What is the best way to handle sundowning?

@bellas, I suffered a trauma when I was in my 30's. I became alcoholic and severely OCD. After I stopped drinking, I was put on Depakote for my OCD and the Trazadone to help my mind rest at night. I was on both medications for about 10 years. I felt that they helped my OCD tendency and I don't think I would have made it through that period in my life without them. At this point if my mother needs medications to help her with her anxiety and delusions, then I am okay with it. I realize that we all strive to keep our parents with us as long as possible but I am more concerned with her quality of life. If my mom's mind can't rest at night and she is pacing, nervous, and exit seeking, none of us are resting and none of us are going to do each other any good. My opinion.

@gsw92498, my mom was given 25mg of Trazadone when we first started seeing the symptoms of Sundowning. She was repeating herself, scratching at her arm, and overall getting nervous. Last month we had an episode where mom hit her head and started hallucinating and having delusions. She was exit seeking and not sleeping. Her dose was increased to 50mg and now she sleeps soundly throughout the night. She does wake up to go to the bathroom but no more of the exit seeking and setting off the alarm. I feel that with her condition it has been very helpful. At one point, in my 30's I took it for 10 years. It helped with the OCD thoughts running through my head that kept me from sleeping.

Two medications, Celexa during the day and Remeron in the evening did the trick for us and allowed me to keep my Mom out of the Nursing Home. Go for low doses first but they were a God send for us. Mom now sleeps at night gets up and does everything she always did and takes a nap but is up and going again, the sundowning stopped..... nothing short of a miracle!

As a geriatrician, I tell families that sundowning in people with dementia is a little similar to the 5pm "witching hour" that parents often see with babies & young children. It's probably a combination of long shadows, being tired at the end of the day, and who knows what else.

Every family has to do some trial-and-error to figure out a way to manage it. Agree with routine, creative redirection, minimizing stressors during this time of day if possible.

Medications are tricky. Most medications that settle people down have risky side-effects, and usually the clinical trials find that medications don't overall help much. But as many of you have pointed out, at the end of the day, it's very important to keep things managable for the family caregivers and sometimes a little medication seems to offer a reasonable balance of benefits and risks.

My main suggestion to the group would be that if you ask a doctor to prescribe medication, start with the lowest dose possible. I once had a neurologist suggest we try Seroquel 50mg for a 91 year old person with some sundowning; most geriatricians start with 12.5mg (which seemed to do the trick for that 91 year old).

Agree with Fraulein that Benadryl and over-the-counter sleep aids (which all basically contain something like Benadryl) should be avoided at they are "anticholinergic". Good luck!

When it began with my mother, it happened every single day, no matter what, it was a daily occurrence. It seems like they become agitated because of night time coming on just like when people are ill they may do okay during the day but when evening rolls around they begin feeling ill again. Honestly medication is all that has worked for us.

ROUTINE IS KEY TO KEEPING SUNDOWNING AT BAY AS MUCH AS POSSIBLE.

You can sometimes tell when a Sundowning episode is coming on if you keep a close eye on what type of day the patient has had. If it's been a rough, hectic day with lots of visitors or doctors appointments bundled on top of each other, medical tests, family events, etc. all of this can trigger the sundowning. You have to be careful with taking the spouse, loved one to social events, Alzheimers' patients are not good in large, loud group settings by any stretch of the word. I've learned the hard way. you do have to sit with them, just go through the process, them your loved one calm and reassured. This can go on for one day to three days at a time. BENADRYL AND OTHER SLEEP AIDS CONFLICT WITH ALZHEIMERS MEDS AND CAUSE MORE CONFUSION, ANXIETY AND ODD BEHAVIOR. DO NOT USE THESE DRUGS. TRAMADOL ALSO WORKS AGAINST ALZHEIMERS MEDS.

I guess that sundowning can be controlled , in an empirical way, using natural supplements .

In an empirical way we observed that the dementia patients that are taking thst supplements, are showing a great enhancing in cognition, mood ,speech, attention, great mood, recognizing again their children and relatives, a better strengh, very cooperative, including asking for baths, etc.

