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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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lavender essential oil with a roller ball - roll up and down bottom of the feet and at the base of the big toe about the time of day it normally happens. It will help sooth and calm them within 15-20 minutes usually. You can use it as often as needed. Sometimes I use it on my mom's wrists and back of her neck if at other times to avoid having to remove shoes and socks multiple times a day. It still helps alot to do it that way...
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There are articles, questions and answers in the ‘Care Topics’ part of the site, which will give you a wide range of information. Click on Care Topics on the right top of the screen. It will come up with an alphabet. Click on S, then scroll down until you come to Sundowner’s Syndrome. 13 articles, 4 discussions, 149 question threads. I hope you find something that helps!
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we use lavender essential oil. it's a HUGE help. We try to use it before the time of day that happens, to prevent it, but even once it has begun you can use it and within about 15-20 min it will soothe them.
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Also Check out the web site Dailycaring. there is so much information about dementia, behaviors, how to handle situations what to say what to do. You can sign up to receive daily emails or weekly emails with valuable information. So worthwhile.
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Regarding sundowners, my Dad [94] was experiencing that.... for him it was quite interesting. He would climb into his time machine and transport himself back to the 1940's.

Dad would call me saying the meeting at work ran late so he missed his bus home. So he will be staying the hotel for the evening. I believe Dad was thinking he was talking to my late Mom. And I knew this was the 1940's as that was last time Dad used bus transportation to get to work. The hotel was actually his room at senior living.

I didn't correct Dad on anything he was saying.... I just played along which I believed made him feel better. Correcting him would only confuse matters more.

Dad would power up that time machine usually after dinner. During the day, he had just normal age memory decline.
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disgustedtoo Sep 2019
How cute/sweet!! If it were only this way for everyone... Much easier to deal with.
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Many good suggestions. You will have to try various things to find what works best for your mother. Everyone has their own "thing" they do, so it will be a trial and error to find what works.

Our mother never lived with one of us after dementia kicked in. Initially the plan was to allow her to stay in her condo and bring in help as needed, for as long as we could, but after less than 3 months, she refused to let the aides in (it was only 1 hour/day, weekdays, and mainly a sanity/took meds check - she didn't need help with ADLs yet (wasn't cooking, but eating frozen dinners and boxed stuff at this point.)

To keep tabs on her and who was coming/going, we put in some cameras (we are all too far away to check on her daily.) Her "sun-downing" was outside the norm, sort of... It started just before she would go to bed, generally 8:30-9:30PM. Initially it would only be some nights, for a couple of iterations, but eventually became a marathon, lasting 1-1.5 hours! She would check the door lock, the sidelights, something in the kitchen that was out of range of the camera (turned out to be the dishwasher) and then the living room (light would shine through the pass-through onto the kitchen cabinets.) She repeated this over and over, tripping the camera every time (it only recorded a short bit after trigger, just enough to see what was going on, who came in, etc.) THIS would trigger my phone twice, once for the camera trip and once with an email clip sent - every few minutes, up to that 1.5 hours! OB was stupid, didn't understand when I sent him a link to sun-downing, and would call her to try to stop it. I suggested he do what I did - turn the sound off the phone until she stops. You can still check, mine still would vibrate, but the annoyance stopped for me by doing this, while still being able to monitor things. A few times she "snuck up" on the sidelights, like she thought someone was out there. Clearly it was her sun-downing, although it was outside the general time of day it happens. It can happen any time of day really, but most have it late afternoon/early evening.

We moved her to MC when the place we choose finally finished their rebuild and she didn't have any more issues, EXCEPT with a UTI. When I first joined this site, I would read about checking for UTI and thought it was hogwash, mostly. That changed when mom had her episode! It did coincide with later afternoon/early evening and she would rant and rave, wanted out because she had guests coming and had to go home! They called me to come - like I could do anything??? By the time I could get there, they had managed to get her into her room with a magazine. Of course this happened on a Friday evening, no access to doc. She did have an appt Monday anyway (wrong time but it was their mistake, so we used it to test for UTI.) Sure enough, she had one. Doc Rxed Lorazepam along with antibiotic. This solved the issue (she only had to take it until the UTI was under control, then she was back to as needed only.)

