I am the sole caretaker of my husband. Every afternoon from about 4-6 p.m. he gets very angry and aggressive. He is on Namenda, Depakote and Seroquel. These drugs don't seem to stop him from these outbursts. How can I distract him so he won't get so angry?
Jeanette, your husband is Sundowning. Try using the search feature to find the Sundowning threads. You need the information so you can talk intelligently about the situation. It is NOT unusual.
Also, talk to your doctor about what is going on. There are drugs for that and it is obvious that the Seroquel is not working. You might need a different drug. You might need an additional one. Or a different dosage. Or to give it to him at a different time. Only his doctor can tell you which way to go on this.
I just checked to see if you were new, and you are. Welcome, although we are sorry you needed to find us. You are in the right place.
Jeanette, sundowning can be many different things depending on the person. My DH does what yours does and follows it with being very tired. If he tries to do to much, the anger and aggressiveness is worse. I try to get him to take a break in the early afternoon around lunch and then it doesn't get so bad. I also try to encourage him to stop working on a project when he gets tired and it helps.
OK, in regard to the meds ... some work better for a given patient than another, or may cause adverse side effects. Different types of meds may be given in combination if a single med doesn't solve the problem. Plus, as Starling said, the dosage may have to be adjusted. This is just one of those things you need to work on with the doctor.
It's a little harder to search our threads for posts about drugs, because we sometimes use "creative" spellings for them.
I've found a couple of excellent articles on meds for treating behavioral problems, but it's going to take a while to get them into a legible form ... not to mention, this site gets cranky about my longer posts, so I'll have to chop them up.
But first, I have to take my husband off for his flu shot... Back in a while.
Welcome Jeanette :) My husband suffered with horrible sundowning for about 3 years. Unlike your husband, mine was upset all night. He use to pace well past 4 am. The seroquel did work for him, overnight he changed. I would do as the others recommended and talk with your doctor about adding another medication or adjusting his dosage.
Another thing I swear has helped him is lighting. I noticed he got anxious as the sun started to fade and the house got darker. I bought lamps and put them in his favorite sitting areas. I also bought the full spectrum sun light bulbs. It really does seem to help him. Best of luck~Nikki
OK. Can't give you a reference for this first article ... it was just posted on "the other site" a couple of years ago, info on the meds may be a little out-dated but overall, it's pretty good.
Behavioral Symptoms
Definition
When Alzheimer’s disrupts memory, language, thinking and reasoning, these effects are referred to as “cognitive symptoms” of the disease. The term “behavioral and psychiatric symptoms” describes a large group of additional symptoms that occur to at least some degree in many, but by no means all, individuals with Alzheimer’s.
In early stages of the disease, people may experience personality changes such as irritability, anxiety or depression. In later stages, other symptoms may occur, including sleep disturbances; agitation (physical or verbal outbursts, general emotional distress, restlessness, pacing, shredding paper or tissues, yelling); delusions (firmly held belief in things that are not real); or hallucinations (seeing, hearing or feeling things that are not there).
Many individuals with Alzheimer’s and their families find behavioral and psychiatric symptoms to be the most challenging and distressing effects of the disease. These symptoms are often a determining factor in a family’s decision to place a loved one in residential care. They also often have an enormous impact on care and quality of life for individuals living in long-term care facilities.
Medical evaluation
A person exhibiting behavioral and psychiatric symptoms should receive a thorough medical evaluation, especially when symptoms come on suddenly. Treatment depends on a careful diagnosis, determination of the possible causes, and the types of behavior the person is experiencing. With proper treatment and intervention, significant reduction or stabilization of the symptoms can often be achieved.
Symptoms often reflect an underlying infection or medical illness. For example, the pain or discomfort caused by pneumonia or a urinary tract infection can result in agitation. An untreated ear or sinus infection can cause dizziness and pain that affect behaviors. Uncorrected problems with hearing or vision may also have an impact.
Side effects of prescription medication are another common contributing factor to behavioral symptoms. Side effects are especially likely to occur when individuals are taking multiple medications for several health conditions, creating a potential for drug interactions.
Non-drug treatment strategies
There are two distinct types of treatments for behaviors: non-drug strategies and prescription medications. Non-drug interventions should be tried first. In general, steps to managing behaviors include (1) identifying the behavior, (2) understanding its cause, and (3) adapting the caregiving environment to remedy the situation.
Correctly identifying what has triggered symptoms can often help in selecting the best approach. Often the trigger is some sort of change in the person’s environment: - change in caregiver - change in living arrangements - travel - hospitalization - presence of houseguests - bathing - being asked to change clothing
A key principle of intervention is redirecting the person's attention, rather than arguing, disagreeing, or being confrontational. Additional strategies include the following: - simplify the environment - simplify tasks and routines - allow adequate rest between stimulating events - use labels to cue or remind the person - equip doors and gates with safety locks - remove guns - reduce risk of fires with extra smoke alarms and control access to the stove - use lighting to reduce confusion and restlessness at night
Medications can be effective in some situations, but they must be used carefully and are most effective when combined with non-drug approaches. Medications should target specific symptoms so their effect can be monitored. In general, it is best to start with a low dose of a single drug. Effective treatment of one core symptom may sometimes help relieve other symptoms. Thoughtful choice of a drug may also maximize its benefit. For example, some antidepressants may also help people sleep better.
