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My mother is moving from first stage dementia into middle stage and has been showing signs of Sundown syndrome. She gets very agitated, antsy/nervous, like she has had way too much sugar or caffeine (which she hasn't). Also, no new medications.


I have been reading on ways to try and alleviate it or make it easier, but was wondering if anyone else has experienced this and may have some tips.

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My mother wants her purse and jacket because she thinks she is going somewhere. The doctor gave Ativan to give her if the agitation becomes too intense. It's not as bad as delirium though - it's like sundowners times 3. I have read to make sure that the room is very bright and maybe listening to music from their past at sundown would help. My mother usually ends up going into her room and I will put on some quiet music, and that seems to calm her down a good bit.
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gdaughter Dec 2019
I say this only in jest...but whenever I hear that someone has Rx for something like ativan, I always think "and if it doesn't help the patient it might help the caregiver" LOL...
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Every person here caring for a senior with dementia knows first hand about sundowner.

The best thing I could do was to eliminate every source of stress after noon. Appointments were morning only...etc.
this way he could have whatever he liked for early dinner and fall asleep in front of the TV or with his coloring books.

any excitement (even a phone call) could set it off.
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Oh yes! It’s very difficult for caregivers but think how scary it is for your LO. Even some medications which were meant to calm had the reverse effect. In some cases, the less medication, the better. Because many of the medications which are supposed to calm actually take away some of their reasoning and therefore they are more confused and scared. We found that keeping our LO’s schedule the same everyday and having his supper early followed by his bath and bed was the best plan. At that point, some light sleeping aid or other medication may help if you can get your LO asleep. The hospital was the worst with the change in everything plus all the noises day and night. We frequently walked all night - up and down the halls. Trying to keep him in bed or his room just made for a big fight and more agitation. So giving him what he wanted - within reason - was actually the best plan for us. Good luck
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My husband began to sundown early in his diagnosis. I had read that the part of the brain that processes (and enjoys) music remains strong for a longer time. I have been playing his favorite music, Frank Sinatra, and the change is astonishing. He goes from agitated and fretful to snapping his fingers! So I have incorporated relaxing music, spa music and Frank into our bag of tricks. I have a google speaker in nearly every room so asking it to play wherever we need a quick intervention is great. We even fall asleep to spa sounds and he has been falling out to sleep peacefully. I set it on a timer while we prepare for bed.
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MarilynR Sep 2019
Perfect, that is exactly what I need. Soft music for her. Thank you!
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Sundowning is typical with Alzheimer's and dementia, especially while in the hospital. I've seen it with both of my parents, and even hospital delirium recently with my mother. It was horrendous. I read this article on the subject when I Googled it:

The term "sundowning" refers to a state of confusion occurring in the late afternoon and spanning into the night. Sundowning can cause a variety of behaviors, such as confusion, anxiety, aggression or ignoring directions. Sundowning can also lead to pacing or wandering.

Sundowning isn't a disease, but a group of symptoms that occur at a specific time of the day that may affect people with dementia, such as Alzheimer's disease. The exact cause of this behavior is unknown.
Factors that may aggravate late-day confusion include:
Fatigue
Low lighting
Increased shadows
Disruption of the body's "internal clock"
Difficulty separating reality from dreams
Presence of an infection such as urinary tract infection
Tips for reducing sundowning:
Try to maintain a predictable routine for bedtime, waking, meals and activities.
Plan for activities and exposure to light during the day to encourage nighttime sleepiness.
Limit daytime napping.
Limit caffeine and sugar to morning hours.
Keep a night light on to reduce agitation that occurs when surroundings are dark or unfamiliar.
In the evening, try to reduce background noise and stimulating activities, including TV viewing, which can sometimes be upsetting.
In a strange or unfamiliar setting, bring familiar items — such as photographs — to create a more relaxed, familiar setting.
Play familiar gentle music in the evening or relaxing sounds of nature, such as the sound of waves.
Talk with your loved one's doctor if you suspect that an underlying condition, such as a urinary tract infection or sleep apnea, might be worsening sundowning behavior, especially if sundowning develops quickly.
Some research suggests that a low dose of melatonin — a naturally occurring hormone that induces sleepiness — alone or in combination with exposure to bright light during the day may help ease sundowning.
When sundowning occurs in a care facility, it may be related to the flurry of activity during staff shift changes or the lack of structured activities in the late afternoon and evening. Staff arriving and leaving may cue some people with Alzheimer's to want to go home or to check on their children — or other behaviors that were appropriate in the late afternoon in their past. It may help to occupy their time with another activity during that period.
With
Jonathan Graff-Radford, M.D.