My aunt have advanced dementia and if she do not takes every day the following supplements ,she starts again with her "old"and odds behavior (as before we started to gives the supplements) ,with hallucinations ,delusions, agressiviness ,agitation , cryings, yells, etc , most the time of the day and most the time of the night .

We are using in an absolute empirical way ,and this is only an anedoctal report.

Only the doctor of the patient can gives permission and have to gives supervision in the use of the following supplements that are controlling not only sundowning , but her agressiviness,delusions ,agitation , hallucionations , insomnia , cryings , yells,etc.

In an empirical way we are giving:

1) L-CARNOSINE : 60 miligrams three times a day.( it is CARNOSINE and it is NOT L-carnitine).(only these small doses).

2) L-GLUCURONOLACTONE : 300 miligrams 2 to 4 times a day.

3) GLUCOSAMINE SULPHATE : 150 miligrams 2 to 3 times a day. 

I know GLUCOSAMINE it is a supplement for joints. 

But when she started to use GLUCOSAMINE for her joints we saw an amazing calmness and control of agressiviness and agitation.We can find in the medical site PubMed SCIENTIFIC ARTICLES that shows that glucosamine stabilizes tau in the microtubules in the neurons, and works as an alternative fuel to the neurons too .

4) ACETYL L CARNITINE (ALCAR) - 30 to 80 miligrams three to 4 times a day.(it is NOT L-carnitine , but is ACETYL L-CARNITINE) ( only these small doses).

5) EXTRA VIRGIN COCONUT OIL - One tea spoon three times a day.(if the patient have diarrhea even with these small doses , the caregivers makes massages with the oil in the thin skin of the arms with the tea spoon of the oil ,once the coconut oil has a comroved fast thras cutaneous absortion (according articles in PubMed).

A lot of friends of mine , after my report , are giving to their relatives with different types of dementia ,with the same amazing effects to enhances cognition,mood and to control the odd behaviors.

Acetyl L carnitine (it is Not L-carnitine) it is a well known food supplement used in small doses to dementias. (we can search in Google).

L-carnosine (it is Not L-carnitine) in very small doses as above , is too a natural food supplement for dementias. The natural source of L-carnosine is the chicken chest.


THE BIOCHEMICAL SEQUENCE OF METABOLIZATION OF GLUCURONOLACTONE :

The natural substance glucaric acid (the byproduct of glucuronolactone metabolization) it is the most powerful substance used by the liver in the detoxifying process of drugs,toxins ,etc.

GLUCURONIC ACID  (a byproduct of glucose (present in all foods) metabolization) it is metabolized to GLUCURONOLACTONE ( or d-glucurono-6,3-lactone or the lactone of glucuronic acid ) that is metabolized to GLUCARIC ACID that is metabolized to GLUCARO-1,4-LACTONE.

Glucaric acid  (present in apples, broccoli, etc.) is the byproduct of glucuronolactone metabolization. 

The best way to find scientific articles that explains the benefits of glucuronolactone is searching in the site PubMed to articles about the natural derivative of glucuronolactone , the Glucaric Acid.

There are dozens and dozens of scientific articles about glucaric acid as a detoxyfing substance and as a heavy metal chelator, peroxinitrite scavenger, and as a "cleaner" of toxic substances.

But this is only an anedoctal report , without none scientific foundation, based in empiric observation only.

We are seeing really amazing enhancings , but ,Only the physician of the patient can gives permissions, and knows the right supplements and the right doses to each supplement.
Please talk to the doctor of the patient.

I've gone the drug route. At this point my sanity and health is more important than a little sedation. Mom takes Seroquel in late afternoon and Trazadone at night time. The Trazadone worked in ONE dose and has continued. The jury is still out on the Seroguel but seems to be helping. Mom's starts in late afternoon but sometimes wakes up with Sundowners. If she is to stay here in my home, I will have to sleep. I am not a martyr, I am not a nurse, I am not a maid. I have become a maid and a nurse through this experience, but a martyr I refuse to be. Don't even feel badly about drugs. Don't let anyone make you feel badly about it either. My Mom is almost 92, has been pretty much miserable her whole life no matter where she is and I'm just figuring I don't have to be. If she can't stop it and I can't overcome it, she will be going to AL very soon. I have been looking at various ones. You are doing no one a favor to sacrifce your life and health for someone. My opinion.

