How do I deal with sundowning?

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How do I deal with sundowning?

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My wife is 78 yrs old. Some evenings she thinks our young children should be coming home and waits for hours at the front window until very late. I cannot reason with her. She is determined to stay there until they come. (Our children range from age 53 to 39. They won't be coming home at night.)

How do I handle this so I can get some rest and survive to take care of her?

Alzheimer's & Dementia Family Caregiver Sundowner's Syndrome

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Can you tell her...any of the following..
**They called and went to a movie and wont be in until later, they said to go ahead and ...(insert something here)..eat dinner, go to bed, watch TV...
**They called and decided to watch the game at "Bobby's" house.
** "Sue" asked if they could spend the night so they won't be home.
**They already came home and went to bed. They came in the back door

The sun going down, changing light and reflections can be troublesome.
There are shadows that you see that make things different.
Make sure that inside the house is brightly lit. I would switch to LED bulbs in a brighter lumen.
Pull blinds or drapes so that windows do not act as mirrors and it looks like people are outside.
Place a dark entry rug in front of the door. Often people with dementia will not cross a dark rug thinking there is a hole in the floor. (works for some not for all)

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Grandma made great suggestions. So far, just having a bright house seems to be helping stave off sundowning. Sure, she complains that we’re wasting electricity, but I’d rather have that fight than her telling me she’s never seen me before in her life and what am I doing in her house (it’s my house).

And when she still sundowns, come up with a good plausible lie. If she remembers them as little, think back to when they were little. Did they ever go to camp? Stay at their grandparent’s house? Use something from her memory bank.

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The electricity..one of the reasons I suggested LED bulbs. Not only are they brighter but they use far less electricity than a regular incandescent bulb (if you can even find one any more) and they are brighter than fluorescent bulbs. And the LED's last far longer than either.

(6)

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My Mom needs some extra anti-anxiety meds for this time of day.

We have the services of a geriatric psychiatrist. It made a huge difference.

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The other day when I visited my mother in memory care after lunch she was "packed" and ready to "go home" when I arrived. We spent several hours, including a group activity that was supposed to distract her. But when it was over, she persistently demanded that I take her "home." I tried asking her where she expected to go, but she assumed I knew and followed me to the door, still asking to "go home." Eventually it came out that she expected to go to her childhood home in another town, which was sold 60 years ago.

She's got anti-anxiety medication since she's been highly neurotic all her life and worries about everything. But at least one of the nurses there told me she does not agree with the use of anti-anxiety medication. So I'm unsure how often she gets that.

After this episode, I decided not to visit her as often as I have been and never after lunch. This is causing me agitation, anxiety and sleeplessness. Some of the other suggestions are good ones, and I'll have my brother, the HCPOA, discuss this with memory care management. Thank you.

(5)

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Just in case you don’t know, there are 14 articles on Sundowning, plus many ma,y old questions and discussions. You can access them by clicking on Care Topics on the top right of the screen, then on S for Sundowning, scroll down to read what you want. Grandma’s comments are brilliant, and there might be some more that would help too.

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Sometimes it is very difficult to deal with sundowning, especially if it impacts the rest of the caregiver. Here’s a web link that might be helpful: https://www.nia.nih.gov/health/tips-coping-sundowning

You may need to try different things until you find something that works, then by that time another new behavior may have arisen.

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Here a a few techniques to try:
1 - Make sure she gets most of her sleep at night. Make sure naps during the day are brief so she will be tired at night. This may cut down on the "confused time" with Sundowner's.
2 - Make sure she gets into the sunshine, but avoid 10 am - 2 pm when the rays are more concentrated to cause skin cancer. Sunlight helps to regulate the circadian rhythm.
3 - Put on more lights in the evening and afternoon. It appears that lengthening shadows are related to more confusion. More light helps things to "look normal."
4 - Redirect her attention as much as possible. Have her make a salad for dinner, set the table, select a movie or tv show to watch, select a radio station... Dance with her to music you both enjoy. The idea is to engage her brain in another thought or activity so "the looking for the children thought" isn't triggered.
5 - Be patient. That "watching for the children" thought is a very strong pathway right now, but will diminish with time.
6 - If her persistent thought/behavior causes her anxiety or "acting out," please notify her doctor. Anxiety and frustration is usually the cause of "acting out." especially when the world doesn't seem to make sense. She might benefit from a mild anti-anxiety medication.

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Absolutely! Everyone of your excellent compassionate suggestions is what worked for my Dad.

