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Dad is 90 with dementia in assisted living. Sundowners is getting him up several times a night. He gets dressed and thinks he has to go somewhere. Facility wants to medicate him, dr says seroquil. FDA says no to that med for elderly with dementia. Doubles mortality rate and stoke. Suggestions or experience? Can't take Benedryl because of prostate issue, and melatonin not option either. Help?

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My mother did not do well on Seoquel, although I know several on this board have parents who tolerate it well. My mom is on klonopin at a fairly low dose, a bit more at night. Also Remeron and I believe Wellbutrin. It keeps her calm but alert.

Yes, the FDA warns against Seoquel for elders. But at that age, I believe that alleviating the terribly upsetting and maddening ( for the patient) symptoms of sundowning, some risks need to be faced.
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If he is in an assisted living facility, I am assuming he has his own apartment? That said, if he is not bothering anyone, who cares if he arises early? He can putter around thinking he has to go to work or the field (most 90 yr. olds had a farm and arose very early), and you should be unaffected because you do not live with him. So why medicate him? Try to have staff keep him busy during the day so he is not sleeping, then he will sleep at night (or not). What difference does it make? The only ones disturbed are staff, and they are awake anyway. He will move into another stage where he won't be getting up and getting dressed at all. Hang in there!
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My mom was on a very lose dose of seroquel. We would give her half a pill and 8 and the other half at ten. We played music on low, kept it on all night, no singers just the music and that really seemed to help her and drown out any outside noises.
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My husband has this, and our nights were badly disrupted with his flailing, shouting, and falling out of bed, etc. I gave him Xanax, which helped greatly. When I asked the doc for a prescription, he said no, it is habit forming (?) He prescribed Seroquel, which did stranger things to my husband. Then Ativan, which also had bad effects. I took it upon myself to give him 25 mg of Benadryl, and it is working fine!
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Remeron worked to us greatly. Mom went to bed and slept through the night and it was a great relief not only to her but to me as well so I could sleep too. The only thing with Remeron their appetite goes through the roof. So when they are awake they are hungry all the time. But it was worth the extra couple pounds she gained for a restful nights sleep. Best of luck to you!
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I agree with some of the commenters. Although toxic medications can "assist" and take away some anxiety (according to the drug companies), they can cause further confusion, increase dementia and even falls. Since I have a background in herbs and alternative medicine, first, I'd look at his diet to see what they are feeding him. It would be a great idea to give him a light snack later in the day, a small turkey or ham sandwich perhaps. Limit or take away all sweets that can drastically alter mood as quick acting sugar is released. The slow release of carbs with tryptophan may help to relax him (through a sandwich or even milk). One of the most popular sleep aids are melatonin. Also, you can try valerian, or any number of herbs-skullcap, catnip, poppy, hops...but you'd have to do a search to see if they might conflict with any of his medications. If there's a good natural food shop or herbalist nearby, go talk with them. Be sure he's getting at least 1000 mg D from supplementation or gets outside in the sun for 15-20 minutes a day. Hope that helps. My mom goes through the same thing but my siblings and her doctor decided to give her a mild sedative, and as I suspected, she fell. Now, we're paying for rehab. What a mess!
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I'm amazed that someone with sundowners can live alone.....even assisted living. My mom is 92 and NOTHING works. She sleeps a few hours during the early evening, but by 9:30 PM she is up for the night. She tries to go outside and has no clue what she's doing. She goes through cabinets and drawers. She even started putting knives in drawers and the refrigerator. Nothing has worked. She's on lexapro and Xanax. She still doesn't sleep. Seraquel did nothing. How do you know what your dad is doing at night? I have the lights on, because she panics if you turn them off. She goes berserk if I even mention turning off the TV. It's a horrible thing. Good luck. I think all patients are different.
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My dad, soon to be 88 was prescribed Remeron (Mirtazapine) for sleep and appetite. Dad badly need help with both.

For the past year, he's slept a lot more consistently at night and his appetite is much better (he needed to gain weight). He's also on Celexa (Citalopram) which is known for its calming anti-depressive effects. He's doing well with these meds.
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My Mom was also given Seroquel but I have been afraid to give it, not sure if what she does is sundowners if happens around midnight she is either really agitated or refuses to go back and sleep and keeps calling me to her room.
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My Mom had sundowners, but, to a much lesser degree than your Dad. I found that a sleep machine (playing nature noises) worked well to calm her. Also, I put the shades down BEFORE sundown and that also seemed to help. I have an article on hubpages re: sundowner. Not sure how to tell you to find it except that I'm 'Gottaloveit2' on that board. I have a lot of articles about caring for the elderly on there and also my own website which I'm not allowed to post here.
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It is def worth the effort to get their meds cocktail right! It took us several attempts but sundowners was an issue four yrs. ago when 88 yr. old grandma came to live with us, but not a problem anymore! Thank goodness! She has dementia plus depression/anxiety which she always had. She takes Abilify and Aricept and Ativan...the 3 A's that plus her other meds are the perfect combo for her! Good luck, be patient and find out what combo works!
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It can be tricky finding the right medication or the right combo of medications that work and sometimes nothing seems to do the trick. I've seen Seroquel uses but have also seen the Remeron, Risperdal and Ativan used in low doses. It's best to start out at low doses and work up if needed than to start out with a large dose. Speak with your fathers doctor to find what the right medication and dosage would be. You can contact the local chapter of the Alzheimer's Association for more information on dementia and behavioral interventions..
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Thank you all so much for sharing. I saw his dr yesterday and he said as long as dad is safe just let him roam at night, no harm. He is not trying to go outside or hurt himself (or anyone else). He recommend meds as a last resort because they often add to confusion and fall risk. Dad has low BP so he is already a fall risk. This is a heartbreaking situation and we just all want to fix it, don't we? And as all your posts indicate, everyone is different. I just keep praying for wisdom, and I so appreciate your answers.
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I'm glad you spoke to his doctor. The facility may not like it. If he likes to fold laundry they can give him some to fold at night when he is up. Small chores may make him tired and he'll go back to bed after a while.
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When I asked the doc for a prescription, he said no, it is habit forming


BEWARE OF BRAIN DEAD DOCTORS !!!!!!