Previously mum used to sundown after four pm,wanting to go 'home to cook for the children.Now she starts at nine in the morning.She always want s to go home.
Anyone know what's the cause of this.

bellas - Between Hospice and his doctor we tried several RX's: Quetiapine (Seroquel) 50mg 1 tab by mouth 3x's daily; Hydrocodone-acetaminophen (Norco) 325mg 1-2 tabs by mouth every 6 hrs. as needed for pain; Hydroxyzine (Atarax)25mg 1 tab in a.m. and noon, 2 tabs at bedtime; Metoprolol Tartrate IR (Lopressor) 25mg. take .5 tab by mouth 2x's daily; Lorazepam .5mg; later we had to use the morphine tabs for pain; These are the RX's we used over a period of 7 months - not all at the same time of course, but working to find the correct dosage and combination. You can google them by name and see what the side effects are and their usage. Consistency and regularity are so important with drugs, as they start to wear off the anxiety and agitation is more pronounced. Ask your doctor for the advice and prescribing. Bless you and know you are not alone on this journey. We were fortunate to have a doctor who listened and observed and supported us all the way. Hugs.

Some of the issues being shared sound like there is some OCD going on as well. I am desperate for an Rx to help my husband with the anxiety and wandering around and it does get worse toward sundown but the OCD seems to be the underlying problem. The neurologist said our doctor should give him Paxil but the doctor refuses to do so. We are looking for a different doctor! I don't think it is wrong to try medications because I can see how miserable my husband is and would not let my pets suffer with being so agitated and anxious and acting out in ugly ways. I appreciate the names of the drugs mentioned in the posts, so many posts don't give the names of the Rx that have or haven't worked, though I know results can vary between patients and conditions. I have been trying for one full year to get something to help with these problems and dealing with him is literally destroying my health so I am determined to find a doctor who will at least be willing to try out what might work and if it doesn't to try something else.

The only thing I have found that works is medication. My mother was getting so bad that we were told to put her into a nursing home. I did not take there advice but knew that if i did not find medication to help her, I probably would have to. I took her to a gerontologist who prescribed two medications, one for day and one for night as she was not sleeping either. It was the right combination for her and she is home and we are able to handle her so much better.

As far as what is sundowning, with my mother she would begin to become agitated around dinner time it looked very much like having a panic and anxiety attack but it doesn't stop. It began and got worse in no time and we thought we were going to go crazy with her.

Go to the doctor immediately and seek medication, note that some medications can actually make the patient worse as it did my mother in the hospital, thank God the gerontologist found the correct meds!!!

The sundowning is a curious thing, you never know what is coming and when. I had the freedom to sit with my husband and just talk and hold his hand. I will tell you this, you will become an "accomplished liar" as someone in my Alz. support group once said. And that is o.k. You have to agree with whatever they say no matter how far off the wall it is. Correcting them does not help. I went through all of this with my dear deceased husband. Engaging him in conversation and changing the subject worked wonders. Sometimes we were holding hands and he was only in his underwear. You do whatever it takes to calm them - imagine if you can - what they are thinking about (not being able to think at all) but doing what those disconnected brain wires are causing him to think and do. It is a horrible disease, some medications work, but take time to be effective, others make things worse. It is a crapp shoot until you find any that will put them more at ease. God bless you all for caring - hang in there - it won't get better, but you will get better at understanding your loved one. Tell them you love them as many times a day as you can. I also learned that if he fell asleep in his chair, I never woke him for a meal. I just let him sleep and watched, because if I made any sound, he would wake up and start wandering. Keep them safe, fed and loved are the best things you can do for your loved ones. Hugs to all who are on this journey - and bless you for caring and doing the Lord's work.

Sundowner’s Syndrome is the name given to an ailment that causes symptoms of confusion after “sundown.” These symptoms appear in people who suffer from Alzheimer’s Disease or other forms of dementia. Not all patients who suffer from dementia or Alzheimer’s exhibit Sundowner’s symptoms, however. Conversely, some people exhibit symptoms of dementia all day which grow worse in the late afternoon and evening, while others may exhibit no symptoms at all until the sun goes down.