People with dementia are susceptible to serious side effects, including a slightly increased risk of death from antipsychotic medications. Risk and potential benefits of a drug should be carefully analyzed for any individual.
Some examples of medications commonly used to treat behavioral and psychiatric dementia symptoms are listed below. These lists do not include every drug used for these purposes. Doctors base their choice of medication on many factors, including the underlying cause of dementia and an individual’s symptoms, living situation, caregiving arrangement, and coexisting health conditions.
Anxiolytics for anxiety, restlessness, verbally disruptive behavior and resistance - lorazepam (Ativan®) - oxazepam (Serax®)
Antipsychotic medications for hallucinations, delusions, aggression, hostility and uncooperativeness - Newer “atypical” agents such as aripiprazole (Abilify); olanzapine (Zyprexa); quetiapine (Seroquel); risperidone (Risperdal); and ziprasidone (Geodon) - Older first-generation drugs such as haloperidol (Haldol)
The decision to use an antipsychotic drug needs to be considered with special care. Recent studies have shown that these drugs are associated with a slightly increased risk of death in older adults with dementia. The FDA has labeled the drugs with a warning about this risk and a reminder that they are not approved to treat dementia symptoms.
To maximize the chances of effectiveness, the choice of a particular drug, how long it should be used, and when it should be discontinued all need to be carefully tailored to an individual’s symptoms and circumstances. The underlying cause of a person’s dementia may also influence the selection of a drug. For example, it is generally considered inadvisable for individuals with dementia with Lewy bodies (DLB) to take antipsychotic drugs.
Although antipsychotics are among the most frequently used medications for treating agitation, some physicians may prescribe an anticonvulsant/mood stabilizer, such as divalproex (Depakote), for hostility or aggression.
Many experts recommend that use of drugs to treat agitation, aggression, hallucinations and delusions in persons with dementia be managed by a physician with experience and interest in this area.
Medications for sleep problems
Some medications are approved specifically by the U.S. Food and Drug Administration (FDA) as “sleeping pills.” Most physicians tend to avoid prescribing “sleeping pills” for older adults with dementia, since in this group these drugs may have serious side effects, including incontinence, problems with balance, falls or increased agitation.
One widely used alternative is the antidepressant trazodone (Desyrel), which tends to make people sleepy.
Anti-anxiety medications are also sometimes used.
Physicians also recommend that individuals with dementia avoid over-the-counter sleep remedies. The active ingredient in many of these preparations is diphenhydramine (Benadryl), an antihistamine that tends to make people feel drowsy. Diphenhydramine further suppresses the activity of one of the main brain cell messenger chemicals whose activity is reduced by Alzheimer’s disease.
Examples of over-the-counter sleep aids containing diphenhydramine that should be avoided include: - Compoz - Nytol - Sominex - Unisom
Diphenhydramine is also an ingredient in many “nighttime” or “PM” versions of popular pain relievers and cold and sinus remedies.
The second article is longer ... happily, I found a link for it. It was last revised 09/07/05, but appears to be an excellent article, very useful info, well worth reading.
http://64.26.26.159/abtalz/medsdrsteinke.asp
The Use of Medications in the Treatment of Dementia and the Associated Behavioral Problems by Gary W. Steinke, M.D.
Nikki, you may be right on the money with the lighting. The first thing my husband does when he gets out of bed whether it is 3 in the morning or 3 in the afternoon is turn on every light in the house. For a while I went around behind him and turned them out now I just leave them alone (except in the middle of the night. I turn them off once I convince him to go back to bed.)
I just know for Lynn it truly does make a difference. My sister and I have even tested it. When he gets a bit anxious we turn on all the extra lights and he calms right down. If we dont turn them on, he gets more and more upset. I think the dark spaces -shadows may be frightening to him. I also did notice a difference with the Full spectrum light bulbs, I can only assume this is because they mimic the qualities of natural sunlight. Anything that helps I will do!
Hate to be the killjoy here, but both seroquel and namenda made my DH aggitated and more difficult to deal with. he is on nothing now for 8mo and docile as a lamb so far compared to before:) divvi
divvi-do you ever get the feeling that we are alone out here. Only our little group understands that dementia victims don't all respond the same way to medications. It's up to us to evaluate, research and call the shots. Gets wearisome.
Mary, I do apologize. I'll add that to my file right away... Do you happen to know if there have been any clinical trials, or is your recommendation based solely on anecdotal evidence?
