Does anyone have advice on dealing with sundowners?

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Does anyone have advice on dealing with sundowners?

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My mom is in an ALF and up until recently was content, all things considered. She has Alzheimer’s and often feels like she’s in the ‘middle of nowhere’ even though she’s 10 minutes from me. (She’s been there almost 9 months now, after living in her home for 53 years.) Her evening calls are on an uptick all the sudden and she is almost in a panic. She wants to go back to her house. She wants to die. She says no one visits or calls where she’s at (which is not true, she just forgets people an hour or two after the encounter.) I have jumped in the car and gone to her which helps, but I can’t do it every time. (Last night I was at a wedding.) It is heartbreaking to hear her so lost in her own mind. Talking her off the ledge over the phone is pretty impossible. Is this just something we as loved ones have to accept as part of this awful disease, or are there strategies for helping our LO get through these episodes? Thank you!

Alzheimer's & Dementia Assisted Living Sundowner's Syndrome

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I kept my mom awake all day, allowing only short naps. She slept all night
The key is keep them occupied and adhere to a strict schedule

Luke

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Our doc prescribed trazadone. It totally fixed that problem. Not that there aren't others. hehe

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My mother's sundowning increased after she began to suffer constipation and her doctor told me to give her "MIRALAX" daily. So I did. I thought the sundowning was to be expected with the dementia and it took me awhile to start looking at what was in her supplements. (Her only Rx is a thyroid pill that she's been on for years and years.)

"MIRALAX" is Polyethylene Glycol which is horrible for dementia patients - and really anyone. There is quite a bit of emerging evidence on the internet that Polyethylene Glycol has transformed formerly pleasant personalities into raging angry behaviors.

I immediately stopped the "MIRALAX" and instead began to use the natural supplement, Magnesium. I give her "Milk of Magnesia" every other day now and I can truly say that her sundowning rages and delusions have almost stopped.

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Edit: Prayers *and* hugs sent.

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Dear ConstanceD: Have you perhaps considered the possibility that your mother requires a higher level of care, e. g. Memory Care? Perhaps as your mother's day winds down and she is experiencing Sundowning, she can take Melatonin, BUT only under a physician's okay. It has to be incredibly tough for you and also your mother. Prayers ad hugs sent.

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My 88-year old mother’s sundowners truly came after sunset, so I don’t actually know if this is useful or not.

She was assessed by an elder psychiatrist and he: 1. Diagnosed her with stroke-related dementia and 2. Removed all the anti-depressants that the hospital docs gave her and 3. Prescribed her with olanzapine.

Every night she takes a small dose about 30 minutes before she goes to bed. Then, she sleeps through the night and wakes up around 8am, ready to go.

It really helped my mom to get a correct diagnosis. The caseworkers kept saying things like she was just depressed and needed cheering up. The elder psychiatrist said, “No, this is a result of the stroke and no amount of anti-depressants will help. “ Then, he explained how stroke-related dementia worked, so that I understood. I still think he’s one of the better doctors I worked with while caring for my mom.

I wish you well and hope you have success!

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https://www.mayoclinic.org/diseases-conditions/alzheimers-disease/expert-answers/sundowning/faq-20058511

https://my.clevelandclinic.org/health/articles/22840-sundown-syndrome

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Constance, I neglected to mention something another of our posters here used with his mother who suffered from advanced dementia with very bad Sundowning symptoms in the late afternoons:

He rented a Richway BioMat heating pad for his mother. I will give you a link to read up about it. It is very expensive, but you can rent one to give it a try.

https://www.biomat.com/?gclid=Cj0KCQjw4uaUBhC8ARIsANUuDjUB4Ldbk6DN5PDxugjdXn2z-0TIijhHen2cvnmNWE7rSA0ocqMzuYQaAsAOEALw_wcB

They also make a BioMat Mini which is less expensive and also available to rent. Go to Google and punch in "Rent BioMat mini in *your area*" and see what comes up.

This poster swore by this BioMat and said it turned his mom from a lion into a lamb; that she'd calm down immediately when he'd place it on her recliner, and she'd go right to sleep.

I cannot vouch for the BioMat personally, but just tell you what one of our posters had to say about it. I thought it would be worth mentioning to you.

The other thing I forgot to mention is a weighted blanket............I have a 15 lb one myself and have found that when I'm anxiety ridden, if I lay it on top of my body, it puts me to sleep almost immediately!! Worth a try for a low price.

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I can only add what works for me and mom 86. She's had horrible sundowners for several years, way before she came to live with me. It typically starts 2:30ish with nonstop pacing, checking, rechecking things, worried questions about her pets, where she should sleep tonight, where she should sit so she can get out quickly without anyone noticing, so on. When this starts is my cue to bring her a piece of pumpkin pie (store has it year round). Then in about half hour a cup of warm honey-lemon water. Sometimes we walk outside to mailbox or driveway. As someone mentioned a stack of towels to fold. Then I just let her pace back and forth thru the house to continue checking, rechecking til dinner around 5:30. Then the nighttime routine of TV and bedtime. This keeps her steady about 9 times out of 10. Before she came to live with me her afternoons were endless panic phone calls to me or my brother, I often got 30plus calls. One time she called over a hundred times in one afternoon (phone stopped counting at 99). This way of managing sundowners is only possible for me because she now lives with me and I'm retired. I offer my experience to you only as ideas you may be able to offer to whomever is available to your mom in afternoons.

