Is there anything else that can help with 'sundowning'?
My dad had a severe stroke two years ago. Some minor health issues since but basically home with my mom as caregiver doing fairly well. All of a sudden he's become very hard to get along with, agitated, cursing and trying on occasion to hit at her. We noticed it starts about 6pm, or just before. His doctor diagnosed sundowning.
We are trying Geodon 40 mg. in the early evening. We thought we had hit on something until last night (he had been on it four days). Last night he woke up at 1 a.m. talking about anything and everything, and never went back to sleep but dozed off and on for awhile. At 5 a.m. nothing would settle him but to get up. He talked nonsense (which we refer to as his fantasy stories) all day, but at least in a good mood, laughing and joking with us. He knows all of his family by name and association but he is not making sense. After doctor's visit today we were told to increase his Lisinopril in the morning from 20 mg. to 40 mg. and that it would help even him out. We are to start that tomorrow. Tonight we were right back like it was even though he had his Geodon. Is there anything else that is known to be effective with this problem? We need help soon. As long as he was cognitive in the day we were able to handle him, but today was horrible. Any advice appreciated.
As dementias progress, whether caused by Alzheimer's Disease, Vascular Disease, Lewy Body Disease, or some other cause, it is common that people become agitated, like your dad. Agitation is particularly common in the evenings, as you have seen, and when that happens, many people refer to it as "sundowning." The cause for this phenomenon is not completely clear, but it seems to be a combination of disorientation from the lack of light, endocrine changes that take place as part of our 24-hour circadian rhythm cycle, and fatigue. As the dementia progresses, the agitation often spreads to earlier hours. The agitation is sometimes mild and consists primarily of restlessness, but it can progress to marked aggression. This aggression can be very frightening and dangerous.
Treatment of the agitation that can accompany dementia is challenging. Some things other than medication can be helpful, such as soft music, a favorite television show, or even comforting smells. It is important to not get caught up in arguing with the person with dementia. While it may be reflexive, it is rarely helpful to try to help them understand their beliefs are not accurate. That often just fans the flames. If the person with dementia is depressed, antidepressants can be very helpful. Some people believe mood stabilizers, like Depakote or lamictal can be helpful, though the studies are not very supportive. Sometimes adding a cognitive enhancing medication, drugs that can slow the course of dementia like donepezil, galantamine, razadyne or mementine, can help. It is also important to help your father get a solid night of sleep, and that will likely at least decrease the intensity of the symptoms. I previously answered a question about sleep problems in people with dementia, and I refer you to that if you are interested.
The most common and probably the most effective class of drugs for the treatment of agitation associated with dementia, however, are antipsychotic medications. These drugs are not licensed by the FDA for this purpose and there is a block box warning when they are used to treat someone with dementia. They are thought to increase mortality in this population. On the other hand, they are often very helpful. This is a very tough area, because using them is risky and not using them is risky. There are 7 "atypical antipsychotic" medications available, and they seem to have a somewhat lower risk for serious side effects than the older antipsychotic medications. This group includes ziprasidone, the medication your father is on, as well as olanzapine, risperidone, quetiapine, aripiprazole, papiperidone and clozaril. They each have a unique mechanism of action, so a trial and error period is sometimes necessary. They each require careful monitoring to titrate the dose properly, and sometimes to adjust the time they are given. These are drugs with significant risks, so you want to be sure the doctor you are working with is knowledable about them.
The Lisinopril your dad is taking is for high blood pressure. It is not a treatment for agitation.
What about the new "trial" drugs in research by UCLA?
What stage of Alzeheimer's is sundowning, and how much longer do they go on?
Have you tried a mid-day nap? I found w/my Mom that just not being so tired helps. That said, her circadian cycle is all messed up & she often goes to bed early & "has another day" from about 1 or 2AM to 6 or 7AM. But she lives in her own little apartment so that she can do whatever she likes w/o bothering us (too much!). We tried several chemical interventions (medications)over 2 years & while none helped, a few made things worst.