(1)

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I controlled my mom's sundowning with daily walks. I also gave her coffee in the morning and early afternoon. I would keep her occupied to keep her awake. She slept all night. Her Alzheimer's also became extremely severe--yet she generally slept all night BUT I worked hard to keep her up during the day, and only let her take very brief naps. I ended up having to get a $700 upright walker but it kept her walking in the park for 5 years. She was able to do 1/4 a mile every single day and I LOVED walking with her. It was like paradise being with my mum taking her for walks. She loved it! If she got the "crazies" during the day it's another walk in the park and when done she was perfectly relaxed. Exercise is more important than pills.

If they sleep all day you will have a severe problem at night.

Be careful using medications because that predisposes to falls and more confusion. Many narcotics will also cause impaction...I never used those meds for my mom. Other than routine stuff she took all her life for her blood pressure and insulin-dependent diabetes. Mom lived to be 90 years, 3 months and was bed ridden the last 3 months of her life because she literally forgot how to stand and could not do it. Complications of kidney and liver disease from her IDDM killed her--not Alzheimer's. In the end I had to get her a feeding tube which she did really well but a body gives out and 10 years of chronic kidney disease (I did the feeding tube for comfort so she would not have to die of dehydration which can take weeks). So all her needs were met to the end and she died very peacefully and her skin was in perfect condition.

Doctors were amazed she lasted that long considering her litany of many chronic illnesses which are too many to list here. I also have to say that her medical management was constant but I kept her sugars very well controlled all her life to the end

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What an amazing person you are. Your mother was very fortunate to have you till she passed. She was blessed with you and you with her.

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I think your wife's issues are more delusional rather than a sundowning problem. Taarna offers some great techniques for addressing sundowning, which you may want to employ. I think grandma1954 more accurately addresses your wife's problem. Your wife is staying up late because your children haven't come home yet. Of course, they won't. You cannot reason with her belief that the kids are coming. Your response needs to validate her concern. You do that by coming up with a reason why the kids won't be coming. Grandma1954 does a good job of suggesting some responses. Go back and read them. Providing your wife with a reason the kids aren't coming may be a reasonable reason in her mind for her to accept that and go to bed.

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My 96 year old mother’s sundowning isn’t as difficult as it sounds like your mother’s is but we have found CBD to be a real help. My mom rocks and becomes anxious (“I can’t sit still”) starting sometimes as early as mid-day. We give her Super-High CBD tincture in small bit of juice. Once you figure out right dose it really helps.
Best of luck!

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I don’t think you can reason with her. She’s showing high anxiety and I would seek anti anxiety medication for her from your family doctor or a therapist, or nurse practitioner.
She’s their mother and will always be worried. They can, perhaps, call a few times to reassure her. But medication may be needed.

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Maybe you can tell her you'll wake her once they come.

Maybe you could say they already came home and are sleeping.

Maybe you can say they're spending the night somewhere like a friend's, grand parent, ect.

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I feel for you! My mother's sun downing was extreme. Do not try and reason with her or answer her questions. Divert, distract and deflect! Try saying, let's have a cup of coffee or tea first. Let's fold these clothes first, let's have a cookie first. I had to try to get ahead of her sundowning by medicating her beforehand. Trazadone worked. It is a sleep aid, but did not make her sleepy. It worked to calm her down. Alzheimer's patients respond differently to medications than us. For a few months I had to give a Trazadone every 2 hours just to get ahead of the sundowning. 3 Trazadones a day STILL didn't make her sleepy. Amazing! Eventually, her sundowning subsided as her memory declined and I was able to decrease the Trazadone to one a day. Try other medications at low doses to see what works, eg. Lorazapam, Seroquel, Gabapentin, etc. Someone mentioned CBD. That's a great natural medicine that may work. It worked for my Mom for a while. Watch the Teepa Snow videos. I learned A LOT from her. All the best.

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I forgot to mention, deep breathing for BOTH of you! Try to remember to take deep breaths while she is sundowning. It will help you cope. Also, hold her hands, look into her eyes, tell her to take a deep breath (you do it with her). Agree with whatever she says. Validate her feelings. "Yes, it's awful. I completely understand what you are going through. It is so hard. But, you are doing very well." At what? Doesn't matter. She will feel comforted to hear that. After that, try dancing with her, you know, Waltz style. Just grab her hand and waist and go. No music necessary. My mother would giggle everytime.

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My soon to be 99 y.o. Mom lives in an apartment down the hall from me. She has 24/7 live-in care and I manage her life, household, medical, medicine and navigate her ailments with her along with doctors that help me with every hiccup.

The geriatric neurologist, palliative doc, geriatric psychiatrist, primary doctor, gastroenterologist, retina specialist, have been a life saver giving her “quality” of life. Mom no longer has sundowning episodes, her depression is minimal, she sleeps most of the night ( not counting bathroom visits), the psychotic episodes have stopped. She’s more pleasant than she’s ever been. Yes, she is on a cocktail of medicines but it has tuned a turbulent
situation into a dignified journey. We tweak her meds and I’m in touch with her doctors regularly.