Best of luck!!
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MarilynR Sep 2019
THANK YOU!!!!! SO MUCH APPRECIATED : )
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My mom's sundowners usually occurs about the late afternoon when we're
on our way back to the CH where she resides. She starts asking about her brothers and her Dad (all deceased) over and over. When I tell her they've passed, she's shocked, why no one told her, etc., but I gently remind her she was there at the funerals but she just forgot.
My mom's sundowners could mean she's tired, since we usually go out 1-2 times a week for about 4-5 hours doing lunch and store shopping (her favorite activity), and really enjoys herself.
Anyway, I've started carrying a water bottle & encourage her to drink thru out the day, especially when the sundowners comes on, and then I change the subject to something more pleasant.
My mom is on meds, and about 3pm when it starts to wear off, behavior agitation sets in & the CG has to give the next dose.
Occasionally 5mg. of Melatonin in addition to her medication helps her settle down at bedtime if she's still restless.
Best wishes.
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In my experience, as a nurse, some patients do really well with Ativan for anxiety or Trazadone for sleep. It helps agitation generally and may calm your loved one, thus encouraging sleep. Melatonin is used alot on my unit as a more natural sleep aide. You might check with your loved one's physician for a prescription for either or both.
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yes my late wife had sundowners, memitine ,not spelled right pc says but I thought I spelled it right. have doctor prescribe my wife did a lot better when she was put on it. you start with 5mg at sundown, and advise doctor how she is doing can increase to 10 mg after like a month, it will take a week or a little more to see the change. my wife got like over it for a long time, she still had dementia not as bad. she was 82 years old/
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I have found out with my mother that when this symptom starts late afternoon is that she is tired and needs to go to bed.
Sometimes this works sometimes it doesnt.
Every day is an adventure with some calm days (very few) and most of them very challenging.
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Mom had it for years -- and sundowning can be dangerous due to falls. I controlled it very well with exercise. I did give her coffee in the morning and afternoon and kept her awake. What helped is taking her to the park and I would walk her a quarter of a mile..everyday seven days a week. It really helped. For the most part she would stay awake all day and sleep all night.

Regardless I used fall mats near the bed and floor alarms--the moment she put her feet on the floor it would go off.

During her 10 years of Alzheimer's disease (now she is very end stage and no longer able to walk), I have *never* given her a single bit of narcotic or psychiatric drug. I controlled her behavior strictly with exercise, and keeping her up during the day. That took a lot of effort. DON'T LET THEM SLEEP DURING THE DAY. Occasional naps are okay--but it is when they get their days and nights mixed up you will run into Sundowning and let me assure you that is very dangerous due to impulsiveness and falls. I gave mom coffee during the morning and afternoons. Coffee, I would say, helped her a lot.
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Mom is in stage 6 and starting to show signs of 7. She has lived with me for almost 7 years and has been sundowning the whole time.

She knocks on my bedroom door 4 or 5 times a night. She doesn't makes sense most of the time and is highly agitated.

She doesn't want the TV or music on. I keep a night light on in her room. I cannot keep her from napping during the day. She will scream, curse and fight you.

Melatonin, Trazadone, mirtrizipine, didn't change anything. We also tried some medication that was in a patch form but she wouldn't let me apply it.

She is now on Seroquel and it has helped some but the night before last she was up 3 times banging on my bedroom door screaming she was going to kill me.

Hwe dosage was increased to 100 mg in the day and 200 at night. I gave her 200 last night and she woke up after 3 hours and was up roaming again for 2 hours until she went back to bed. She is now up again and it is 5 in the morning.

