What sundowning medications can help with Sundown Syndrome?

A fellow caregiver asked...

What types of sundowning medications are there, and how can they help with Sundown Syndrome?

Expert Answer

Paula Spencer Scott is the author of Surviving Alzheimer's. A Met Life Foundation Journalists in Aging fellow, she writes extensively about health and caregiving; four of her family members have had dementia.

Sometimes antidepressants and antipsychotics are prescribed to counter the aggression and combativeness that can characterize sundown syndrome, the decline in behavior in someone with Alzheimer's that often occurs after sunset or in the early evening. It's not known what causes sundowning, but fatigue and the internal body clock may be involved. Sometimes melatonin is used to treat sleep disturbances with Alzheimer's, but over-the-counter sleep medications are not recommended because they can interact negatively with Alzheimer's medications.

Because they can have serious side effects, drugs to treat aggression are considered a last resort. Their  use also needs to be monitored carefully. Longterm use of antipsychotics, for example, is associated with twice the risk of death.

Sometimes there are behavioral approaches that can help with difficult behaviors. Some tips for dealing with sundowning:

* Organize the day so that taxing events (outings, visits) happen early in the day.
* Exercise during the day to encourage tiredness come evening.
* Try closing the draperies before the sun goes down, so the person is less aware of the day-to-night transition.
* Distract with soothing activities. Music often works well.
* Wind down the evening gently, such as with warm milk or a sponge bath (if it's tolerated and enjoyed, not if it’s problematic).

Be sure to consult the person's physician as well and explain the specific problems in detail.