What is Sundowning?

My dad would reach for something on the wall that wasn't there, see mom stand in the corner of the room. He would see a fish on a fishing pole a lot( he loved to fish) I would say wow! That's a big one Dad and he would smile. If he'd call me Lois (my Mom) I'd say what do you want Charles. Broke my heart! I miss him!

Yes, I agree without meds, melatonin, and exercise during the day. Limit caffeine all together if you can. The disrobing could be a money-maker at a strip club, but perhaps not! Just a little Black Friday humor...

The neurologist has my mom on Depakote. Was not thrilled with this at first but finally (after 2 months plus), she does seem somewhat better, still has some nights where she gets angry and wants to "go home." I swear every day/night, it's something different anyway. She's definitely not so whiny and little girlish talky here lately. I work from home; she lives with me now for 6 months. Could be she's just finally adjusting to the move, who knows? I will have to say that on my nights off, she's much better with me being in the same room with her anyway, so you do wonder about meds. Most nights I'm working in the back room and sometimes she's been overactive. The constant little girl voice thing was driving me nuts more than anything but again, not so bad lately. I do think the neurologist is using her as a guinea pig to try out the depakote. He explained it truly is just trial and error. I do have mirtazapine to help her sleep but hardly ever give her that now, makes her too groggy the next day but oh yeah, if she's extra ornery and so I can get some sleep, I will give that to her occasionally. Now with the time change, the problem is making her stay up to at least 8 p.m. (she wants to go to bed at 6:30 p.m., and I can't turn in till at least 12:30 a.m., don't want her roaming at night if at all possible).

I finally went the medication route for my dad. When he hallucinates he does not sleep. It goes on for days which means I don't sleep either. I just started the medication about a week ago and so far it doesn't help but I assumed it would be by trial and error. I will move onto the next med if necessary. I tried to handle it without medication but it was just impossible. He will wonder, get undressed, urinate wherever, go through drawers, talk all night and all day....the list goes on. The wondering is what really worried me because of the possibility of him falling. He was given an antipsychotic but like I said it has yet to help. I hope to find something that works.

!!!!!!!!!!! If you find out the answer to this question please let the rest of us know! My Dad has sundowned for some time now, but over the past month it has gotten quite horrible. He wanders and has delusions from at least 5 PM until bedtime at 10 PM, sometimes longer. He is anxious, he worries, he has delusions, he has hallucinations. For the past week he has continuously told us that he needs me or my husband to take him to work, to the doctor, to the hospital, to see this or that person about some unknown problem. Last night he wandered around by his bathroom door, wanting to know about the toilet and where the water goes when its flushed and where the pipes were (this has been ongoing off and on for months). He is worried about his identification card and wants to know where it is and whether its lost and whether it stills works. He saw a snake in the bathroom. The "people" have taken over certain areas of the house, etc. He lost his paperwork. He lost his files. Once you think you've gotten everything answered, he comes up with something else. He turns everything you tell him back on you and conversations go round and round in circles! He won't sit still for a minute! I finally called the neurologist's office and made an appointment for just my Mom and myself to discuss the problem. Hopefully he can make some adjustments in medications and in when they're given, or give us something new to try out. I agree with sandwich42 as far as sedation goes. We would rather have him taking some type of med to calm him down in the evenings than have him go through the stress this must be causing him (and us!). Mom can handle everything else, and the daytime hours aren't that bad. But he starts up right when she needs to sit down and get some rest!

The best you can do is be calm. Don't try to argue with them. Try to care for the person. If that person doesn't want that give them 10-15 to do what they want alone then try again. Sometimes the person may want someone else. I care for a sun downer. Sometimes she won't let me do anything but when I get her daughter she calms down and I can finish getting her ready for bed.

Talk to the doctor about medication that can help with this as it's only going to get worse, not better. Make sure to understand possible side effects.

Some people are not in favor of medication to calm our folks down, since it sounds like it's just done for convenience, but I think of it differently. I myself would not want to be agitated, naked, combative, belligerent, and a big fat handfull for my family/caretakers. *I* would rather be a little sedated and not go through the daily stress of something like that or inflict it on my family.