Need help with treating Sundowners Syndrome in MIL. Are there any medications or anything that can help?

Talk to her doc about meds. For my dad it’s Ativan. It’s a tough call to drug dementia patients but my feeling is I’d rather have him calm than paranoid, fearful and obsessive.

Maybe you could request whether the Nursing Home could trial a program for seniors at night. ElderServe at Night,” an innovative dementia care program
offered at night by the Hebrew Home at Riverdale, a senior care facility. The program has received national and international recognition with healthcare leaders from around the world visiting in an effort to replicate it.

http://www.programsforelderly.com/memory-night-program.php

The staff indulges the urges that dementia and Alzheimer's induce, walking with patients who crave a 2 a.m. adventure or taking evening trips to the circus or restaurants. 'We're kind of like the party house on the block,' said Deborah M. Messina, who is 32 and the director of both the day and night programs. The lights are on all night and the music is going.

Here's some tips from the Alzheimer's Association for dealing with/preventing Sundowners Syndrome:

Tips for Coping with Sundowning
Late afternoon and early evening can be difficult for some people with Alzheimer’s disease. They may experience sundowning—restlessness, agitation, irritability, or confusion that can begin or worsen as daylight begins to fade—often just when tired caregivers need a break.

Sundowning can continue into the night, making it hard for people with Alzheimer’s to fall asleep and stay in bed. As a result, they and their caregivers may have trouble getting enough sleep and functioning well during the day.
Possible Causes
The causes of sundowning are not well understood. One possibility is that Alzheimer’s-related brain changes can affect a person’s “biological clock,” leading to confused sleep-wake cycles. This may result in agitation and other sundowning behaviors.
Other possible causes of sundowning include:
Being overly tired
Unmet needs such as hunger or thirst
Depression
Pain
Boredom
Coping with Sundowning
Look for signs of sundowning in the late afternoon and early evening. These signs may include increased confusion or anxiety and behaviors such as pacing, wandering, or yelling. If you can, try to find the cause of the person’s behavior.
If the person with Alzheimer’s becomes agitated, listen calmly to his or her concerns and frustrations. Try to reassure the person that everything is OK and distract him or her from stressful or upsetting events.
You can also try these tips:
Reduce noise, clutter, or the number of people in the room.
Try to distract the person with a favorite snack, object, or activity. For example, offer a drink, suggest a simple task like folding towels, or turn on a familiar TV show (but not the news or other shows that might be upsetting).
Make early evening a quiet time of day. You might play soothing music, read, or go for a walk. You could also have a family member or friend call during this time.
Close the curtains or blinds at dusk to minimize shadows and the confusion they may cause. Turn on lights to help minimize shadows.
Preventing Sundowning
Being too tired can increase late-afternoon and early-evening restlessness. Try to avoid this situation by helping the person:
Go outside or at least sit by the window—exposure to bright light can help reset the person’s body clock
Get physical activity or exercise each day
Get daytime rest if needed, but keep naps short and not too late in the day
Get enough rest at night
Avoid things that seem to make sundowning worse:
Do not serve coffee, cola, or other drinks with caffeine late in the day.
Do not serve alcoholic drinks. They may add to confusion and anxiety.
Do not plan too many activities during the day. A full schedule can be tiring.
If Problems Persist
If sundowning continues to be a problem, seek medical advice. A medical exam may identify the cause of sundowning, such as pain, a sleep disorder or other illness, or a medication side effect.
If medication is prescribed to help the person relax and sleep better at night, be sure to find out about possible side effects. Some medications can increase the chances of dizziness, falls, and confusion. Doctors recommend using them only for short periods of time.

Best of luck!

Sundowner’s Syndrome is common in Stage 3 of Alzheimer’s disease. It is when Competency of the patient to live independently and make legal decisions is no longer possible. I consider it the hallmark indicator.

I agree with other comments here about ruling out UTI/medical issues or recent med changes, first. Sundowner’s Syndrome was the clearly defining moment for us in caregiving. All the routines changed. My mother in law retreated to her bedroom most of the time, except when actively Sundowning. She became more dependent, incontinent, almost bedridden, and clearly had difficulty with current date, who we were, where she was, who she was, and her age/perception of self. We got a new version daily. Some of it was a past reality, some of it was fantasy/delusion born of desires/dreams.

Some of it was fun. I became a beloved daughter in law, instead of a hated woman trying to take over her home and stral “her man”. At times she thought her son was her husband! That subsided with meds...she eventually stopped recognizing it as her home, and thought she was visiting us! The stories she would tell!!! She lived an interesting life, and the blessing of caregiving was getting to know her in a new way, and thankfully, her warped sense of humor remained intact. She became more content, except during those episodes; medication changes helped with anxiety after dark, and keeping the lights on for her/tv on.

But, it also meant alot of LATE NIGHTS, or middle of the night wake ups to return her to her bed, as her biological clock was clearly out of whack. My supervisor at work could not understand sometimes why I requested FMLA leave to come into work a couple of hours late...just to get some sleep!!! Another family member usually took the day watch at 8 am-6 pm.

When it was really bad, my husband and I would alternate taking days off to catch up on sleep/housework/laundry. By the end, after 6 months of hospice care, we struggled to work even PT. After her death, the depression, and guilt of being thankful for release of that burden kicked in...and we both had medical issues that we had delayed care for, crop up. So, watch for burnout. It can happen, even when help is a tag team project. So, if you can, plan a leave of absence or time away after your loved one departs. It takes about a year to recover, atleast.

Have you discussed this situation in a meeting with her care team?
Has she been tested for a UTI recently? I would ask for this tomorrow.

Hi Windy!
For my mom the medication that worked for her, most of the time, was Seroquel. She started on 12.5 mg which is half the smallest dose available. She only took it once a day around 4:00 p.m in preparation for her sundowning. Yes, had to buy a pill cutter to cut those tiny pills in half.

Ativan had the completely opposite effect as intended on my mom, it caused her even more agitation and confusion. Finding the right med is most often trial and error which can be very stressful. We all want that magic solution, but dementia doesn't work that way.

Sometimes a geriatric psychiatric assessment is necessary to find the right combo of meds that will work. My mom was admitted for geriatric psych assessments on several occasions. It is a very individual thing. What works for one may not work for another.

We tried different meds and doses before we found a med that worked. She gets Seroquel at around 4 (now It’s dark at 5). She also gets Ativan when she’s really agitated. It’s working so far

DILkimba, I hope that you guys find something that helps her. She may not remember, but man that has to be so hard to go through everyday. As they live in the moment it must be terribly frightening for both of them.

I would encourage FIL to only visit before the time she starts sundowning, at least until she gets on something that calms her down.

Best of luck getting something on board quickly that works.

My mom who resides in assisted living facility suffers from Sundowner Syndrome she would wander through house at night, and was even entering other residents rooms frightening them while sleeping. After doctor prescribing a couple of medications, that didn’t help, the third one was Seroquel and there has been an improvement with her sleeping and has reduced some of her anxiety. Unfortunately paranoia still pretty serious, but only getting up a couple times at night now.

Contact MIL physician for assistance with medication that could help. Wishing you the best.

Difficult to do if she is in a facility but. In her room change lights to LED it is a brighter light.
Anti anxiety medications might help
Melatonin might also help but if she is not willingly taking medications that might not be an option.