Suggestions for Sundowning and Agitation? Medications?

Alex_K · January 2021

I am getting stressed out!

DH has been Sun-downing for the past several months to the point where he gets into everything, gets agitated, will not sit down and when it comes to bed time he becomes angry. He had a brother, now passed away, who had this issue but his wife did not remember what medications the doctor put him on to keep him calm in the evening. For now my DH takes 25. mg Seroquel in the morning at 8:00 am, one at 1:00 pm, and one at bedtime. It does not seem to help his agitation and restlessness from 3:00 pm until bedtime. The doctor said we could up the dosage but I am not sure extra would help.

As for a caregiver other than me this would not help because he does not want anyone else to touch him. He does not trust anyone else and sometimes not even me.

He cannot be easily distracted and I let him pace but he can get into all kinds of things and that makes me nervous. Are there other medications I could mention to the doctor that we could try or is Seroquel the best one?

The sundowning has been going on for 3 months and I am at the point where we need to do something different. We are not at the point for him to go into a facility since he can walk, eat, uses the toilet.

Thank you for any help you can offer.

M1 · January 2021

alex, I would reassure you to follow the doc's directions. You've got lots of room to move on the Seroquel dose; doses of up to 400 mg/day are used and you're only at 75 mg. Check with your doctor, but you could easily double the afternoon dose to start. Usually they'll want to change just one dose at a time so you can see what works. Good luck--

LaurenB · February 2021

I second the idea of calling the doctor and seeing what they suggest. It could be as easy as increasing the dose of medication or changing the times that it is given. As a therapist who has worked in nursing homes for 20+ years with PWD, many of my patients can walk, talk, use the bathroom and still need 24 hour care for their safety and/or their family is not able to provide the care at the level that they need. It's a tough journey.

Lauren

physicsmom · February 2021

It's kind of a last resort, but we give my dad Ativan in the evening when nothing else works. You get a bit of a zombie effect, but at least he's not punching people with it.

MamanMe · May 28

Sundowning with insomnia. My mother has just started Seroquel 12.5mg. She has dementia. It’s only been a week, but I’m not seeing any drowsiness. Does it usually take awhile to be therapeutic? Will call doctor, but wanted feedback to set expectations. Thank You

Pamela

Bobbi615 · May 29

https://alzconnected.org/discussion/comment/273434#Comment_273434

For reference, my loved one is now on 25 mg twice per day and is a 155 lb female. It makes her very drowsy but does not stay in her system long. Seems like 12.5mg is too low a dose, but I am not a doctor and do not know the risks to your mother.

JPJardinel · June 22

This sounds like such a hard, exhausting stretch. I really feel for what you're going through. Reading this, what stands out to me is how isolating it is to manage sundowning largely alone, especially when no one can soothe the person you're caring for but you, and sometimes not even then. The detail about not remembering what medication helped your DH's brother years ago is such a relatable, frustrating gap, since so much caregiving knowledge gets lost between families instead of being passed along. Three months of agitation every afternoon into bedtime, with a medication that doesn't seem to be touching the worst hours, would wear anyone down. I also think it's worth saying that you're being thoughtful about this, not jumping straight to a facility, but recognizing he's still capable in a lot of ways while also being honest that something has to change. Asking about alternatives to Seroquel rather than just upping the dose shows real engagement with his care, and I hope this community can offer some options to bring back to the doctor.

I based my comment on these references:
https://www.webmd.com/alzheimers/manage-sundowning
https://hopebridge.care/dementia-sundowning-syndrome-signs-triggers-and-solutions/

mummu · July 13

What too do mother in law wondering around outside at two in the morning after her family has been over to celebrate her birthday i told them this is too much for her that I noticed she looked over tired that her son took her out all morning that day I don't think he gave her time to wind down and she ask me why so many people here told her that everyone here for your birthday i knew that she was tired but no one listen to me my grandfather was 98 yrs old and that his oldest put him in the hospital and he passed away I don't want them tieing her up like they did my grandfather I think I angry for them not listening

Jeff H · July 15

My DW was in a similar situation with sundowning. Aggressive and agitated in the late afternoon. Her neurologist prescribed Rexulti which is the only drug FDA approved for that. It has worked wonders. My DW's aggressive and agitated behaviors are gone. Maybe ask your DH's neurologist about Rexulti. The only down side is it's a top-tier medication and can be costly. For me, it's been worth every penny. Good luck.

persevere · July 15

I’ve been towing this same line for several years now. Been through several meds with the DW who also suffers from aphasia. Talk to your dr about depakote. It can help. Buspirone is another non sedative that has helped. But know this. Some of these like serequol and depakote and Valium, all of which we use are sedative. This is not a bad thing for those who can’t sit or lay down from the time they’re awake until they finally fall asleep at night. Sometimes it is absolutely necessary.

persevere · July 15

https://alzconnected.org/discussion/comment/277371#Comment_277371

Jeff, did you ever use anything else before rexulti?

Suggestions for Sundowning and Agitation? Medications?

Comments

Commonly Used Abbreviations

Community Guidelines

Categories