The nice things about this med, for us anyway, are:
1) it doesn't take days/weeks to "work". Within 10-15 m, even first time.
2) we can start/stop without issue
3) the minimal dose was enough to take the edge off
4) it didn't dope her up, just soothed the anxiety

Again, what works for some might not work for others. Certainly I would try all the non-Rx methods first - less is more, but if none of those work, you might have to "experiment" with medications. This one, as with others, is considered a potential fall risk, but I would rather that than her in that state which could cause more injury for her, the staff or another resident! It never caused any falls for her and was the lowest dose they use.
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Yes. Experienced. If the dementia is FTD, there is no medication and Alzheimer's medication will be very harmful.

This is my wife before we found the only medication.

https://www.facebook.com/ellery.sir/videos/vb.1478413961/10210349485401673/?type=2&video_source=user_video_tab

This is after we found the medication and have been using it since 2013.

https://www.facebook.com/ginger.rose3X3/videos/10202389374773028/
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MarilynR Sep 2019
Wow...what a difference. I am so sorry you are going through this with your wife. How difficult this must be for you. I am happy that you found something that makes her smile. Hang in there... guess there really isn't much else you can do, is there....

Thank you for sharing!!
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My husband have Alzheimer's/dementia and what I would do I would take him for a ride every evening when he was very agitated. We would ride for fifteen to twenty minutes pass that house a couple of times then when he would tell me that I passed up his house I would turn around pull into the garage bring him in the house and get him ready for bed; and call on the Lord a lot. You have to go along with their agenda; because they don't know what's going on.
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I've had mom with me since April 2019, but cared and arranged caregivers as need he past 4 years. I love having her with me, it's so much easier for me and money has become tight. $8,000 a month for her to stay home. Nights are our special moments. She's much more alert at night. We watch TV together after I put her to bed and I sit in the recliner next to her. She sleeps a lot 18-20 hours a day. Immobile and incontinent and a great sense of humor. She's a doll BUT...does sundown sometimes. She wants to go home to her childhood home with her mom and dad, and wants me to take her. Sometimes she'll go all afternoon and evening, and I tell her I'll see what I can do. Then I leave the room for a few minutes, go back in and ask her if she ever cooked in a pressure cooker, or what color should I paint the room, or something from her past. I never ask her a question that would make her have to stretch her thinking because she drops her head and doesn't answer, almost as if she understands the questions, but has no idea how to answer it. Distraction...Distraction. NOW, if they become combative, and you cannot calm them, as long as their personal needs are met, they are dry, not hungry or thirsty, sometimes you have to let them go on and go about your business (maybe with earphones), especially when they call you 50 times within 5 minutes or less. BUT...rest assured, at night when you put them to bed, they have no idea about how they felt earlier and called constantly for you. Just love them keep their environment the same and they will become more comfortable. Sometimes I wonder it I take her out for me or her, She's much rather be home watching Tom Selleck in Blue Bloods...Truth.
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Yes - my Mom got more agitated in the evening. The two things that seemed to work the best for her were: 1. routine - fortunately, she was a creature of habit so we just kept a regular routine when she moved in with us and that seemed to help 2. distraction - I couldn't reason with her so I would get her interested in a quiet activity that she liked. Usually, I'd get her ready for bed and put on some of her favorite music (old church hymns or recordings of my Dad singing) and get her all comfy in her lift chair/recliner and she was set for the night! You just have to find what works in your particular case.
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When we all age, there is a gradual decline of life force, essential to run the body and brain functions. "Getting tired" is the norm for the elderly. The cause is unique to each person. However, some commonality is that vascularity/circulation is reduced due to organ tiredness. The energy reduces in the fading years, etc. Keeping it simple, Chinese medicine has had answers for this for hundreds if not thousands of years. There are longevity formulas which when used, regularly, will alleviate agitation, improve overall body and cognitive function within 7 days. The key is assessment by a seasoned Chinese medicine practitioner with specialization in Chinese herbal medicine.
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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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The NH my mom was in agreed as well as her dr so I brought in wine & a small pewter glass [2 to 3 oz that I put her name on in nailpolish] so that when she sundowned they would ask her if she would like a glass of wine & she would snap out of it, put a big smile on her face & say 'oh yes please' .... she purred & was a gentle pussy cat as she enjoyed her treat - however mom quite often would have a pre-dinner drink before the dementia so it was something she always enjoyed

I would bring in the wine which was kept in the fridge in the medicine room & replace as needed - I felt this was good for her & the staff because she was easier to manage & she wasn't medicated with other problems associated - this was usually once a week or so

