Sundown is a part of Alzheimer's but what do I do when the sundown is in the morning?

Any experiences with time released alprazolam for anxiety, delusions, hallucinations and violent outburst during delusional episodes? For two months our family member has been having manic cycles of no sleep and repeated circling of the interior of the house, going upstairs, talking to the television, grabbing belongings and stacking them by the door, forgetting who her caregiver is and hitting and throwing water on her, and banging on doors wanting to escape. The 3mg of alprazolam has helped her to sleep for two days and she has been waking for meals, potty breaks and some conversation albeit in a groggy state. We cut the dosage in half and are only giving her 1.5 mg (time released) in the mornings. She is sleeping and we wonder if the exhaustion from the past two months of these repeated manic sleepless stages haven't caught up with her now that the anti psychotic medication is calming her. We see a new neurologist in a week. Are the comparable meds that are not habit forming, that don't wear out their potency in order to keep her on a sustainable calm level? Or are we doomed to have her go into psychotic, manic episodes again if the neurologist takes other approaches? Am interested in what has worked. Thanks.

To UncleDave. Your post was most helpful. I too wondered what it was called when the "sun downing" was occurring in the morning! My Mom fit your description to a T this morning. However, she was never diagnosed with dementia or Alzheimer. Her personality changes when she is kept overnight in the hospital. It happens every time. Last March she was ok for the first 3 days during a 6 day stay. When she came home, two days later, she was back to her old self. A month later she went back in and they found she had a UTI. She said one night over in the hospital and it was a night from hell. Again, once at home she was fine. She does have some memory loss, I'm not going to say she doesn't. But I have never seen her like the way she is NOW. She had gone to the hospital by ambo last Sunday because I thought she was having one of her "incomplete seizures". She also was confused when she spoke with me. Mixing things up, events, etc. I knew something was wrong. They found she had a mild UTI. She was given antibiotics and kept overnight for "observation". I was a bit against the idea because I knew what we'd all be in for. The reason I went along with it was because during a routine chest xray, they found a mass on her left lung. A CT scan was done and confirmed that there was a mass of concern with suspicion for malignancy. I took Mom home Monday evening and for the next two days, she was doing this sunrising stuff and waking up 3-4 times in the middle of the night, wandering in her room, opening up dresser drawers, straightening things, using her jewelry container to pour water in for our 4 cats. SHE DOES NOT KNOW ABOUT THE CT SCAN. I took her to the primary care doctor and to her Pulmonologist on Thursday. I discussed the results with both doctors and they have told me it is cancer and a malignant type. They want to do a PET scan. Doing a lung biopsy is too invasive for my mother's condition healthwise. We do plan to tell her about the results, but we can't do this until she gets past this confused state of mind. I really thought she was going to get past it. For the past two days she has been 85% herself. Last night I'd say 99% herself. This morning, the phone rings at 4:30 am and it's my MOM! She managed to call my cell phone (which she does have issues with making calls because of her hearing impairment). She asked me to come downstairs. I did, and when she saw me she asked why I was there. She thought she was in her sister's mother's home but that it looked like her own. She asked me if I had seen my Aunt Clara recently. She is deceased-since January 2015. I reminded her gently, that she had gone to heaven. She responded as "I know." So it's weird. I managed to get her back into bed after she used the bathroom. Then 3 hrs later I heard her move about through the monitor that I have in my room. I came down stairs to find that she had removed the down comforter off her bed and put on the blanket that was on the bed previously. The down comforter was new to her, but she did not care for it. She told me to use it. She said the cats were getting lost in it. She is a creature of habit like most of us, so she wasn't keen on using the comforter. I put it away and gave her the morning medications. She wanted to go back to bed, so that is where she is now. She may be getting her days and nights mixed up. I really am so lost at this point. I called her neurologist on Friday and told her about her confusion that was not going away. She said I should take her back to the ER. I didn't think it was the best thing for her. She'd go through this confusion all over again and then some. She gets combative and angry and they had to put mittens on her with this last stay at the hospital. I didn't think it was the best thing and I wanted to give it a few more days at home. I don't know what doctor she should see. Her primary doctor saw her first on Thursday, but she wasn't as confused mentally when she saw him at 3 pm. By the time she saw the Pulmonologist it was 5:15 pm. Her personality had changed drastically. So with that being said, I would think she needs to see someone that can test her for dementia? What kinds of tests are done for this and what is the solution, if any? Thanks for listening and any suggestions you may offer. I hope I posted this in the right place. Julia

Sunriser's Syndrome? I learned something new from you today, Uncle Dave.
Kindest Regards. And the description is spot on. This has been forwarded to my client's husband. Am dedicated to providing him with as much factual "education" as possible as he is overwhelmed.

