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My mother is moving from first stage dementia into middle stage and has been showing signs of Sundown syndrome. She gets very agitated, antsy/nervous, like she has had way too much sugar or caffeine (which she hasn't). Also, no new medications.


I have been reading on ways to try and alleviate it or make it easier, but was wondering if anyone else has experienced this and may have some tips.

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Sundowning is typical with Alzheimer's and dementia, especially while in the hospital. I've seen it with both of my parents, and even hospital delirium recently with my mother. It was horrendous. I read this article on the subject when I Googled it:

The term "sundowning" refers to a state of confusion occurring in the late afternoon and spanning into the night. Sundowning can cause a variety of behaviors, such as confusion, anxiety, aggression or ignoring directions. Sundowning can also lead to pacing or wandering.

Sundowning isn't a disease, but a group of symptoms that occur at a specific time of the day that may affect people with dementia, such as Alzheimer's disease. The exact cause of this behavior is unknown.
Factors that may aggravate late-day confusion include:
Fatigue
Low lighting
Increased shadows
Disruption of the body's "internal clock"
Difficulty separating reality from dreams
Presence of an infection such as urinary tract infection
Tips for reducing sundowning:
Try to maintain a predictable routine for bedtime, waking, meals and activities.
Plan for activities and exposure to light during the day to encourage nighttime sleepiness.
Limit daytime napping.
Limit caffeine and sugar to morning hours.
Keep a night light on to reduce agitation that occurs when surroundings are dark or unfamiliar.
In the evening, try to reduce background noise and stimulating activities, including TV viewing, which can sometimes be upsetting.
In a strange or unfamiliar setting, bring familiar items — such as photographs — to create a more relaxed, familiar setting.
Play familiar gentle music in the evening or relaxing sounds of nature, such as the sound of waves.
Talk with your loved one's doctor if you suspect that an underlying condition, such as a urinary tract infection or sleep apnea, might be worsening sundowning behavior, especially if sundowning develops quickly.
Some research suggests that a low dose of melatonin — a naturally occurring hormone that induces sleepiness — alone or in combination with exposure to bright light during the day may help ease sundowning.
When sundowning occurs in a care facility, it may be related to the flurry of activity during staff shift changes or the lack of structured activities in the late afternoon and evening. Staff arriving and leaving may cue some people with Alzheimer's to want to go home or to check on their children — or other behaviors that were appropriate in the late afternoon in their past. It may help to occupy their time with another activity during that period.
With
Jonathan Graff-Radford, M.D.

Best of luck!!
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MarilynR Sep 12, 2019
THANK YOU!!!!! SO MUCH APPRECIATED : )
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My husband began to sundown early in his diagnosis. I had read that the part of the brain that processes (and enjoys) music remains strong for a longer time. I have been playing his favorite music, Frank Sinatra, and the change is astonishing. He goes from agitated and fretful to snapping his fingers! So I have incorporated relaxing music, spa music and Frank into our bag of tricks. I have a google speaker in nearly every room so asking it to play wherever we need a quick intervention is great. We even fall asleep to spa sounds and he has been falling out to sleep peacefully. I set it on a timer while we prepare for bed.
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Reply to Tetertottering
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MarilynR Sep 12, 2019
Perfect, that is exactly what I need. Soft music for her. Thank you!
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My last senior had every symptom possible with Alzheimer's - I thought. A really quirky one was that for lunch every day, I would have to set out 5 places at the table. Keep in mind now, it was only her & me in the house. BUT....her husband, sister, & brother lived in the walls in her home. (all were deceased) But come lunchtime, guess who showed up?! So there the five of us would sit, every day. Client would not touch one bite till everybody else was served. Oh, the conversations they had!! I learned things about her even her family didn't know. The trouble would start when one wouldn't show up, usually the hubby. Client was convinced he & neighbor were having a hot, torrid, affair, and that's when the sundowners kicked in - 2 pm on the dot. We walked entire neighborhood searching for her deceased, lying, cheating hubby.! The stroll helped with the agitation, a lot. I miss that beautiful lady...
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EnduringLife Sep 16, 2019
This brought a smile....
We have to laugh when we can.
This disease is so horrible and just devastating, but having watched many patients and just recently my dear mom go through it, there are some moments of comfort that are found in the experiences.
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Sundowning is very common. We calm folks down by:

1 paper dixie cup small
1 cotton ball
lavender oil

we a dip cotton ball in lavender oil (just a little), place cotton ball in paper cup and hand to patient to walk around with. It calms them tremendously. They love to keep smelling it. We distribute these cups about the time we know they will start to sundown.