You need to find out what your mom will respond to in the same way because you know her best but off the top of my head you could try mini chocolate bars, granola bars - mainly something that doesn't spoil easily, is easy  for the staff to give her & is portion controlled that is not going to upset dietary or medicinal restrictions [my mom was diabetic]
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By reading some of the responses already Sundowning can occur in many ways. In the case of my wife it was first, that she would not change her clothes for bed clothes. So she wore the same thing day and night, and they got pretty high as you can imagine. She knew I wanted to take them off and change them but the message never got to her taking them off or letting me take them off. It has to do with what is involved in dressing or undressing. The actions are to get ready to do it, then start unbuttoning or buttoning, or unzipping, one by one until you get to the last button, and then the cuffs, one by one, then opening the shirt and removing your shoulder from one side, then the other... If you break the job down to discreet actions done in a required sequence you can see that someone who cannot process more than one movement at a time is just dumbfounded at the complexity of it all, actions we do without thinking, mostly. That is where the Alz person is; lacking the execution ability that she once had. And so the frustration comes out in Sundowning. At least that's how I look at it. To go on, we got the help of Home Health Aides, who have great experience in the process and show a level of confidence in what they do that impresses the patient, or client as they say, and even when they ask permission - "May I unbutton your blouse?" the client seems to be amazed that it is happening and there is no problem with dressing. Then came the bedtime issue. She would not go to bed, would not move from her chair to the bedroom or bathroom. Again I think it is the execution ability to stand up and walk to the bedroom that just is not there. So more frustration. Added to the problem was that her arthritis in her knees got to be really bad (with lack of movement I expect) and she would avoid pain and just not walk. Now she has lost the ability to walk at all, which solves the Sundowning problem, so to speak, and confines her to a wheelchair, which seems just fine to her.

So my advice is to try to figure out what the frustration is all about, from the details of what is going on in her mind that she just cannot do even though she (or he) wants to do. Something may occur to you to lessen the frustration for her. I hope this is helpful.
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My mother yelled more in the evenings at the nursing facility and they told me it was sundowners syndrome. She had dementia but her behaviors were worse in the evenings for sure. Even the maintenance man told me he heard her yelling out in evenings. I was there more during the day so I didn’t see that. Staff told me.
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I find the Sundowners is more difficult when the routines are not maintained and/or the LO is in an unfamiliar place. My Gram did fine visiting us - wherever the military sent us - as long as we kept the routine the same in the evening. I tried to keep her room the same no matter where we were - and she visited with my mom every year for a week or 2.

Having extra lights on as the sun goes down can help too. As others have said, keeping a relaxing evening routine is most helpful.