He always took an afternoon nap. Xanax helped for awhile, but even that didn't help for long. He has since passed away after a turn for the worse, and 5 days after Hospice came in. He is at peace now. Heaven has no Sondowners!!
I especially "liked" the notation that Lisinopril is a blood pressure med and won't help his problem ! As a "lay person", I am not beyond asking: Where oh where is dad's doctor coming from?! He gave an off the wall suggestion, merely to placate, I think. Thank you for posing this problem. Many caregivers are in the misdst of dealing with this and so glad for Dr. Robbins response.
Thought this was a great topic, and good, thoughtful answer. We get asked about sundowning a lot and have a little bit of (non-clinical) info on our website: http://www.agingwisely.com/old-age/ (terminology) & http://www.agingwisely.com/sundowners-syndrome/ (some tips). I know it can be exhausting as a caregiver. Hope you find some good solutions!
Experienced sundowners taking care of my mother, she would start about 3:00 in the afternoon. I found that having something sweet, like cookies, fruit or a piece of candy seemed to help, also turn on some lights, do not try to correct them they just get worse. Go along with their stories. Food seems to be of upmost importance, so make sure they have dinner at about the same time. I do not like the medications they just seem to create problems during the night with sleeping and they just have stranger episodes of delusion, and make no sense. Some days are worse than others. Try not to pay too much attention to them, but watch to make sure they don't hurt themselves. Continue trying to live your life too the best of your ability, and usually on a bad day they will want to retire early. Tomorrow will be another day.
firstly, sudden onset of sundowning is unusual. secondly, "sundowning" that lasts throughout the night with violent and acting-out behavior is NOT sundowning.
classic dementia sundowning is usually a 2-hour thing or regular pattern and time, often with regular themes -- like being lonely, deserted, frightened and so on.
sundown is a time when many people experience emotional reactions -- babies are fractious, many people are sad, and elders with dementia have a highlighted emotional workout, often using the unhappy themes of their life.
it needs a planned approach. more sleep, perhaps an after-lunch nap, a snack of maybe fruit and juicwe about 2 hours before it usually begins. support, loving attitude and a diversionary program helps. someone who insists Mom (dead for 55 years) is coming to dinner can be helped by eating out and returning home after the sundowning thing has subsided. others need an arm around the shoulder, a box of tissues and you, listening and supporting. as in "Uh-huh", "Oh honey!", Really?", "I know you miss them," and so on.
Sundowning is when you'll hear real emotional truths about how this person feels at this time -- lonely, afraid, longing for the family they once had -- and all you have to do is be there. sometimes with an old family album so they are triggered to talk about those they miss so much.
Now, that jumping around all night thing is more usually a mental health issue -- maybe Bipolar, borderline personality stuff, perhaps schizophrenia long pretended away by family, PTSD in old soldiers and women abused as children. and it needs a more useful psychiatric intervention. i'm not keen on psych meds for elders, but by gosh, it can help bring peace and freedom from the terrors of psychiatric conditions to someone who has long struggled with them.
i cannot emphasise strongly enough that sundowning itself is NOT violent, aggressive, threatening and going on all night long. it is NOT. i really wish that this picture of so-called sundowning had not become popular myth, often in ther very families not willing or not able to discern real mental illness possibilities in their own parents or spouses.
i've worked with elders with dementia for 20-plus years. of the violently aggressive so-called sundowners i've personally dealt with (and folks, they are few and they are rare -- it's mainly myth that they are common and usual) one was a paranoid schizophrenic, one bipolar, two were PTSD and one more allergic to medication which made her violently act out while under its influence.
so if somethig new, violent and different starts to happen, you ask yourself, "What changed here?" If you can't figure out what ( new meds, UTI, whatever), a doctor is needed and preferably a good psychiatrist because they will have all the other tests done.
please, family members, dont put up with violent acting-out assuming it is sundowning and inevitable. it is neither. get help. you'll be glad you did.