I don't know what to do. She is 86, walks with a walker. She has roamed so much this last 2 weeks she has a trail from her walker in scratches on my wood floor.
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Gsc1964 Sep 2019
If I didn't know better, I would think I wrote this! Only difference is it's my 86 y/o father. The meds they put him on do seem to help him sleep at night sometimes, but it's a rollercoaster ride. He will do pretty well for a few nights, and then be up and down the next few nights. Yes, his walker has worn a path on my wood floors from his chair to his room! I don't know how much longer I can deal with this and the incontinence issues, but he can't afford memory care facilities. My only thing I can suggest is to have a home caregiver come once or twice a week to give you a break. I would go crazy without that.
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Yes, my father had this, and they gave him meds to calm him..I believe it was Ativan...
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As a geriatric social worker in a skilled nursing facility, sun downing was one of our biggest challenges. What we found helpful was hand massages, calming atmosphere. Try to stay calm yourself. Not easy, I know. At our facility we had one resident who everyday around 3:00 would become agitated stating that she needed to get her daughter off the bus. What we did is engage her in in conversation about the situation, provide reassurance that her daughter was safely off the bus and then diverted her attention to something else. Have you had a conversation with her physician? Or a consult with a geriatric psychiatrist? Maybe an adjustment or an addition of medications is in order. Good luck. It's difficult.
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My last senior had every symptom possible with Alzheimer's - I thought. A really quirky one was that for lunch every day, I would have to set out 5 places at the table. Keep in mind now, it was only her & me in the house. BUT....her husband, sister, & brother lived in the walls in her home. (all were deceased) But come lunchtime, guess who showed up?! So there the five of us would sit, every day. Client would not touch one bite till everybody else was served. Oh, the conversations they had!! I learned things about her even her family didn't know. The trouble would start when one wouldn't show up, usually the hubby. Client was convinced he & neighbor were having a hot, torrid, affair, and that's when the sundowners kicked in - 2 pm on the dot. We walked entire neighborhood searching for her deceased, lying, cheating hubby.! The stroll helped with the agitation, a lot. I miss that beautiful lady...
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EnduringLife Sep 2019
This brought a smile....
We have to laugh when we can.
This disease is so horrible and just devastating, but having watched many patients and just recently my dear mom go through it, there are some moments of comfort that are found in the experiences.
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Sundowning is very common. We calm folks down by:

1 paper dixie cup small
1 cotton ball
lavender oil

we a dip cotton ball in lavender oil (just a little), place cotton ball in paper cup and hand to patient to walk around with. It calms them tremendously. They love to keep smelling it. We distribute these cups about the time we know they will start to sundown.

Try different oils on different folks. Some love certain smells over others but do not overpower their cotton ball or it will be too abrasive for them.

Just a little goes a long way.

Hope this helps...
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Thekay Sep 2019
I love this idea but I am afraid momma would think it was something to eat.
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Yes Marilyn, my mil is 92 and has dementia and sundowners. every afternoon around five o’clock she would start fidgeting and looking at her hands front to back and look outside the window and roll up a Kleenex (or) napkin she would ask can you close those blinds and is the condo locked up can you please lock up we would have to assure her that we are here and everything is ok, her chair swivels so she can see her bedroom , kitchen, pretty much she could see every room except the two bathrooms but she would again say is that door locked I wish you would close those blinds she was so nervous and if my husband was outside and I was in the bathroom she would get out of her chair and could hardly stand up and would close the blinds, if we were across the way to the community pool she would close the blinds and windows and it would be so hot in the condo we had to start leaving the air on all the time but then of course she would be cold . God Luv these precious family members who have this awful disease.Its hard for them to understand any of this and for us too but she always went to bed around 7 and she would ask off and on about the blinds and just be so nervous she would not go to bed until everything was closed and locked up ,I would assure her we were there to keep her safe and would never let anything or anyone hurt her so one night I told my husband to close the blinds when she asks and sure enough she said THANK YOU within two minutes she said well I think I’m going to bed, And would sleep all night ! So the comfort of her knowing before she goes to bed that everything is locked up and blinds closed she was safe so we continued to do that even though we waited for her to ask us ,we would go close them and she was comfortable and would go to bed so we learned from that experience, if we were out for a few hours the sigh of relief when we returned was so unbelievable we felt terrible leaving her so if we had to run out or just wanted to go to the hot tub we would wait until she went to bed and leave lights on and the Tv so she wasn’t so nervous and think that we were there. So best of luck with all that you are doing to help with the dementia and sundowners. I will pray for you🙏
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gdaughter Dec 2019
My mom plays her own routine, but going to bed early means she is often up at 2 or 3 AM disrupting my sleep. Dad is deaf so he is clueless in spite of her turning lights on....
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Melatonin gummies 10 mg. Purchased at Walmart works wonders. We also put everything my dad needed in one room (his bedroom). This kept him from wandering. There is also a clock for dementia patients. Tells time, day or night, date, day of week so he could read it & not be so confused.
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My husband has sundowning and is on quetiapine (generic for seroquel) three times a day. The med keeps his sundowning at bay ... most of time, but it resurfaces every now and then even with medication. It is usually between 1-5pm. I have noticed that once he has sundowning, it is too late for the med. He has to ride it out, which could be the whole night. He takes a low dose in the morning with breakfast, one full dose at 1pm and last full dose at 4pm. Usually the 4pm is crucial because that is around the time he gets most agitated.