P.S. I'm an RN and it occurs with many senior patients, not just AD.
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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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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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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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Excellent replies here. My mom was very afraid at night. When I lived with her the blinds had to be down by sunset and doors locked and checked every 10 minutes until bedtime. She was certain that robbers were out there and that somehow if they couldn't see us they wouldn't come in. It helped if I tried to get her away from the tv early evening and reading or working on a puzzle instead. I gave her a warm bath, then a banana with yogurt at bedtime to help her sleep. The sundowners has gone away now. In fact she sat on the assisted living front porch with me last evening as it got dark with no fear. I really like the lavender on a cotton ball in a cup idea and wish I had thought of it. I'm going to try that on myself, as I have a hard time putting myself to bed at night.
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HI that is what I am going through with my Dad. His is slowly growing into Dementia.
The few tips I have is;
When she gets agitated try to redirect the conversation to something she knows, understands and likes. That is the best way I have tried to combat this awful disease.
Do not talk business during night hours and she most likely want to talk about things in the past; let her.
When redirecting the conversation go talk about things in the past.
Ssometimes to may have to leave the room to collect yourself cause it can be aggravating to you also.
She may keep asking the same questions just answer her.
I also recommend taking the Savvy Caregiver Training class given by Elder Options or if military ask the Veterans Administration. Although its mostly catered around Dementia, & Alzheimer they are all connected and you would learn a lot. The best thing is it's a free class and you will get sometime away and meet great people.
I hope it helps.
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My Mother experiences this, too. It is very difficult to manage on our end because we can't imagine what she does. We have learned that it helps to close the blinds/window coverings prior to the sun going down so she doesn't notice the daylight change. We play peaceful music in the background and no loud TV. This helps some. Hope it helps you. My prayers are with you through this difficult time.
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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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Schorzman123 Sep 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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Melatonin gummies 10 mg. Purchased at Walmart works wonders. We also put everything my dad needed in one room (his bedroom). This kept him from wandering. There is also a clock for dementia patients. Tells time, day or night, date, day of week so he could read it & not be so confused.
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Yes Marilyn, my mil is 92 and has dementia and sundowners. every afternoon around five o’clock she would start fidgeting and looking at her hands front to back and look outside the window and roll up a Kleenex (or) napkin she would ask can you close those blinds and is the condo locked up can you please lock up we would have to assure her that we are here and everything is ok, her chair swivels so she can see her bedroom , kitchen, pretty much she could see every room except the two bathrooms but she would again say is that door locked I wish you would close those blinds she was so nervous and if my husband was outside and I was in the bathroom she would get out of her chair and could hardly stand up and would close the blinds, if we were across the way to the community pool she would close the blinds and windows and it would be so hot in the condo we had to start leaving the air on all the time but then of course she would be cold . God Luv these precious family members who have this awful disease.Its hard for them to understand any of this and for us too but she always went to bed around 7 and she would ask off and on about the blinds and just be so nervous she would not go to bed until everything was closed and locked up ,I would assure her we were there to keep her safe and would never let anything or anyone hurt her so one night I told my husband to close the blinds when she asks and sure enough she said THANK YOU within two minutes she said well I think I’m going to bed, And would sleep all night ! So the comfort of her knowing before she goes to bed that everything is locked up and blinds closed she was safe so we continued to do that even though we waited for her to ask us ,we would go close them and she was comfortable and would go to bed so we learned from that experience, if we were out for a few hours the sigh of relief when we returned was so unbelievable we felt terrible leaving her so if we had to run out or just wanted to go to the hot tub we would wait until she went to bed and leave lights on and the Tv so she wasn’t so nervous and think that we were there. So best of luck with all that you are doing to help with the dementia and sundowners. I will pray for you🙏
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gdaughter Dec 2019
My mom plays her own routine, but going to bed early means she is often up at 2 or 3 AM disrupting my sleep. Dad is deaf so he is clueless in spite of her turning lights on....
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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 2019
I love this idea but I am afraid momma would think it was something to eat.
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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 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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As a geriatric social worker in a skilled nursing facility, sun downing was one of our biggest challenges. What we found helpful was hand massages, calming atmosphere. Try to stay calm yourself. Not easy, I know. At our facility we had one resident who everyday around 3:00 would become agitated stating that she needed to get her daughter off the bus. What we did is engage her in in conversation about the situation, provide reassurance that her daughter was safely off the bus and then diverted her attention to something else. Have you had a conversation with her physician? Or a consult with a geriatric psychiatrist? Maybe an adjustment or an addition of medications is in order. Good luck. It's difficult.
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Yes, my father had this, and they gave him meds to calm him..I believe it was Ativan...
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Mom is in stage 6 and starting to show signs of 7. She has lived with me for almost 7 years and has been sundowning the whole time.

She knocks on my bedroom door 4 or 5 times a night. She doesn't makes sense most of the time and is highly agitated.

She doesn't want the TV or music on. I keep a night light on in her room. I cannot keep her from napping during the day. She will scream, curse and fight you.

Melatonin, Trazadone, mirtrizipine, didn't change anything. We also tried some medication that was in a patch form but she wouldn't let me apply it.

She is now on Seroquel and it has helped some but the night before last she was up 3 times banging on my bedroom door screaming she was going to kill me.

Hwe dosage was increased to 100 mg in the day and 200 at night. I gave her 200 last night and she woke up after 3 hours and was up roaming again for 2 hours until she went back to bed. She is now up again and it is 5 in the morning.

I don't know what to do. She is 86, walks with a walker. She has roamed so much this last 2 weeks she has a trail from her walker in scratches on my wood floor.
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Gsc1964 Sep 2019
If I didn't know better, I would think I wrote this! Only difference is it's my 86 y/o father. The meds they put him on do seem to help him sleep at night sometimes, but it's a rollercoaster ride. He will do pretty well for a few nights, and then be up and down the next few nights. Yes, his walker has worn a path on my wood floors from his chair to his room! I don't know how much longer I can deal with this and the incontinence issues, but he can't afford memory care facilities. My only thing I can suggest is to have a home caregiver come once or twice a week to give you a break. I would go crazy without that.
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