SUNDOWNING WAS THE BEGINNING OF THE END in my case. Father (age 79) started showing signs of vascular dementia within five years of his first stroke (minor) then RAPIDLY became irrational, aggressive, combative, abusive, and outright oppositional with paranoid delusions and periodic hallucinations. He began acquiring and spending money fraudulently, spinning wild stories of things he was going to do, getting lost while driving, and worst of all, refusing ALL assistance including medications and countless offers for medical assistance. He believed there were no rules that applied to him and he could do what he wanted when he wanted - child-like. In the morning, especially when he actually did sleep, he could appear to be almost normal BUT by evening, he regularly became disoriented, belligerent, and at times, completely impaired. In the end, after a year of MANY police, adult protective services, and other social services interdictions, he walked away from his home, was picked up in a disoriented state by the police, and taken to the hospital never to return home again. While in the hospital, he became combative and adversarial with the staff requiring restraints and sedation - within a few hours he suffered a major stroke, never recovered, and passed away 10 weeks later.
My attempts to have him declared incompetent early on were met with opposition by his doctor who outright refused to do so since he "appeared" mostly normal during the day. While he had a vast array of medications, he refused to take them and it is very difficult to help someone who won't help themselves or refuses all help from others.
My hope for you is that your medical "advisors" are on the same page with you; that you are able to develop a support network (friends, family, social services) that can provide assistance; that your father's environments can be adequately controlled so that he enjoys what he can and is prevented from hurting himself and others in the time that is left.
I think that one of the things that is missing in the medical community's research is how strokes (vascular disease) creates dementia. My mother has vascular disease and was found thru MRI's to have had a number of small strokes (T.I.'s). Her doctor though tried to address her cognitive loss and yes, sundowning behavior, by treating her as if she had Alzheimer's. Alzheimer's is the default diagnosis when no others can be identified. But in my Mom's case, it was clear she has vascular disease and the subsequent small strokes created dementia in her.
That said, all the general meds used to treat the psychosis that comes from Alzheimers were dreadful for my mother and in fact put her in the hospital for a week.
A neurologist, which we had to get on our own since her primary care doctor wouldn't refer (she felt that it would take too long to get an appointment!), tried some different drugs and the one that has helped tremendously to control her agitation is Depakote. She is taking a very small dose. She is in assisted living now as my father cannot take care of her on his own. But she is doing well and is in a way more healthy than before.
It is still tragic and heart breaking but she is calm, can participate as much as possible in activities (well her version of participation).
If you haven't seen a neurologist, please have your Dad see one and have the neurologist address the unique effects of a stroke that causes dementia as compared to dementia caused from plaque build up.
I really don't have anything helpful, but just wanted to share what my mom does. She is 78 and has severe Alzheimer's.....she gets violent at times, but most times is very sweet. She does take an anti-psychotic drug along with her Namenda and it is suppose to help her sleep at night, but doesn't. So, many nights, she gets up and tries to leave the house (usually around 10pm or so).....totally confused and trying to "go home". Of course, she is already at home where she has lived all of her adult life. It is heartbreaking.........she gathers up an armful of clothes, some framed pictures and her "pocketbook" and out the front door she would go...that is until we installed locks that she cannot operate to get out. That has seemed to settle her down knowing that she cannot get out. One night I had to chase her down the road and we live on US Hwy 27!!! My husband had to get the car and we had to call the neighbors to tell them that she was headed their way....long story short, we got her in the car and back home and back to bed. She has a lot of pain in her legs during the day, but you can believe that night that she was "moving on"!!! She is tall and long legged and I am short, so I could not catch her!! Seems pretty funny now, but it was really a bad situation!!! So far, since the locks have been installed, things are better....much better!!! That's my story!!
My father is on risperidone and this works very well to reduce agitation. A dose after dinner takes care of the sundowner syndrome.
