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My husband is 82 and was diagnosed with Medium Dementia about a year or so ago. He seems to be getting gradually worse, which was to be expected, but recently he is wanting to go to bed around 7 pm and he seems to be getting more and more confused in the evenings. How do you handle this....my patience are funning very thin. Thank you

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My mother was xanax 0.25 that help her rest. Also she look at her favor shows and then she goes to bed. Also try or ask Doctor to help you with something for rest. Melatonin is safe try asking for second opinion. Play there favor music at time. Agree above stop all phone call so he can rest.
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My Mom takes Seroquel which has helped a lot. She started with 12.5 mg two and a half years ago, she is now up to 75 mg. I give it to her about 4, helps until she goes to bed at 6:30. I also try to keep her away from the evening news, NCIS, Law and Order, anything like that she completely misinterprets and thinks her children who are now old women are somehow in danger. I even stopped phone calls after 5:30 because they seemed to set off delusions. Though, narc sissies don't like it. Too bad.
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4thdaughter,
I just saw your post and I apologize. I did not mean to include your case specifically. I definitely would use your situation as an example as one that I would use medication if I were at the point you were. Anyway, who am I?? Just very interested in opinions. I was wondering though...What you seem to describe does not sound like the typical "sundowning" scenario. I am not by any means an expert, but seeing people who aren't there and the extra added anxiety and fear may be that there is a paranoid issue going on beside the dementia or that the dementia is affecting that part of the brain. I'm sure your doctor would know. Some "sundowning" clients are known to be ornery, combative, confused, and stubborn. Some just have night terrors, or very bad night mares. When they become paranoid, fearful, delusional, or display some other psychiatric tendencies, it is usually, not due to the dementia, but secondary to it, or related to it. In very rare cases, some people have been hiding a personality disorder all of their lives, and no longer have the ability to control their behavior due to their lost memory, (they forget to act nice, or not paranoid). My Mom is starting to be very demanding. She will just say " ok, I'm ready for dinner", and " your not going to actually feed me that, are you? " Where are going today?" "Whats next on the agenda? Its never, hey, Sara, do you need a minute to pee?
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"Sundowning" in my opinion is everything you all are describing. It is the brain's inability to process what's happening in real time due to changes in neuro-chemestry, which are affected by metabolism, physiology and usually is triggered by fractured light sources. When your loved one gets to this point, and it is safely diagnosed with an intermittent confusion or "sundownding", and not something more serious like a Urinary Tract Infection, (please have this ruled out first) I like to use distraction in the form of music. Out of the five senses, I believe listening to be most useful to calm the anxious mind. Sounds of ocean breezes, or bird noises are all so very calming. People have used herbs and teas for relaxation with scents as well. Going to sleep with a recording of a narrated book is a helpful tool. A monotone voice reading of a novel perhaps. Medication, even in herbal form can often times cause confusion rather than help induce sleep in the elderly and should only be used as a last resort. If needed though, the lowest dose that is effective for the least amount of time that is needed, often times 3 months or less should be used. Evaluation with the care provider should be made at that time.
If your loved one is to the point where you are so frustrated, you want to pull your hair out, they are out of "control", constantly standing at the door trying to escape, or yelling and screaming obsceneties at you, or just somewhere in between,then don't worry, your just like every other hard working care giver. Hang in there, join a support group, and pat yourself on the back. No one else will touch this job with a ten foot bed pan,

Sara, RN
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I agree with GayleV - "sundowning" can go on all night and it's not just a matter of wanting to go to bed early. It's seeing people who aren't there, sometimes yelling and screaming, anxiety and fear ("I know there's someone outside my window!"). Medication is the best bet to ensure the whole household gets a good night's sleep.
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All of these suggestions are good. My husband has it and we try everything and take one day at a time. We still have some bad days but when they happen I have learned to shut my mouth and just keep close to him. He loves cowboys and all I really need to do is turn on the cowboys. I get him icecream and pray that he will go to sleep soon. When we stick to normal schedule and he gets lots of sleep and naps all is well. I started last June 2013, he is now 72 and hopes it will go away.
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Fortunately my husband didn't want any alcohol, shortly after his Alz diagnosis. I was glad.... that's all I would need, a tipsy alzy man.
Very lucky, his nighttime activities did not start until almost 6 years after diagnosis. And only happened maybe 6 times so far. I quit work last year, so our schedules didn't really matter.... night, day, whatever.
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Dad (94) gets sleepy when he is bored, in addition to when he is tired. We have a predicatable schedule, and whenever something alters the evening schedule, he wants to stay up later and later (which is bad news). I don't want his cycle to flip flop. We watch the news while he eats dinner (a 90 min process) Wheel of Fortune, the 8 oclock show (usually CBS: comedy, NCIS, 90 min.) He likes America's funniest Videos (WBTS on cable) and old familiar shows like monk, Law and Order criminal intent, Criminal MInds (too creepy for me). I also put on Dirty Jobs, River Monsters during the day. I try movies that have action, and/or in his time of life (1940-1950) Pearl Harbor, My dog Spot, silly SiFy mutant monsters in the lake kind of movies. Men in Black, etc.

So days he does better than others. I keep him hydrated, which was difficult until I got SoBe coconut water juices. He does better when he drinks these.