Change PCP now
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Have you looked into Risperdal? My dad is in the same situation. Risperdal mellowed him out and calmed him down.
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My mom took Seroquel for a short while and it helped but I had concerns based on what I researched so her new doctor said lets try melatonin and it works. Both her doctors did say that Seroquel is ok if given in small doses. I do find that if she goes out or does things during the day to keep busy she is tired enough at night to sleep and sometimes sleeps 1/2 of the day as well. Good luck to all of you with similar problems. It can be maddening to be woken up all hours of the night. Especially when you have to go to work the next day.
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I agree with ferris1, let him do his own thing, as long as he is calm. Staff want to medicate to make it easier on them, but it could cause falls if he still tries to get up. If he gets up during the night, have them deal with it and give him something to do to keep him busy.
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I agree with "UncleMike" on much of what was said. I will throw in that I personally have some sleep issues, and I have found that a product called SOMNAPURE PM works well. As I understand, it was developed by MIT and is all natural. I am able to purchase it at the CVS drugstore. Make sure you get the SOMNAPURE with the PM at the end. You would have to buy this out-of-pocket, and I am sure that the pharmacist at the place you dad is staying would have to approve it. But, unless they can provide a true reason for not letting him use it (and not that the pharmacist has no clue as to what he/she is looking at), then push to give it a try for a month and see how it goes. He should take it 30-60 minutes before going to bed and NOT any later.
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seroquel worked great for my husband with dementia and helped with his sundowners and the other issues involved. My husband is in his late 50s and alot younger then your dad but this medication helped for us.
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My mother also had sundowners during the evening when she would get very aggitated and angry. Her primary care doctor recommended seeing a geriatric psychiatrist. He prescribed a anit-depressant. It took a couple of tries before we found one that worked without any side affects. She started on sertraline, which caused stomach problems. We tried escitalopram, which caused hives. Now she is on fluoxetine 15mg, which she has been on for 4 months. The anit-depressants has helped with the sundowner symptoms. Each medication and situation is so different for each individual and does take some time to find the right medication and situation which will work. So far this is working well for my mother.
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One study showed that when the staff asked the person to sit down and gave them a snack then the person felt as if he had accomplished whatever he intended to do. It also served to distract him and he'd go peacefully to bed.

Obviously this is harder to do if you are the sole caregiver in a home situation, but perhaps there's something to be gained from knowing that.

Also, SAD lights help some people with sundowning. These lights combined with what was already suggested (pulling the shades down before dark) may help some people.

Keep sending out ideas about what works. This is something that can be a huge problem for caregivers in any setting.

Carol
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Like everyone says each patient is different. I would not want him wandering at night. My husband who is in mid-stage of alz. takes .5 mg of Ativan in the morning, 10 mg of Celexa in the afternoon for his depression(he wants to drive and I sold his car so he feels he is stuck in the house and wants to go out driving) and I give him another .5 mg Ativan at night to sleep. Most of the time he sleeps well, he does have dreams and talks in his sleep occassionally but at least I can get some sleep because I have to go to work and need my rest.
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Wandering at night alone is an accident waiting to happen for an elder. This needs to be corrected. The person who medicated their elderly parent with a low dose of Benadryl is right on target!
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I understand your situation my mother has had alzheimers for 18yrs she just fell at her facility 4 days ago because she liked to get up at night too.She is 89 and I'm at the hospital right now she is in her final journey as we speak its up to god now and were keeping her pain free.Not alot of meds you can give them and not alot of facilities really know how to handle Alzheimer patients!my advice love them as long as there alive enjoy the good times with them and even tho we took care of her for 17 yrs and 1year in facility we have never forgotten our mother or left her!To everyone walking in my shoes god bless you
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So true! I am praying for peace and comfort for you and your family.
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In answer to help you Dad with Sundowners. My husband had this and was up all night, going outside, overturning furniture, breaking lamps and pictures and we finally put him in a nursing home. They had a hard time regulating his meds, first they gave him Depakote, didn't work. Then they gave him Seroquel and he had a more violent reaction. finally they gave him Risporadol and it worked. Just a note, the geriatiaric physician at the hospital told me not to worry about the side effects of any of these drugs. Our aim is not to prolong the life of people who are so far along with dementia. Whatever the side effects, so be it and if they die a little sooner, we should all feel we are only helping them pass through this horrible disease even faster. KM
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Give him two Advanced Melatonin Calm Sleep (Fast Dissolve) which you can get over the counter. Give them to him twenty minutes before bedtime. He should suck on them until they melt in his mouth (no water). My husband has a tendency to chew them because he just doesn't understand. However, they have still worked on him. They get him through most of the night. Hope they work for you! These easy-to-melt-in-your-mouth tablets help reduce stress and anxiety and should help him sleep. Good luck!
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My husband takes 100 mg Trazodone, 5 mg melatonin before going to bed. If he wakes up in the middle of the night, he takes a Calm Forte (an alternative medication not a prescription) seems to get him back to sleep most of the time.
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The best aid for sleeping and it is non habit forming and not a medication is Valerian Root. It doesn't smell very good, but it is all natural, and can be picked up at any health food store. Everyone that I know that takes it is amazed at the results. It comes in a capsule, so it can be put in a milk shake or food.
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