This is a tough issue, so we have to remember the basics. As Dr. Robbins said, soft music and not arguing with the patient can help. Nutrition is also the key. Is he eating the wrong types of food that can worsen his condition - like sugary and fatty snacks? Is he eating enough protein? We often see that elders are lacking adequate nutrition. What is his perceived stress level? Can he possibly be engaged in something constructive before his sundowner syndrome starts? These are all aspects to consider for a more holistic care. For more information you can also visit www.alzheimersprevention.org.
I tried 5 different medications in varying doses until we struck the RIGHT one for us. This is majorly used for epilepsy. Three drops of Rivotril administered three times daily morning, noon & night with 20mg of paracare liquid. This has kept my husband on a very calm even keel for the last 3 years, taking care of any pains he can't tell us about as well as sundowning, agitation etc. He was diagnosed with Alzheimers 8 years ago and also has vascular disease and Atriel fibrilation causing TIAs [mini strokes]. He is completely dependant on care for everything but is very gentle, easy to love and deserves the dignity of a peaceful existence which I will ensure for as long as it takes, this from his loving wife of 58yrs along with very excellent caregivers on a roster basis.
i hate to see references to anti-psychotic drugs being used for the normal beaviors of alzheimer's and similar dementias.
there is NO justification for it, other than to "quiet down" those who may be feeling anxious or upset. no doubt a 2x4 round the side of the head would quiet people down too, but is that medical treatment?
numerous reports from Europe, Canada AND all over the USA are now documenting the numerous deaths brought about by wrongly treating normal dementia with the use of anti-psychotics. being "upset" is not being psychotic. if it were, then most caregivers could be classified as "psychotic" too.
bad doctoring and bad caregiving are the main reasons why people with dementia don't get the appropriate care and help that they need. and we all need to become much more educated about what dementia really is (which is: a description of observed behaviors such as confusion, memory issues and cognitive impairments).
as to what causes that appearance -- well now, THAT is what good doctors are supposed to look for, since about 15 percent of everyone said to have alzheimer's has a treatable, curable or at least adjustable condition due to an established cause. others have identifiable kinds of name dementias, such as Lewy Body dementia, Korsakoffs syndrome (alcohol-related), vascular dementia and so on and so on.
my unmedical but experiential bet is that up to 90 percent of everyone said to have alzheimer's doesn't. they do exhibit dementia, yes, but as to what,how, when and why -- that's a different issue.
a recent report on this very site showed that 50 percent of autopsied people said to have been diagnosed with alzheimer's in life showed absolutely NO identifiable signs of brain issues identified with alzheimer's.
so we all need to educate ourselves, trust what we see and communicate it to others, because the real dementia doesn't yet have a real picture of it out there.
caregivers have much to contribute to the education of other caregivers and even to doctors. so, fellow caregivers, look, see, notice, report, write, speak out. your words can be very valuable.
My mother has only been in the same city with me for a year. The hardest part has been in knowing what medicines to accept that are recommended by the nurses and on-site doctors at the Memory Care Center where she lives. When I go on line to do some research, it is most often that I find that "this drug is NOT recommended for dementia patients"! But, they all seem to take them. She was put on Ativan to deal with her "sundowners" and it was a nightmare! She totally changed and went from being able to play UNO to not knowing what to do with the cards I dealt her! After way too many weeks, I insisted that she be taken off the Ativan and what a positive change. A nurse practitioner I took her to put her on Depakote and that seemed to be find for at least the past six months until today when I received a call from the nurse. She had been doing some strange things and agitated with staff members. She called later to say the doctor had been in and was recommending 25 mg of Seroquel at bedtime. Again...you go on line and it says it can be fatal for older patients and not recommended for dementia. My sister says no but what is the alternative? I lose sleep over these decisions and pray that we are making the right ones. My mother is still pretty high functioning and I couldn't stand seeing her turned into a zombie. I work full time and visit her after meal time which is her hardest time...and also the time that there are no planned activities for the residents. We play UNO or some easy card game for almost every visit. She still beats me most of the time and is her one pleasure. Other residents often join us and it is a fun time and good to see them laugh and enjoy that time. I wish I could do it every night!
Any experiences with the Seroquel?