He has trouble hearing and wireless headphones work wonders (for me not to get blasted by TV volume) He will not read books, but does like Time, Forbes, People and National Geographic with lots of pictures of places he has been.

We also have a patio door that looks out on a pinwheel that spins when there is wind, flowers, hummingbirds, my cat...

I use full spectrum lights, 100 watts next to his chair, during the day. I have light blocking car windshield covers on his windows so he room is dark except for nightlights to the bathroom. We stop fuilds about 2 hours before bed at 9pm so he is up peeing less at night (prostate cancer). I also put antigas liquid (in the baby section) in his dinner drink to lessen the sense of pressure that might be getting him awake and to the bathroom. Even so, he goes hourly til about 3am? Maybe not sleeping well has your dad tired.
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My husband sometimes experiences sundowning in different ways when he falls asleep at 7:00 every evening unless we have company (seems to be the bewitching hour). Sometimes, when I wake him up to go to bed when I am ready, around 10:30 or so, he will be completely unaware of where he is and totally anxiety ridden and confused. Other times, he will smile and ask what time it is and I tell him it's time for bed. I give him his evening meds before he goes to bed along with a couple of ibuprofen and he usually sleeps until around 4 or 5 a.m. Can't figure out what makes the difference in this pattern.

I have just found out that playing the "oldies" on the TV channel calms him down during the day and seems to keep his spirits up. Hope it lasts! We even dance sometimes when he feels up to it.
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Sorry to step away from a specific answer, but I just need to explain something. "Sundowning" happens during all parts of the day/and night when the light out of doors is dark or fading. It does not just happen at the time of day that the rest of us call "sundown" ie: sometime between approx. 6:00 and 9:30, depending of the season. As a 28 year night shift RN I dealt with one heck of a lot of "sundowning", and I never arrived at work earlier than 10:00 pm. So there is no "getting through" sundowning. It's not over till they fall asleep, (either on their own, likely in the early am, or via the use of medication.) They are like totally different people, when the morning come. Yes, occasionally you run into patient who might calm down after a while (usually not) but mostly they were pretty much climbing the walls, till they passed out.
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I would say, let it go and let him go to bed at 7 provided he is still sleeping in until 7or 8 in the morning.

Other suggestions are to stay in sunnier rooms and turn on all the lights -- change bulbs to highest wattage lamps will allow and turn them all on. This will help keep him going. Play peppy music (better than TV which likely doesn't hold his interest).

Plan a walk or sitting out on the porch with a cup of tea, soda and some dessert at 7. You won't push him til 9 but might get an extra hour out of him.
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My grams is experiencing the same issue. One of the things I noted is when she gets more water in the earlier part of the day, it is not so bad. But with the heat lately, she is more easily tired. She no longer gets caffeine and I use herbal teas with her lunch. She takes a nap. But by 7 she is very tired. I let her be, reassure her if she gets worried about stuff. She is trusting me more now that she was in the beginning. When she has a bladder infection it is much worse. So I monitor her urine and ensure she is hydrated. I don't know if the two are connected, but this seems to help. Good luck.
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An excellent dementia specialist/nurse practitioner advised that an ADLO should take two naps every day - one after breakfast and one in late afternoon and said this would help with sundowning and help a person sleep at night. It worked for my mother!
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With mom, three ounces of Pinot Noir adds a blush to her cheek and a more relaxed outlook. Red wine is a vasodilator and has lots of resveratrol and melatonin.
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Second the advice to use Melatonin; it's worked for us and we haven't seen any side effects as we might have with meds.
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A light Comedy TV show or music at bed time always worked well for me. Also if having problems with going to sleep, try Melatonin first. Can buy over counter and it's a natural chemical our body produces when we sleep.
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Medications can be used. Contact your husbands physician.

Just FYI. I am a care taker as well as an R.N.; I am actively engaged in working.
I go to bed when I am tired. Sometimes it is at 7 P.M., sometime 8 P.M., rarely do I stay up past 9 P.M. Some of us have an internal clock that simply tells us when to sleep.
Sundowners Syndrome can be troubling. Seek attention from your husband's physician to see if any medications can be given. GOOD LUCK...
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Let go to sleep at his own time. I agree above let him look at so favorite show and music to relaxed him. Trying giving him some relaxing teas. Sometime warm milk is helpful to relax. Avoid alot of visited in evening time. I think you are doing good job.God bless You.
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At home, we planned casual relaxing activities to begin in the later afternoon and transition through and past sundown. And we tried to be with Mom during the sundowning period so she wouldn't be alone while in the SNF.

Don't plan any excursions, visits, appointments, etc. later in the afternoon - make them in the morning so you can both return home and your DH can adjust without coming home in the evening.

Does he have any favorite tv programs that he could begin watching in the early evening?

Listening to music could help him relax; put on a CD of his favorite songs, or tune into one of the relaxing music channels on tv.

If he really is tired let him go to bed around 7 or whenever he feels like it. Perhaps it's his own subconscious way of putting himself self at ease if he senses that he's confused and can't handle it.

Keep visitors to a minimum in the afternoon as well - too much activity could aggravate the confusion.

Good luck.
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