What is the best way to handle sundowning?

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this includes extreme agitation, derobing, and combativeness.

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@bellas, I suffered a trauma when I was in my 30's. I became alcoholic and severely OCD. After I stopped drinking, I was put on Depakote for my OCD and the Trazadone to help my mind rest at night. I was on both medications for about 10 years. I felt that they helped my OCD tendency and I don't think I would have made it through that period in my life without them. At this point if my mother needs medications to help her with her anxiety and delusions, then I am okay with it. I realize that we all strive to keep our parents with us as long as possible but I am more concerned with her quality of life. If my mom's mind can't rest at night and she is pacing, nervous, and exit seeking, none of us are resting and none of us are going to do each other any good. My opinion.
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@gsw92498, my mom was given 25mg of Trazadone when we first started seeing the symptoms of Sundowning. She was repeating herself, scratching at her arm, and overall getting nervous. Last month we had an episode where mom hit her head and started hallucinating and having delusions. She was exit seeking and not sleeping. Her dose was increased to 50mg and now she sleeps soundly throughout the night. She does wake up to go to the bathroom but no more of the exit seeking and setting off the alarm. I feel that with her condition it has been very helpful. At one point, in my 30's I took it for 10 years. It helped with the OCD thoughts running through my head that kept me from sleeping.
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Two medications, Celexa during the day and Remeron in the evening did the trick for us and allowed me to keep my Mom out of the Nursing Home. Go for low doses first but they were a God send for us. Mom now sleeps at night gets up and does everything she always did and takes a nap but is up and going again, the sundowning stopped..... nothing short of a miracle!
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As a geriatrician, I tell families that sundowning in people with dementia is a little similar to the 5pm "witching hour" that parents often see with babies & young children. It's probably a combination of long shadows, being tired at the end of the day, and who knows what else.

Every family has to do some trial-and-error to figure out a way to manage it. Agree with routine, creative redirection, minimizing stressors during this time of day if possible.

Medications are tricky. Most medications that settle people down have risky side-effects, and usually the clinical trials find that medications don't overall help much. But as many of you have pointed out, at the end of the day, it's very important to keep things managable for the family caregivers and sometimes a little medication seems to offer a reasonable balance of benefits and risks.

My main suggestion to the group would be that if you ask a doctor to prescribe medication, start with the lowest dose possible. I once had a neurologist suggest we try Seroquel 50mg for a 91 year old person with some sundowning; most geriatricians start with 12.5mg (which seemed to do the trick for that 91 year old).

Agree with Fraulein that Benadryl and over-the-counter sleep aids (which all basically contain something like Benadryl) should be avoided at they are "anticholinergic". Good luck!
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When it began with my mother, it happened every single day, no matter what, it was a daily occurrence. It seems like they become agitated because of night time coming on just like when people are ill they may do okay during the day but when evening rolls around they begin feeling ill again. Honestly medication is all that has worked for us.
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ROUTINE IS KEY TO KEEPING SUNDOWNING AT BAY AS MUCH AS POSSIBLE.
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You can sometimes tell when a Sundowning episode is coming on if you keep a close eye on what type of day the patient has had. If it's been a rough, hectic day with lots of visitors or doctors appointments bundled on top of each other, medical tests, family events, etc. all of this can trigger the sundowning. You have to be careful with taking the spouse, loved one to social events, Alzheimers' patients are not good in large, loud group settings by any stretch of the word. I've learned the hard way. you do have to sit with them, just go through the process, them your loved one calm and reassured. This can go on for one day to three days at a time. BENADRYL AND OTHER SLEEP AIDS CONFLICT WITH ALZHEIMERS MEDS AND CAUSE MORE CONFUSION, ANXIETY AND ODD BEHAVIOR. DO NOT USE THESE DRUGS. TRAMADOL ALSO WORKS AGAINST ALZHEIMERS MEDS.
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I guess that sundowning can be controlled , in an empirical way, using natural supplements .

In an empirical way we observed that the dementia patients that are taking thst supplements, are showing a great enhancing in cognition, mood ,speech, attention, great mood, recognizing again their children and relatives, a better strengh, very cooperative, including asking for baths, etc.

My aunt have advanced dementia and if she do not takes every day the following supplements ,she starts again with her "old"and odds behavior (as before we started to gives the supplements) ,with hallucinations ,delusions, agressiviness ,agitation , cryings, yells, etc , most the time of the day and most the time of the night .