A great article in the New York Times (Dec. 2010) describes "Sundowners'Syndrome" as almost eliminated in the few nursing homes that take a new approach to helping with agitation and depression. Sedatives or tranquilizers can become a thing of the past, but cookies and chocolate take on new importance. This rarely taken approach almost certainly calls for round-the-clock care, but I have already told my kids that that is the way I wish to be treated if I ever develop these kinds of issues, so let's all start saving every penny. I LOVE chocolate!
Go to : http://www.nytimes.com/2011/01/01/health/01care.html
Do you disagree with specialists, brain scans, and doctors opionions and advise? One can only deal with this terribly debilitating disease the best they can, remebering that there are huge variances in all patients. To show continual love is the best medicine of all.
In response to alovingdaughter: My Dad has been on Seroquel. He has been on it for about a year. It is the only medicine that has been able to help him. My understanding is that deaths only occur rarely and those on higher doses. My Dad is on 200mg a day right now. I guess the doses can go up to 800mg a day. Yes it is dangerous but all drugs can cause death and at least this helps him not be so agitated and unhappy. Nothing else has worked for us. My Dad seems happy on it and I'd rather have him pass happy then anxious/unhappy. Good luck with your Mom.
My wife has this problem during the last 2 years, and problems here described are somehow similar. For agitation Drs. gave her Seroquel 25mg in hospitals and nursing homes. At home I stopped seroquel since she could not sleep dr prescribed Lunesta. This worked fine except it created a continous diarrhea. Doctor gave her Benadryl for sleep and this works fine w/o side effects. Most of the time wife and get along very well as I ignore issues with memory loss. She sleeps during mid-day and it is OK. Sometimes at about 7-8PM she talks about to see her mother,and I just keep talking to her and play classic music. Give her Benadryl and eventually she goes to sleep. Problem happens with CHANGES to her. We go out for a ride and have dinner all goes fine. But coming home is a tragedy since she wants to go to her mother (dead over 50 years ago). I have problems to handle this specific situation since if she tries to leave she may fall if I stop her(she uses wheelchair since broke hip while ago). Benadryl has worked very well and I just asked doctor when should I give it to her when we go out(CHANGE) Joseph
I wrote the above article and would like to expand it. Many doctors and nursing homes give to patients Seroquel for agitation. I disagree with this method, mainly in nursing homes and skilled nursing facilities, where they do it to get off their backs a patient who asks for help. I witnessed this 24 hours while watching wife at those facilities. As I said at home for about 2 years I don't give to wife Seroquel even her doctor prescribed it. Wife got more agitated with medicine AND her blood sugar(glucose) went to the skies. From 95 to 125. Terrible!I personnaly take care of her, take her to the park, talk to people and have fun. At home, sometimes during eve she asks about her family, visit her mother. I follow the conversation and give her alternatives. Maybe tomorrow we go to visit her!Fine she says. At night (1-2 AM) she got restless and could not sleep. Doctor gave her various sleeping medicines that did not work. Lunesta is great and she could sleep 8 hours, but she developed intense diarrhea. Finally, doctor recommended Benadryl-OTC (1-2 caplets).It has worked fine for 4 months w/o side effects, and she sleeps 8-9 hours. So I have been successful with wife's situation and plan to do it for ever with her.
What I am trying to get answer from her doctor how do I medically handle wife when she goes through a sudden CHANGE (#1 enemy for these patients). For example going out and returning at eve, when she becomes very frustrated and wants to go to her mother's home since our home is not hers. Will see!. If anybody knows of a good psychiatric in USA, please let me know, since Insurance companies' doctors don't know how to help these conditions. You know the well known statement from doctors/hospitals:"If you have an emergency condition mental or physical call immediately 911. My own experience that ERs responses to 911 calls are excellent in body physical situations, but for mental problems they have shown to me they cannot handle the situation. They are not qualified to resolve the problem except, give to her Seroquel. That I know so I don't go to ERs for those problems
hallo Anon, yes, there are many great psychiatrists all over the place. most of them can certainly do a meaningful interview and assessment with you and your person with dementia, to help both of you and certainly to assess, review and intervene where appropriate with medications. ask in your own community. there will be at least one. check with local mental health care programs, since good psychs are often involved with those. ask your senior services or agency on aging. it's really not so hard to, do your homework and you will be rewarded with access to someone with the right expertise. neurologists aren't much good for behaviors, because they deal with brains, not the thought and feelings of brains (isn't that absurd?!) do your own local research, even check on-line in (for example) angie's list. if not familiar with that, get a computer geek to help you -- your little grandson, for example. all the best, my friend.