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How to handle it when the days are shorter?

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The best advice you'll get is this:

Sundowner symptoms are the result of a struggling liver, not brain disease.

If the person has managed to get some rest during the night then their liver will have a tiny bit of energy available to start the day. This is helped by the cortisol boost, if this part of their hormone system is still functioning. That cortisol will boost the brain and body, which is why their behaviour and cognition may be okay in the morning. The downside is that the cortisol in the blood has to be processed by the liver which is already in severe distress. This, plus what they eat, drink and get exposed to toxin wise in the morning and during the day, will determine whether their system responds with sundowner symptoms, or not. If the person is well hydrated with clean water, on a low fat/low protein/no refined sugar, organic vegetable and fruit diet, this takes the pressure off the liver and digestive system in a number of ways, and over time the sundowner symptoms will start to reduce. Why? Because the liver is receiving some proper support, finally.

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This could be difficult to implement in a care facility.

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She is having an uptick in confusion and anxiety in the evening. There could be a lot of triggers: starting to get tired, change in lighting (ask to have more lights in her room and to turn them up early in the afternoon, the level of medications in her blood stream starting to decline... The most concerning symptom is her increasing anxiety levels - she is scared. Non-medication efforts include keeping her room the same, keeping her routine consistent, turning on more lights in the later afternoon, and soothing activities to engage her mind. She may also need a prescription for a mild anti-anxiety agent to help her relax with everything appears confusing and scary.

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I have heard of nurses giving Melatonin with great success. Seems like an easy thing to try. Wishing you the best.

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Each person is different. Some medications work while others don’t. There’s a lot of really good suggestions mentioned such as turning on the lights, closing the blinds, distracting them, etc. But medication works for my mom, as her behavior ranges from crying nonstop to fighting. The medication calms her down and actually helps her fall asleep at night. I’d rather see her calm and relaxed rather than frantic and nervous. Sundowning is tiring on them and us caregivers. Yet, it shows up every day! Just find what works for her.

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200 mg magnesium glycinate at 3:00 pm

another 200 mg magnesium glycinate at 3:00 pm

If it is really severe then give one dose of 400 mg glycinate at 3:00 pm

This reduces anxiety and calms agitation and will help parent sleep at night.

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I found better lighting helped.
Closing blinds or drapes so he would not see his reflection in the glass at night helped.
Staying on a schedule helped.
Melatonin did little for him.
Each person is different so what works for one may not work for your mom.
It is very possible that your mom would now do better in MC rather than AL. It would have a discussion with administration. It might even be possible for her to spend a few hours in MC for a bit she will get used to staff and get to know some residents. (this might be like her "adult day care" for the time she is there.

I am a firm believer in medication that will help reduce anxiety, there is no need for someone to be in distress when it can be lessened or prevented. This is a discussion for her doctor, and it might take a bit of tweaking to get the right med and right dose.

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To help my elderly Aunt through her Sundowning, we turn on the lights in the areas where she is even before necessary (researchers believe that the shadows or time of day plays a role but they're not sure why). Then we distract her with a "purposeful" activity, like folding a stack of kitchen towels or walking to the mailbox or around the house. The activity moves her mind away from "going home" (where she already is but there's no convincing her otherwise during Sundowning) and it burns energy so she sleeps better. It enabled us to take her off of Tylenol PM and melatonin.

Since your mom is in AL, is it possible to talk to admin about having staff take her out of her room during this time and to an activity? Or to make sure all the lights in her room are on? You will need to try different strategies, Sundowning isn't same every day or week. Giving staff the tools to help her will go a long way.

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My dad’s would start every day around 3. We’d have the “I need to go home” conversation over and over for a few hours. I was told just to tell him I’d take him home tomorrow to calm him down (since he wouldn’t remember I said it anyway) but I found it hard to lie to him like that. Sometimes I just had to say, I have something to do right now but I will talk to you about it later. It was very painful to go through. In my dads case, as his dementia progressed, the sundowning got better toward the end and he was actually easier to deal with after a time and didn’t get into the going home thing as much.

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Unfortunately there is nothing you can do to make her feel better. She needs custodial care around the clock. Obviously, you can't do it and no one should expect that you quit your job and everything else for a lost cause. Her condition will continue to worsen with time. Eventually, she won't even know who you are. It's a sad reality but you can't deny it or escape from it. It's my duty to tell you the truth an not to give you false and unrealistic hopes.