We are using in an absolute empirical way ,and this is only an anedoctal report.

Only the doctor of the patient can gives permission and have to gives supervision in the use of the following supplements that are controlling not only sundowning , but her agressiviness,delusions ,agitation , hallucionations , insomnia , cryings , yells,etc.

In an empirical way we are giving:

1) L-CARNOSINE : 60 miligrams three times a day.( it is CARNOSINE and it is NOT L-carnitine).(only these small doses).

2) L-GLUCURONOLACTONE : 300 miligrams 2 to 4 times a day.

3) GLUCOSAMINE SULPHATE : 150 miligrams 2 to 3 times a day. 

I know GLUCOSAMINE it is a supplement for joints. 

But when she started to use GLUCOSAMINE for her joints we saw an amazing calmness and control of agressiviness and agitation.We can find in the medical site PubMed SCIENTIFIC ARTICLES that shows that glucosamine stabilizes tau in the microtubules in the neurons, and works as an alternative fuel to the neurons too .

4) ACETYL L CARNITINE (ALCAR) - 30 to 80 miligrams three to 4 times a day.(it is NOT L-carnitine , but is ACETYL L-CARNITINE) ( only these small doses).

5) EXTRA VIRGIN COCONUT OIL - One tea spoon three times a day.(if the patient have diarrhea even with these small doses , the caregivers makes massages with the oil in the thin skin of the arms with the tea spoon of the oil ,once the coconut oil has a comroved fast thras cutaneous absortion (according articles in PubMed).

A lot of friends of mine , after my report , are giving to their relatives with different types of dementia ,with the same amazing effects to enhances cognition,mood and to control the odd behaviors.

Acetyl L carnitine (it is Not L-carnitine) it is a well known food supplement used in small doses to dementias. (we can search in Google).

L-carnosine (it is Not L-carnitine) in very small doses as above , is too a natural food supplement for dementias. The natural source of L-carnosine is the chicken chest.


THE BIOCHEMICAL SEQUENCE OF METABOLIZATION OF GLUCURONOLACTONE :

The natural substance glucaric acid (the byproduct of glucuronolactone metabolization) it is the most powerful substance used by the liver in the detoxifying process of drugs,toxins ,etc.

GLUCURONIC ACID  (a byproduct of glucose (present in all foods) metabolization) it is metabolized to GLUCURONOLACTONE ( or d-glucurono-6,3-lactone or the lactone of glucuronic acid ) that is metabolized to GLUCARIC ACID that is metabolized to GLUCARO-1,4-LACTONE.

Glucaric acid  (present in apples, broccoli, etc.) is the byproduct of glucuronolactone metabolization. 

The best way to find scientific articles that explains the benefits of glucuronolactone is searching in the site PubMed to articles about the natural derivative of glucuronolactone , the Glucaric Acid.

There are dozens and dozens of scientific articles about glucaric acid as a detoxyfing substance and as a heavy metal chelator, peroxinitrite scavenger, and as a "cleaner" of toxic substances.

But this is only an anedoctal report , without none scientific foundation, based in empiric observation only.

We are seeing really amazing enhancings , but ,Only the physician of the patient can gives permissions, and knows the right supplements and the right doses to each supplement.
Please talk to the doctor of the patient.
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I've gone the drug route. At this point my sanity and health is more important than a little sedation. Mom takes Seroquel in late afternoon and Trazadone at night time. The Trazadone worked in ONE dose and has continued. The jury is still out on the Seroguel but seems to be helping. Mom's starts in late afternoon but sometimes wakes up with Sundowners. If she is to stay here in my home, I will have to sleep. I am not a martyr, I am not a nurse, I am not a maid. I have become a maid and a nurse through this experience, but a martyr I refuse to be. Don't even feel badly about drugs. Don't let anyone make you feel badly about it either. My Mom is almost 92, has been pretty much miserable her whole life no matter where she is and I'm just figuring I don't have to be. If she can't stop it and I can't overcome it, she will be going to AL very soon. I have been looking at various ones. You are doing no one a favor to sacrifce your life and health for someone. My opinion.
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Previously mum used to sundown after four pm,wanting to go 'home to cook for the children.Now she starts at nine in the morning.She always want s to go home.
Anyone know what's the cause of this.
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