Geriatric neurologist and group of sensitive physicians is the best advice.

When my mom asked me “why are you here?” I said “you gave me life and I’m giving you quality of life”

My heart goes out to you.

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Sundowning is a tough nut to crack. My dad had severe Alzheimers when my sister took him into her home. Sister and BIL were both retired, I was still working, but I slept with dad in the same room one night a week to give them some rest. Dad would get up, usually around 1:00 AM or so and go off on a dementia rant. No prescription medication worked real well, unless he was snowed. We used it rarely, we didn't want to. I stayed over for a few full moons. That was the worst. You will have to rely on a Dr's advice, I have no answers for you. I do have a funny story though, after a bad night when I was staying over, we got my dad up in the morning to dress him. My sister told him you gave Frankie a hard time last night. He said he was "just negotiating" with me. We all had a good laugh over that, and he had a good day. Best wishes to you.

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The moon link is interesting. My mother worked a rotation as a student nurse in a mental institution (it was in the 1950’s before they were all closed) and has always said that the patients' symptoms were worse during a full moon,

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Please read “36 Hour Day” and watch some of Teepa Snow’s - YouTube videos.

The advice is invaluable.

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Imho, you should read the book, "The 36 Hour Day" to fully understand why you cannot reason with your wife since she may appear to have a broken brain.

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It sounds like she has a bad case of dementia, and I think you might want to try ignoring her whenever she says that. Also, you might want to consider putting her into a good facility where she would get good care.

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For quite awhile, Melatonin helped with the sundowners. Lorazapam also worked. Once these stopped working, the geriatric psychiatrist tried various antipsychotic meds and my sister had such bad reactions at very low doses that she was hospitalized - first for two weeks (Latuda) and then for four (on Zyprexa). She also had a very bad reaction to Trazadone - she got stiff as a board (a condition known as dystonia). She is now on a very low dose of Klonopin before bedtime.

Each person reacts differently to these meds and it often takes 4-6 weeks to see the full effect. They have to be watched very carefully for side effects.

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5mg melatonin helps get us through most afternoons and evenings. Takes the anxiety off. Melatonin does not get dad to sleep anymore. Now we are trying 25 mg nortriptyline and 1 ibuprofen pm (he sleeps most nights with this combo) but now he have a potty time issue if you know what I mean. So I've starting to look at the cbd oil.

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Your wife has dementia and you can wait until the cows come home, it will only get worse and I doubt any medication will help. You cannot continue to live like this - you will be destroyed - and then what. You have two choices: get a caretaker for evenings and nights or she must be placed. There is financial help available to do this. I don't know if would be possible to give her a potent sleeping pill so she sleeps and you get some rest. What else is she doing? Is it possible to ignore this behavior? If it is harming you, then YOU must put a stop to it by choosing a solution so you have some peace. I see no other way to help.

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maybe pretend that your children called you when she was napping and said that they are staying over at a friends house and that she (your wife) will see them soon but that she should rest knowing that they are safe at a friends house. not sure if it would work but worth a try. wishing you luck.

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My father is on Buspirone for anxiety, clasapane at night and 10mg melatonin. These medications helps him relax and sleep. I have my dad on a very strict schedule from the time he wakes up until he goes to sleep. My dad would say every evening I need to go home. I said you are at home and redirect his attention. The medication will help you redirect. You need a good nurologist that will help with each issue that arises.

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My heart breaks for you. I am so sorry you have this hard road to travel.
I think distraction distraction distraction.
Hey Sally, while we are waiting let's get this pretty puzzle started.
Can you help me with the dishes while Julie is coming?
Since the kids are not here yet let's get that spa treatment you wanted. ( A bath)
Sally, they love you so much, let's call them to chat! ( If this is reasonable)
While we are waiting for the girls to come let's find those fun ... ( Fill in the blank) to show them.
Creativity and distraction is vital to your peace of mind. Also there may be some liquid antianxiety med you could mix in with her favorite treat (ice cream at our house). Talk to doctor or PCP to get their thoughts on medication help.

Oh! One more idea:
Get her a weighted babydoll. Sometimes in memory care that helps mother's care for their baby. ...it might help.
Best wishes

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Low doses of melatonin starting at noon has really helped my mom for about 2 years now. There is documentation in medical journals on the use of Melatonin for Sundowning. The journal I read it from is "The Archives of Gerontology and Geriatrics" year 2000. A good article to print and give to your LO primary doctor.
Its an old article, but it has good information.

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How do I deal with sundowning?

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