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My mom was experiencing severe sundowners. 25-30 phone calls or text messages screaming “‘I want to die”, “ I want to go home”, “ I need my car back”. The AL team put her on 25 mg of seroquel at 6pm. That began to help, but determined her anxiousness began as early as 3pm. So we’ve added a second dose after lunch 12:30. Huge improvement! She is way less anxious, the nightly phone calls have stopped and she admitted she’s sleeping better since she started taking her “ vitamin” as it helps with insomnia. She’s more rested therefore way less episodes of sundowners.

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Have her checked for infections. If she's taking pain meds, see if you can reduce the dosage. My mom had sundowners until we realized it was an effect from medication. Medical induced delirium is real and often alleviated after the infect or meds are removed, or reduced.

Also have all levels checked. Vitamin D deficiency can also contribute. As another person mentioned, take her out in the sun daily.

I don't think most people realize a lot of 'dementia' comes from other sources that seem to have nothing to do with the mind. That's where I'd start. What meds is she taking? What dosages? (Most doctors OVERDOSE elderly.) Does she have an infection? Even if she has Alz, checking all these can some times reduce the ALZ symptoms. Good luck.

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Currently my Mother who has Dementia still lives at home with my Father. We are currently attempting to subside my Mothers sundowners with a tiny amount of alaprazolom (Xanax). HOWEVER, Dependent upon the current late day mood of my Father this seems to work. If he “loses it” over something and yells, no amount of medication will work and she might be awake and fidgety till after midnight. So many times the degree of Sundowners is influenced by others.

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With my BIL we added 30mgs of melatonin in his night time meds which he takes around 5pm to 6pm it helps with sundowning. He likes his pop pepsi he now drinks decaffeinated diet pepsi it helps with that too. Unless like yesterday he went and got his own at a store and drank it last night he was up still at midnight. We have dark curtains in his bedroom and they are always pulled shut as well as his curtains in the living room. He has dementia and has had it now for over 6 yrs.

Prayers that you find something that works for you.

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I have some tips.Since the days are longer now,I adjusted my father eating patterns, so now he eats later in the evening (5:30-6:00). As he's eating I close his shades in his room and get him ready for night time.He watches TV and chills out.At 10:00 pm my husband turns the TV off and he goes to bed, most of the time.!
Just one of my tricks😀

,

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I feel so badly for her. Can you just imagine living in that kind of nightmare? You need to consult a physician and see about medications.

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Not a big med fan, BUT in this case, I would ask the doctor about it. There's no reason to allow her to be in such a panic every day. She may need to move to MC as they are MUCH better equipped to deal with such behaviors, and should actually expect them since they are so common with dementia patients.

Maybe plan a visit a couple of times a week around the time that these begins. Or hire an aide that can sit with her for a couple of hours when she usually starts having issues.

Good luck.

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As mom approached the end of her life, the Sundowning reached a horrible level. Memory Care wasn't able to help her in any special way, either, b/c let's face it; when they're anxiety ridden & insisting on going home, nothing is going to help them except medication. When hospice got involved, the nurse got approval for .25 mgs of Ativan every 6 hours which helped mom A LOT with the Sundowning. Then as time went on, they increased it to .5 mgs. I consider Ativan to be a lifesaver for Sundowning, I really do. It calmed mom to the point where she was fairly managed and I could speak to her and keep her relatively anxiety-free.

Part of this you DO have to learn to deal with b/c even with meds, your mom is likely to still have her bad times with Sundowning. Hopefully there is enough staff at her AL to help her through the tough times. Mom's MC staff were amazing with her. Have you tried giving her a baby doll? Many women with ALZ are very comforted by taking care of a baby in swaddling, as they did when they were young mothers. Give it a try, what have you got to lose? You can search 'lifelike baby dolls' on eBay and buy one for a reasonable cost online.

Wishing you the best of luck!

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For us the answer is routine/schedule, good sleep, proper meds at the right time, and healthy diet. I say diet because if he doesn't eat right, he seems to get sick, high BP's, or infections and that makes it go way out of whack. You cannot always control all that but we have seen when he is on track what a difference it makes in our case anyway.

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Maybe Mom is ready for Memory care. Talk to the RN at the AL. Als ate limited in the care they can give.

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I can share what worked with my dad (now passed) and my mom 86.
I was advised to get them a good, long time outside in the sun each day.

My mother's doctor started her on a med for chronic anxiety which she has had all her life and included panic attacks. She loves her lavender/chamomile tea for the evenings. Her sundowning seemed to be a stage that has now pretty much passed. Mother has an evening sitter that arrives at 5:00 and this also has helped a lot.

Maybe one of your mom's friends could visit in the evening. I am sure AL's staffing is reduced in the evenings. My mom also learned deep breathing techniques to calm her down. Unfortunately her anxiety raises her BP too.

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1. Talk to her doctor about meds.

2. Talk to the ALF about having them check in with her at her usual "panic time".

3. When mom calls, tell her that there people she can talk to in her residence. Encourage her to go to the common area.

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Does anyone have advice on dealing with sundowners?

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