Medication Suggestions for Sundowing

Mturn

We have reached a pretty emergent situation with my FIL.  MIL has extreme burnout and can't take caring for FIL anymore.  We have been looking at Adult Family homes and Memory Care Facilities to move him to but haven't found a place yet.  He is on the wait list at one facility.  In the meantime we have overnight caregivers 4 to 5 times a week and someone that comes in twice a week to take FIL out for aprox 3 hours to walk or get coffee.  FIL is sundowning and gets very difficult in the evenings.  His constant pacing, opening and closing doors, wiggling door knobs, flipping  lights off and on and non-stop talking and paranoia are more than my MIL can take. She's mentally done.  Medicinally speaking we have tried melatonin, dayvigo, various doses of trazadone and even CBD gummies.  Nothing works to get him to relax or to sleep.  Can anyone offer any suggestions on what medications worked to calm their LO down?  Were getting desperate.  Thank you.

Rick4407

Hello Mturn, My wife took a small dose of Seroquel (25 mg) which helped with the sundowning as well as making her sleepy.  Over the past 4 years we have slowly increased the dosage to about 100 mg in 2 doses, late afternoon and an hour before bedtime.  Rick

Dio

My DH tried a bunch, but the only one that worked was 1mg Ativan/lorazepam 2x a day, or up to 6x per day as needed. We only added more when he was on a trip and his friend gave him an extra 1mg when DH got very agitated. It's supposed to be stronger than valium. He was on 50mg seroquel for 4 months but sundowning started anyways, so we got Ativan.

M1

Mturn, what do his docs say?  there are so many different possibilities and considerations that may be unique to him--I hope you've put this same question to his docs.  Atypical antispychotics like Seroquel/quetiapine are certainly a possibility.  Benzodiazepines like Ativan also work but can carry fall risk in the elderly and addiction/tolerance risk (in everyone), but there are many others---

Martin Robbins

I, as the primary caregiver for my mother, needed sleep.  I had the opportunity once I hired a caregiver, but was unable to fall asleep.  My doctor prescribed trazadone, but, even at higher doses, it didn't work.  Then, I got temazepam (Restoril), which works every time I take it.  Not only does it put me to sleep, it keeps me asleep for at least 6 hours.

May flowers

Medicinewise, what works for one LO might not work for another. My FIL was put on a lot of different medicines at one time but was pretty much a zombie. When he came home in January after surgery,  we weaned him off everything, and tried one thing back at a time. Most of the meds had the opposite effect - made him more agitated. What ended up doing the trick for him was Risperidone. It calmed him but did not make him a zombie. He has slept through the night 90% of the time now for the past 6 months, plus he gets a small morning dose so we can change/clean him without too much agitation.

I would recommend that instead of letting the doc add one on top of another, that they try one at a time. If you use a geri-psych, I would ask that they do it that way. I know if they are inpatient they only have a short amount of time to get the meds worked out so they don't do a lot of trial with each med, but we found at home we could do that. It took a few months.

ImMaggieMae

Risperidone helps my DH too. It gets rid of the agitation while still keeping him mentally alert. It was originally prescribed in the hospital when he was there for a week to get his meds adjusted. Seroquel failed. It started working within a few days. The dosage was increased once after 7 months. I can see the difference within 1/2 to 1 hour when he is acting nervous and fidgety before bedtime. He’s told me it makes him feel calm and has asked me a few times when it was going to be time to take it. It’s a liquid that we measure in a syringe and squirt in his mouth. The only other dementia drug he takes is Memantine. He does take 6mg of Melatonin at night along with the Risperidone and Memantine. He sleeps through the night.

I agree with May Flowers about recommending it to the doctor. I think they often just throw things at the wall until something sticks. This has sure worked well for us. 

​fesk

I agree that what works for one may not work for another. Risperidone did not work well for my mother. She was up for hours each night and it gave her side effects. It may be exactly what your FIL needs though. It is all trial and error.

I also agree with only changing one med at a time.

Mturn

Thank you all for your suggestions.  I really appreciate the help.  We have made a list of the mentioned medications and I hope we can get an appointment to talk with a Dr. about these soon.  We are currently waiting on a referral for a Geriatric Physician.  The Geriatric Psychologist isn't accepting new patients.  We also discontinued working with our neurologist after going back and forth with medications, dosages, poor communication and prescribing meds that after researching and watching seminars we realized you shouldn't prescribe to people with alzheimers.  One thing is for certain...this whole sad situation has been a huge learning experience for us, as I'm sure it has been for all of you as well.  Thank you all again.

​fesk

Mturn, I see one of the reasons you stopped going to the neurologist was because medicine was prescribed that shouldn't be given to people with Alzheimer's. Many of the medications that are used to control extreme behaviors are antipsychotics and they do come with the warning they should not be used for elderly dementia patients. However, sometimes they are the only thing that will work. Do as you are doing - research and question everything. You may want to see if a different medication can be used first before trying antipsychotics. Wish you the best of luck and keep us posted

notjolly

Is Trazodone 50MG a strong dose. Has anyone had side effects taking it? Reading all the side effects I'm wondering if 50 MG is strong. My brother doesn't sleep well and sometimes it take hours for him to get to sleep then he doesn't sleep long because he has to keep getting up to go to the bathroom. I just don't want him falling if it makes him dizzy. The doctor prescribed it after having a video visit with him and some of the questions he answered.

Martin Robbins

No, 50 mg is not a large dose of trazodone.

That's the amount I was prescribed.  I needed sleep, but, as her primary caregiver, I would need to hear my mother and wake-up when needed.  That's why my doctor prescribed trazodone instead temazepam.  Mom passed last week, and I now take 2-15 mg of temazepamat bedtime.

notjolly

Thank you Martin, I just got another couple of perscriptions from the doctor for Risperidonn and Escitalopram. I'm not sure I want to load my brother up on all that. I think I will take one at a time for awhile. If one works I will hold off on the others until I think I need them. I have to read if they are ok for dementia patients in their 80's. With all the side affects ,one being stroke, I don't want to over due it.