Your mother’s doc should get her on the med now because it takes time (a month for my husband) to take effect. You will see the night-day difference. There are many meds out there, so ask her doc for advice. Most are cheap with Medicare.

Another option is to try CBD - the non-addictive/good oil in marijuana. You can get them in capsules. It is available online, but not covered by insurance. It is expensive.

Dealing with someone having sundowning is NOT fun. You are not alone. Keep us posted. Good luck.
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Schorzman123 Sep 2019
quetipine is what I gave dad for his sundowners I could definitely tell a difference in his symptoms and made them more manageable 💕
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My Mother experiences this, too. It is very difficult to manage on our end because we can't imagine what she does. We have learned that it helps to close the blinds/window coverings prior to the sun going down so she doesn't notice the daylight change. We play peaceful music in the background and no loud TV. This helps some. Hope it helps you. My prayers are with you through this difficult time.
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HI that is what I am going through with my Dad. His is slowly growing into Dementia.
The few tips I have is;
When she gets agitated try to redirect the conversation to something she knows, understands and likes. That is the best way I have tried to combat this awful disease.
Do not talk business during night hours and she most likely want to talk about things in the past; let her.
When redirecting the conversation go talk about things in the past.
Ssometimes to may have to leave the room to collect yourself cause it can be aggravating to you also.
She may keep asking the same questions just answer her.
I also recommend taking the Savvy Caregiver Training class given by Elder Options or if military ask the Veterans Administration. Although its mostly catered around Dementia, & Alzheimer they are all connected and you would learn a lot. The best thing is it's a free class and you will get sometime away and meet great people.
I hope it helps.
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Excellent replies here. My mom was very afraid at night. When I lived with her the blinds had to be down by sunset and doors locked and checked every 10 minutes until bedtime. She was certain that robbers were out there and that somehow if they couldn't see us they wouldn't come in. It helped if I tried to get her away from the tv early evening and reading or working on a puzzle instead. I gave her a warm bath, then a banana with yogurt at bedtime to help her sleep. The sundowners has gone away now. In fact she sat on the assisted living front porch with me last evening as it got dark with no fear. I really like the lavender on a cotton ball in a cup idea and wish I had thought of it. I'm going to try that on myself, as I have a hard time putting myself to bed at night.
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I take it a day at a time...or evening as the case may be. My mother has a nasty streak and there have been increasing subtle changes...good news, she changed her undies twice...bad news they were soiled and she threw them down the laundry chute...also hanging on to her purse and looking for a hiding place to stash it. Spitting grape skins in the sink though not necessarily a sundowning thing. She goes to bed earlier, and then CAN get up in the middle of the night. We have dead bolted the doors to outside and if she goes out the patio door, the yard is locked and secure. IF medication should be an answer for us, I doubt she would take it. At least once or twice a week she now leaves her vitamin and supplement and 1/2 a BP pill. Before we knew what was going on she went 3 months without the BP medication and she's still here, just having her 97th birthday...so I don't worry.
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There is definitely a difference in my moms temperament based on the time of day.  Towards the end of the day, mom is always more confused and agitated so basically, I don't plan anything for later in the day.  She will eat between 4 and 5 and after that she will rock in a chair looking at traffic or she watches TV until bed time.  Anything more than that is a problem.  My advice is to keep a strict routine and very low key.  I like the idea of the cotton ball sprinkled with lavender oil... I might try that one!
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We have found lavender essential oil extremely effective. We use Young Living brand. I hear some people are allergic, but hopefully that's not the case. We use it around 3:30 daily - roll it up and down the bottom of her feet, and at base of big toe. Often around 5:30 I use it again on my mom on her wrists and back of her neck. I use this nightly to help me sleep better. It has been a HUGE help to us with her meltdowns as long as you catch it before it gets too bad. Also, be aware of over-stimulation - that always makes it worse. My mom is 95 and we've used this for 5 years for her - also use it at night to help her relax and sleep better.
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I find the Sundowners is more difficult when the routines are not maintained and/or the LO is in an unfamiliar place. My Gram did fine visiting us - wherever the military sent us - as long as we kept the routine the same in the evening. I tried to keep her room the same no matter where we were - and she visited with my mom every year for a week or 2.