Most Physicians' will prescribe an anti-phycotic drug which yes does help to some degree. However when Sundowning begins it is best to leave lights' on so that the person doesn't actually realize that it is getting dark. Turn some soft music on. Dont' have a coat rack in the bdrm. or anything of that nature as the person with Alzheimers' often see's this as someone standing there which scares them. Make sure they are eating properly, Ensure is a good supplement for those who dont' eat very much. This they can have 3 times a day. Myself I have found leaving lights' on, soft music, a good diet. Prescription medication if needed. Lighting is a key source so they are unaware of it becoming darker, this is why they call it Sundowning "The Sun goes Down". Hope this has helped.
just to add something. as a friend of mine told me, when she took her Mom to the neurologist to find out what really was going on, the neurologist said, "We neurologists deal with structure of the brain. To deal with the thought in the brain, you need a psychiatrist." That was how her Mom finally became diagnosed with (lifelong previously undiagnosed) Bipolar condition and is now doing very well on the right meds, not over-medicated at all but fully able to be her real funny and smart self, without being driven by a Bipolar condition. So, for behaviors wild and out of control on an ongoing basis, try a psychiatrist for a real solution. And please remember that wild and crazy and violent is NOT normal to dementia. Dementia may have occasional outbursts (often evoked by unskilled caregiver interaction) but life as a long journey of over-the-top behaviors -- no, that's something else.
To know more about normal dementia, take a look at my newly published book "Speaking Dementia," by Frena Gray-Davidson and available on amazon.com, where you can read inside it for free too!
Don't despair on sundowning -- in my caregiving life i could eventually figure out a plan that worked for everyone i ever cared for (it takes observation, trials and errors and an empathetic attitude) with dementia. with the seriously mentally ill elder, no, it never worked, but at least we got those to a good psychiatrist. don't believe anyone who tells you sundowning can't be helped. it can and my experience is that once you make a good sundowning plan, it goes away. it is ONLY a sign of stress in dementia. that's all.
This answer is in reference to a gentleman who gets wild at different times of the day, and my response is based on experience with my wife for about 7 years. She had similar outbursts at different times of the day mainly about 2-3 AM. She got up with a lot of strength, walking in the room, falling, etc. After my discussions with a neurologist, she suggested keep her at home, provide attention and love as much as possible AND remove as many as posible of her medications:Seroquel, trazadone, lunesta, ambien, etc, etc. I did that and worked with the care giver to provide attention to her so she saw herself at center stage. I took her to the park, restaurants, coffee shops and interacted with people. The whole world changed and she is for her situation a normal person. What I mean we know she has the problem but it is never touched or mentioned. I challeged her with topics ranging from sports, weather, politics and explain to her when she says I don't understand. For sleeping and prevent any potential problem I give her Benadryl 24 mg prescribed by her doctor. You see I have changed a person so remove as many as possible of his medications, and provide attention, care and love. you'll succeed! Joseph
Personally meds didn't help Mom much and if they did the effects didn't last long. I wouldn't provide any meds that will prolong the suffering. Pain free and sedated worked best for both of us. Her pain free and me sedated!
Sundowning isn't a myth IMHO. Mom went into overdrive as soon as the sun set. She went until she got tired of going. So we had to figure a way to fool her senses. We used bright lights when Mom was supposed to be up and dim when she was suppose to sleep.