I aggregate and share these tidbits on
"Mainzone Knowledge Network"

Sunrise Syndrome,(sun?riz) a condition in which a person with Alzheimer's wakes up rising in the morning and their mind is filled with delusions which include include beliefs about theft, the patient's house not being their home, a spouse is an impostor, belief an intruder is in the house, abandonment, spousal and paranoia, people eavesdropping. Sometimes the person may carry over content of a dream.

One observation is that Sunrise Syndrome is different from Sundowning because the person may wake up in a confabulation mind set. During a Sunrise Syndrome conversation with the content may filled with confabulations; verbal statements and/or actions that inaccurately describe history, background and present situations.

Sundowning in contrast displays as confusion, disorientation, wandering, searching, escape behaviors, tapping or banging, vocalization, combativeness; the demons of anxiety, anger, fear, hallucinations and paranoia come out.


Hallucinations and delusions are symptoms of Alzheimer's disease and other dementias. With hallucinations or delusions, people do not experience things as they really are.

Delusions are false beliefs. Even if you give evidence about something to the person with dementia, she will not change her belief. For example, a person with dementia may have a delusion in which she believes someone else is living in her house when she actually lives alone. Delusions can also be experienced in the form of paranoid beliefs, or accusing others for things that have not happened. For example, the person with dementia may misplace an item and blame others for stealing it. Some people with dementia may have the delusion that others are "out to get them." For example, he may believe that his food is being poisoned.

Keys here with my Alzheimer's friend/client is to be keen to spot symptoms of morning Sundowner's, and first of all, lock doors. We installed coded locks that we lock from the inside of the house and unlock with our code. We installed pins on all the sliding glass doors leading from the inside of the house to outside patio areas. Sundowning at Stage 6 includes the urge to run, and in our case, she hallucinates and becomes hyper paranoid hence doesn't recognize us and thinks she has been abducted. I let her roam freely around the inside of the house.
I keep small bowls around the house with protein snacks that she finds and will nibble on. I offer to phone one of her sisters which sometimes is a relatively good distraction and not always. Soft music is put on. Television cable offers a myriad of musical genres. We go to light classical and soft acoustic sounds. We all smile at her, and don't ask questions at all. If she sits and frowns in a stare, we let her.
We just give her space. If she asks questions we simply say yes and that we love her and that she is safe. She used to enjoy gardening and interior designing. Sometimes I put the HGTV network on and during a particularly rough Sundowning episode she stops in her tracks, walks over to the television and waves "hello" to the Property Brothers. (: She thinks at times they are speaking directly to her and she engages in "conversations" with them and smiles and sits near the television and is albeit briefly connected and distracted. At those times I go to her and offer up something like, "Wow! You found them. Aren't they wonderful? Aren't they amazing?" She responds well each time.

Yes, it's difficult to care for a person with severe dementia in the home, especially by yourself. I don't know how people do it. I couldn't do it. Bless you for your patience.

Thank you for the answers .yes mom is on a schedule and I wake her everyday but Friday and Saturday.God gives me the patience to handle it .we pray everyday

My cousin has awakened and asked me if she was in a dream or if things were real. I think that due to the dementia they have a hard time differentiating between dreaming and reality. Being better one day and not the next is also common. I have learned to not expect one type of behavior, because it can change often.

What I might suggest for the mornings is to have her on a schedule, so that she is awakened slowly in the a.m. at the same time everyday. Someone could sit in the room to calmly greet her with a good morning, assuring her she's snug in her bed and it's time to wake up and get dressed. Watch or assist her with her dressing and bathroom trip and escort her out of her room. That might keep her calm and oriented as to where she is. If she's on a schedule, maybe it will help keep her calm and less confused.

I think a lot of the time it is hard for them to leave the dream world behind when they wake up, especially if they are taking meds that may effect their sleep, either directly or as a side effect. Opening the blinds/curtains, having an alarm clock radio come on softly, or going into her room in the a.m. to help her with her morning routines may all be helpful.