Having extra lights on as the sun goes down can help too. As others have said, keeping a relaxing evening routine is most helpful.

P.S. I'm an RN and it occurs with many senior patients, not just AD.
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My mother yelled more in the evenings at the nursing facility and they told me it was sundowners syndrome. She had dementia but her behaviors were worse in the evenings for sure. Even the maintenance man told me he heard her yelling out in evenings. I was there more during the day so I didn’t see that. Staff told me.
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By reading some of the responses already Sundowning can occur in many ways. In the case of my wife it was first, that she would not change her clothes for bed clothes. So she wore the same thing day and night, and they got pretty high as you can imagine. She knew I wanted to take them off and change them but the message never got to her taking them off or letting me take them off. It has to do with what is involved in dressing or undressing. The actions are to get ready to do it, then start unbuttoning or buttoning, or unzipping, one by one until you get to the last button, and then the cuffs, one by one, then opening the shirt and removing your shoulder from one side, then the other... If you break the job down to discreet actions done in a required sequence you can see that someone who cannot process more than one movement at a time is just dumbfounded at the complexity of it all, actions we do without thinking, mostly. That is where the Alz person is; lacking the execution ability that she once had. And so the frustration comes out in Sundowning. At least that's how I look at it. To go on, we got the help of Home Health Aides, who have great experience in the process and show a level of confidence in what they do that impresses the patient, or client as they say, and even when they ask permission - "May I unbutton your blouse?" the client seems to be amazed that it is happening and there is no problem with dressing. Then came the bedtime issue. She would not go to bed, would not move from her chair to the bedroom or bathroom. Again I think it is the execution ability to stand up and walk to the bedroom that just is not there. So more frustration. Added to the problem was that her arthritis in her knees got to be really bad (with lack of movement I expect) and she would avoid pain and just not walk. Now she has lost the ability to walk at all, which solves the Sundowning problem, so to speak, and confines her to a wheelchair, which seems just fine to her.

So my advice is to try to figure out what the frustration is all about, from the details of what is going on in her mind that she just cannot do even though she (or he) wants to do. Something may occur to you to lessen the frustration for her. I hope this is helpful.
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The NH my mom was in agreed as well as her dr so I brought in wine & a small pewter glass [2 to 3 oz that I put her name on in nailpolish] so that when she sundowned they would ask her if she would like a glass of wine & she would snap out of it, put a big smile on her face & say 'oh yes please' .... she purred & was a gentle pussy cat as she enjoyed her treat - however mom quite often would have a pre-dinner drink before the dementia so it was something she always enjoyed

I would bring in the wine which was kept in the fridge in the medicine room & replace as needed - I felt this was good for her & the staff because she was easier to manage & she wasn't medicated with other problems associated - this was usually once a week or so

You need to find out what your mom will respond to in the same way because you know her best but off the top of my head you could try mini chocolate bars, granola bars - mainly something that doesn't spoil easily, is easy  for the staff to give her & is portion controlled that is not going to upset dietary or medicinal restrictions [my mom was diabetic]
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My Mother had it when she moved in with us 1 1/2 years ago. I explained to the doctor that she would close all the blinds thinking someone was watching her. Didn't want to go to bed, would get up in the middle of the night and get dressed and try to run out the front door. The Doctor gave her Melatonin 3mg and within a month she was fine. Mom is still taking it once a day at night only.
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When we all age, there is a gradual decline of life force, essential to run the body and brain functions. "Getting tired" is the norm for the elderly. The cause is unique to each person. However, some commonality is that vascularity/circulation is reduced due to organ tiredness. The energy reduces in the fading years, etc. Keeping it simple, Chinese medicine has had answers for this for hundreds if not thousands of years. There are longevity formulas which when used, regularly, will alleviate agitation, improve overall body and cognitive function within 7 days. The key is assessment by a seasoned Chinese medicine practitioner with specialization in Chinese herbal medicine.
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