My husband with vascular dementia almost broke my finger several months ago as his pain, agitation, and unpredictable behavior grew worse. His Mayo trained dementia geriatric specialist could not get control of his continuing disturbing behavior (mental illness runs in the family). Dr. has referred spouse to palliative care who closely monitors his meds and volatile behavior. Sometimes he is irritable and negative all day long; other days he is okay until sundown. I give him 25 mg. Seroquel to control his behavior in the evening. I caregive ALONE (no help in 7 yrs) and he outweighs me by 60 lbs. I need all the help I can get because talking sweetly and feeding him chocolate will not calm him down.
My 97 yr old grandmother takes 25 mg seroquel at 10 am,(so she's not nasty to hospice aids by 1:30) and then 50mg at bedtime. Also ativan 0.5 3x day so she doesn't get aggressive and delusional! Sha has always been high strung and to some degree arguementive! All these meds and she won't close her eyes to slept or map at all during the day. When she was living alone, she self medicated with whiskey until she began to fall down drunk. She had lived in an assisted living facility for over 5yrs, where wine is served at lunch and dinner,as much as she wanted. But god forbid she fell down, no help from staff, call 911! I'm thinking maybe a lifelong history of bi polar disorder. She is in late stage dementia; legs to weak to walk, starting to get weaker to stand, doesn't know family members including me her main caregiver., recently started becoming nasty to me, when before only hospice aids. I know it's the disease, and chronic uti's,and possibly chf at this point, but you want them to be at some sense of peace, so the meds are given. I do think they are hitting a level of unresponsive ness , but how much more can she take. Each time I give a pill, I hold my breath. 97, 100 lbs maybe, high blood pressure, short of breath(oxygen),etc. she's amazing! Is it just me, or is it. Miracle she waes up each day?
First it is important no matter if they can walk or not that you get exercise somehow during the morning and afternoon hours. Get them outside for some sunlight. After noon naps can often lead to lack of sleep. Benzodiazapams do not work on my dad and they only have to be increased to keep working so forget them, They can also have the opposite effect. Dad gets rispiradone, an antipsychotic but it it took us three trips to the psych ward to get this. If he gets too combative take him to the hospital and have them work with him to get him on some new and different drugs. Then it is important you recognize when this is about to happen and give the drugs prior to the sundowning because they might refuse them otherwise. To sleep my dad takes trazadone which works wonderfully and is not a sleeping pill but an anti depressant that makes him sleep quickly. Often times the hospital will send them to a psych ward type lock down place of your choosing and medicare will pay for most of this. If he gets violent ask him if he wants to go for a ride, take him directly to the ER but have a good place in mind where you want him to go afterwards for follow up care and therapy. There are many drugs some work for some and not for others. Dad has been with me 6 years with Alzheimer's, he no longer walks, or barely at all. I also have excellent aides who are calm and he is often better handled by them at these times than by me. Do your research, check places out, get a list together before you have to take him to the ER, then when they call to see if you want him to get therapy afterward you will have several good places to choose from. I have handled dad in every situation it seems, now 7 years into it he is in end stage, yet he still talks and still knows who we are. It is the close loving family and constant one on one attention that keeps him this way I think cause most people at this stage no longer talk. Remember use the ER if he gets violent, it is hard to do, to commit him, but it will only be for a few weeks to get him stabilized on a med that works well for him. Remember check out your local nursing facilities and find one that specifies lock down and Alz specialties. You will get a day or two to find a bed to transfer him to after the hospital stay is over, and often beds are filled, so start searching now. YOU CAN get this under control, you can. Often the music SOUNDSCAPES or some airy music, even something to eat like give him a pudding snack to eat, can help. Mostly you want to be prepared if he does get really violent and use every resource you have cause the hospital will ask where you want him sent to for rehab and medicare will pay for so many days there, go to these places or call, get your list together, be prepared and please see that someone is there with your mom at sundowning time or an aide is there to help. I mostly use male aides for my dad, it seems to work better. Best of luck, it will work out if you do your homework.
