzheimer's. In the end I had to get her a feeding tube which she did really well but a body gives out and 10 years of chronic kidney disease (I did the feeding tube for comfort so she would not have to die of dehydration which can take weeks). So all her needs were met to the end and she died very peacefully and her skin was in perfect condition.

Doctors were amazed she lasted that long considering her litany of many chronic illnesses which are too many to list here. I also have to say that her medical management was constant but I kept her sugars very well controlled all her life to the end

My Mom needs some extra anti-anxiety meds for this time of day.

We have the services of a geriatric psychiatrist. It made a huge difference.

My soon to be 99 y.o. Mom lives in an apartment down the hall from me. She has 24/7 live-in care and I manage her life, household, medical, medicine and navigate her ailments with her along with doctors that help me with every hiccup.

The geriatric neurologist, palliative doc, geriatric psychiatrist, primary doctor, gastroenterologist, retina specialist, have been a life saver giving her “quality” of life. Mom no longer has sundowning episodes, her depression is minimal, she sleeps most of the night ( not counting bathroom visits), the psychotic episodes have stopped. She’s more pleasant than she’s ever been. Yes, she is on a cocktail of medicines but it has tuned a turbulent
situation into a dignified journey. We tweak her meds and I’m in touch with her doctors regularly.

Geriatric neurologist and group of sensitive physicians is the best advice.

When my mom asked me “why are you here?” I said “you gave me life and I’m giving you quality of life”

My heart goes out to you.

Grandma made great suggestions. So far, just having a bright house seems to be helping stave off sundowning. Sure, she complains that we’re wasting electricity, but I’d rather have that fight than her telling me she’s never seen me before in her life and what am I doing in her house (it’s my house).

And when she still sundowns, come up with a good plausible lie. If she remembers them as little, think back to when they were little. Did they ever go to camp? Stay at their grandparent’s house? Use something from her memory bank.

Maybe you can tell her you'll wake her once they come.

Maybe you could say they already came home and are sleeping.

Maybe you can say they're spending the night somewhere like a friend's, grand parent, ect.

My 96 year old mother’s sundowning isn’t as difficult as it sounds like your mother’s is but we have found CBD to be a real help. My mom rocks and becomes anxious (“I can’t sit still”) starting sometimes as early as mid-day. We give her Super-High CBD tincture in small bit of juice. Once you figure out right dose it really helps.
Best of luck!

I think your wife's issues are more delusional rather than a sundowning problem. Taarna offers some great techniques for addressing sundowning, which you may want to employ. I think grandma1954 more accurately addresses your wife's problem. Your wife is staying up late because your children haven't come home yet. Of course, they won't. You cannot reason with her belief that the kids are coming. Your response needs to validate her concern. You do that by coming up with a reason why the kids won't be coming. Grandma1954 does a good job of suggesting some responses. Go back and read them. Providing your wife with a reason the kids aren't coming may be a reasonable reason in her mind for her to accept that and go to bed.

Sundowning is a tough nut to crack. My dad had severe Alzheimers when my sister took him into her home. Sister and BIL were both retired, I was still working, but I slept with dad in the same room one night a week to give them some rest. Dad would get up, usually around 1:00 AM or so and go off on a dementia rant. No prescription medication worked real well, unless he was snowed. We used it rarely, we didn't want to. I stayed over for a few full moons. That was the worst. You will have to rely on a Dr's advice, I have no answers for you. I do have a funny story though, after a bad night when I was staying over, we got my dad up in the morning to dress him. My sister told him you gave Frankie a hard time last night. He said he was "just negotiating" with me. We all had a good laugh over that, and he had a good day. Best wishes to you.