Try different oils on different folks. Some love certain smells over others but do not overpower their cotton ball or it will be too abrasive for them.

Just a little goes a long way.

Hope this helps...
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Thekay Sep 16, 2019
I love this idea but I am afraid momma would think it was something to eat.
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We have found lavender essential oil extremely effective. We use Young Living brand. I hear some people are allergic, but hopefully that's not the case. We use it around 3:30 daily - roll it up and down the bottom of her feet, and at base of big toe. Often around 5:30 I use it again on my mom on her wrists and back of her neck. I use this nightly to help me sleep better. It has been a HUGE help to us with her meltdowns as long as you catch it before it gets too bad. Also, be aware of over-stimulation - that always makes it worse. My mom is 95 and we've used this for 5 years for her - also use it at night to help her relax and sleep better.
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I take it a day at a time...or evening as the case may be. My mother has a nasty streak and there have been increasing subtle changes...good news, she changed her undies twice...bad news they were soiled and she threw them down the laundry chute...also hanging on to her purse and looking for a hiding place to stash it. Spitting grape skins in the sink though not necessarily a sundowning thing. She goes to bed earlier, and then CAN get up in the middle of the night. We have dead bolted the doors to outside and if she goes out the patio door, the yard is locked and secure. IF medication should be an answer for us, I doubt she would take it. At least once or twice a week she now leaves her vitamin and supplement and 1/2 a BP pill. Before we knew what was going on she went 3 months without the BP medication and she's still here, just having her 97th birthday...so I don't worry.
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Every person here caring for a senior with dementia knows first hand about sundowner.

The best thing I could do was to eliminate every source of stress after noon. Appointments were morning only...etc.
this way he could have whatever he liked for early dinner and fall asleep in front of the TV or with his coloring books.

any excitement (even a phone call) could set it off.
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Reply to Katiekate
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My husband has sundowning and is on quetiapine (generic for seroquel) three times a day. The med keeps his sundowning at bay ... most of time, but it resurfaces every now and then even with medication. It is usually between 1-5pm. I have noticed that once he has sundowning, it is too late for the med. He has to ride it out, which could be the whole night. He takes a low dose in the morning with breakfast, one full dose at 1pm and last full dose at 4pm. Usually the 4pm is crucial because that is around the time he gets most agitated.

Your mother’s doc should get her on the med now because it takes time (a month for my husband) to take effect. You will see the night-day difference. There are many meds out there, so ask her doc for advice. Most are cheap with Medicare.

Another option is to try CBD - the non-addictive/good oil in marijuana. You can get them in capsules. It is available online, but not covered by insurance. It is expensive.

Dealing with someone having sundowning is NOT fun. You are not alone. Keep us posted. Good luck.
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Reply to Worriedspouse
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Schorzman123 Sep 16, 2019
quetipine is what I gave dad for his sundowners I could definitely tell a difference in his symptoms and made them more manageable 💕
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There is definitely a difference in my moms temperament based on the time of day.  Towards the end of the day, mom is always more confused and agitated so basically, I don't plan anything for later in the day.  She will eat between 4 and 5 and after that she will rock in a chair looking at traffic or she watches TV until bed time.  Anything more than that is a problem.  My advice is to keep a strict routine and very low key.  I like the idea of the cotton ball sprinkled with lavender oil... I might try that one!
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Reply to Jamesj
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My Mother had it when she moved in with us 1 1/2 years ago. I explained to the doctor that she would close all the blinds thinking someone was watching her. Didn't want to go to bed, would get up in the middle of the night and get dressed and try to run out the front door. The Doctor gave her Melatonin 3mg and within a month she was fine. Mom is still taking it once a day at night only.
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