Also get a geriatric psychiatrist, but find a good one, ask the Visitng Nurses or whatever, but find a good one. Dad was on seroquel, now rispiradone. One on one is the best anyone can do for an Alz. patient, get aides if you have to, but watch them, you need a caring one who listens to the parent and engages with them, someone they can trust. I think the ER is best in a violent situation but it is the facility you choose after the hospital that will matter the most, do your homework. Lunesta can have many side effects like awake sleeping, etc, confusion, it is why I use the trazadone.
I worked as a caregiver for many years, and now my Step Dad has developed sundowning. He has had a series of mini-strokes, of which he stubbornly refused to seek medical help within the necessary timeline.
He also suffers from vertigo and low moods swings. He cries easily from the frustration and stress. I really think that when we get older, we suffer brain damage and our thought patterns go astray when their "thought paths" get blocked or broken. I really don't think it is some long forgotten mental illness that has now come to the surface.
Thanks for the advice about bright light and cookies. I think it may help him.
I've been caring for my 90 year old mother for 5 years years, since she began dialysis. She had been on a low dose of citalopram, started by her primary care doc prior to my intensive management of her care. During a months long rehab, she developed a hospital induced syndrome of "anxious-depression". An adjustment of the citalopram and just being home seemed to eleviate the emotional discomfort. Her memory has been poor, rarely knowing the day of the week, yet she knows people and is capable of finding humor in life. Every hospitalization over the past 5 years has yielded the same syndrome of anxious-depression. On top of the 20mg citalopram, mom was prescribed initially 7.5 mg of remeron, now 15 mg. These medication increases occured as the duration and magnitude of the hospital induced anxious-depression syndrome increased. During the latest round of this syndrome I realized something and did some research on the cholesterol lowering statin she was on. I also saw her cholesterol levels taken at dialysis the last 3 years and 2 levels were below 100, one slightly above. Cholesterol is needed for the proper maintenance of the cell membranes of seretonergic brain cells. The particular statin she was on is capable of crossing the blood brain barrier, and has a list of side effects that mimic many of my mother's symptoms. Now add the hospital effect where she eats very little and is on low fat/renal/ diabetic diets, or as I like to call it the purreed cardboard diet. Also add the tests and procedures that require fasting for for up to a day. During these malnourished hospital stays she was still getting the statin and was tested as having low cholesterol levels. The sundowning has also occured in the last few instances of this anxious-depressive syndrome. Last week I suggested to her PCP that we stop the simvastatin, he hemmed and hawed, but agreed given her age and over all condition that stopping the statin wouldn't cause a problem until her next cholesterol test in the fall. In the past week the depressive components of the syndrome have abated, however the anxiety component has become a cyclical sun down type syndrome. It starts every day at 3:30 and lasts until about 5:30. During that period she gags and says she feels like something is comming up in her throat and then she spits in a paper towel and complains about feeling like she's going to pass out. She soesn't vomit or dry heave, but rather hacks up a tiny bit of clear spit from her throat. At dinner, around 5:00 she eats little and once back in the living room with a couple of cookies that she does eat, all the symptoms are gone. Currently I am waiting to see if the sun downing component of this syndrome abates as did the depressive componet now that the statin was stopped. Supposedly the damage to the seratonergic cell membranes is repairable upon ceasing the statin. Her PCP seems to want to increase the citalopram to 30mg, however when she was on that high a level once before, she was zonking out during the day and having these wierd hypnogogic states where she would move her hands as if knitting or something and she would talk to or about things, and she would respond if you quietly asked her about what she was talking about, her eyes closed and hands moving, all the while. To sum up, sometimes less is more. Check all medications your loved ones are on, especially statins. Cholesterol is only checked once a year, because thats what insurance allows. Cholesterol is used by the body in positive ways, for normal functions. It seems like most medical professionals are so focused on lowering cholesterol that they don't really consider what too low is. I'm keeping my fingers crossed that the progress I have observed over the past week will continue. It would be great if something as simple as stopping a drug might improve her condition.