Does anyone have any suggestions for what really works for sundowning?

My husband, 88 has Alz and is taking 20mg citalopram , is really present during the day, we can go out and have good conversation etc. , but come night, he will sleep and wake up a few hours later and he does not know where he is and asks constant questions to try to get his memory, he asks how did he get here, no matter if he is home or away from home, he wants to go home even though he is home, ask when did we move here, we've lived in place 12 years, sometimes he doesn't recognize me as wife, but he speaks of someone who taught school with him 60 years ago, this can go on for hours, and then he sleeps and awakes not remembering anything of those episodes . He is always kind and tells me he's sorry, but something is happening to him and he don't know what to do. He tries so hard to remember and he just talks for hours. I listen to him and reassure him the he will be ok until he falls asleep. No medications have worked so far. I hope you find some answers, this is very disheartening, and so sad to watch.

Sundowning is a challenge to handle - my mom (who passed 2 weeks ago) would do it often. I found that melatonin gummies at bedtime helped for a sound sleep. If your mom likes "candy" this is a good option. My mom was also put on a low dose of Seroquel which also helped. She would also seem more combative at bedtime which is frustrating for sure. So maybe try some of the natural sleep aids and as for the anger it is a baffling part of dementia. Does your mom like animals? I got my mom a cute stuffed kitten that would have a calming effect on her. I understand how exhausting it can be with the up and down at all strange hours of the night. Also I would keep mom up in the day as much as possible ( not napping long times) so she would be more tired at bedtime. Hope some of this helps.

Her sundowning symptoms (since going off the citalopram) are hyperactivity, mean-ness, walking the halls, slamming doors, sometimes spitting and hitting. Citalopram 10mg seemed to work better for these symptoms, but her doctor recommended switching to mirtazapine for improvement. I'm not sure if I need to give the mirtazapine more time (7.5mg, only on it for a week so far) or if I should go back to the citalopram, but it is much worse on the mirtazapine.
Other strategies that we have tried are melatonin (some improvement), and light therapy (none).
Additionally, has anyone tried citalopram and mirtazapine in combination? I know that there is a warning of seratonin syndrome if used together, but think it is sometimes used with good results (?)
Thank you for sharing any ideas.

More info from you would be helpful:

- what symptoms is she still having?
- what non-medication therapies or strategies have you already tried?