Sunshyne, there are days I would love to be in a clinical trial for the bat! <grin> I'll have to admit it is just an imagine that comes to my mind when his sundowning gets bad! I get over it before the sundowning goes away for the night!
bluedaze, we who are here and sharing are opening up the way for ourselves and others on symptoms, medications, and processes to deal with whatever materializes with this disease. We are pioneers! I've learned so much from those here! I don't think we'll be alone much longer. Word is spreading and more are coming to read Joan's page and learning as well. Over the next 10 years, if they haven't discovered the cause and cure, more millions will need to be here. That is sad.
My DH is on Aricept, Namenda, Paxel, Depakot and Risperdal. He is still sundowning. He tells me tonight that he is paranoid about someone coming in the house and taking things. Also that the dark does make him anxious. He is getting more delusional as the months go by. I have tried all non medication routes. I hate to increase pharmacy on him now....seems like he is taking a lot.
mmarshall, can you ask about seroquel that lots take here? it has good resullts for most here. maybe drop the depakote ?ask your dr friend, get some changes going. there are meds that do help better. Divvi
As I said on the other site about Sundowning, turning on all the lights in the area where he was (and closing the shutters to the outside) stopped his Sundowning. He sleeps in the day and so the lights didn't keep him awake at night. It was a simple solution for a terribly upsetting problem. And! Seroquel works when several other drugs did not. As I said before, every person's chemistry is different. There is no ONE magic pill when it comes to a calming drug.
I'm SO glad I found this site and all the helpful info; so when one thing or another happens I have an idea what to do (or not). A couple evenings ago my husband was walking around w/a sort of glazed look in his eye. He went in the kitchen, and I asked if I could help him. "No." What are you looking for? "I don't know." So, I says to meself, "Self, this must be the 1st episode of sundowning my friends at alzspouse have been talking about." He walked around a bit more and then sat down to watch TV.
Zibby, you will KNOW when it is sundowning. ( as an aside: ...I go to the kitchen and forget why every day! -- :-) )
When my precious husband was sundowning, he was wild. What's the word?.. Manic? More manic than confused. He was totally crazy! He slapped at my hand, was into everything, buzzing around like a mosquito. He couldn't answer any question I asked. I might as well be talking to him in the Swahili native tongue. The look in his eyes was more like a mad caged animal.
We're so glad you are going to be helping US with ideas and encouragement just as we're here for you. It's a strong alliance..thanks to Joan.
Just read through this and trying to figure out if this is what my DH is experiencing. His problems come on after he has been asleep for quite a few hours. Is this the same thing? He is on pain medication for severe arthritis, aricept, and started on Dimebon (finished with the clinical trial and is on the actual meds) a few weeks ago. He also has melatonin just before bed. This is new for him...or for us! VBG!
And what does he DO after sleeping for several hours, Patsy? Most of us have associated sundowning with problems starting as it goes dark - early evening or even late afternoon, rather than waking in the night... meds adjustment time, most likely!
briegull, he wanders around "looking" or thats what he says. I didn't think Sundowning was a good fit for what he is doing but thought I'd get clarification since I haven't had to deal with. In my lists of meds I forgot to mention Lexapro (20 mg). That has done the trick in the past as far as anxiety goes. I will contact his doctor and see what he thinks. Thanks for your suggestion. I knew I could count on caregivers!
Weejun, TTT ? I'm sorry I'm new to this and don't quite understand the abreviation. My DH is very anxious at bed time and sleeps for a couple of hours, then wakes up with the symptoms described by others in this page. I guess he has sundowning as I have been reading others blogs on their LO's and he is the same. I have also tried Lexapro for him unsuccessfully - 20mg.
Strange, my dh's sundowning -- which took the form of wanting very urgently to go "home" -- has completely disappeared. Hope it stays that way because it makes late afternoons and evenings much more pleasant. SO, those of you who are dealing with it: this too shall pass. By the way I am not the same Jeanette as the one who started this thread. She seems to have disappeared.
Turn the tv up, check besure he is safe in hospital bed with rails up, offer one-half banana, offer other half and water. Check diaper see if it is wet or soiled. He sundowns from 4pm until 8ish ... give or take 1 hr. Forgot to say get your earplugs in if your going to read and not watch tv. This sounds cruel but i check on him often and i dont get too close either cause he is combative.
Bad day of sundowning today, just when I thought I had it under control. It started 3pm and he is beginning to wind down at 8:30pm. (I think) Usually I tolerate it. He is now laughing and carrying conversation with someone. The laughter makes my heart feel good!
nellie, my DH laughs a lot during the sundowning process. Sometimes I ask him what he is laughing at but most of the time I am just glad that he seems to be happy.
Yes the laughter is good! He use to name people and I could figure out who is was talking with. Now words are jumbled and today I noticed he could barely get banana to his mouth.
Thanks bluedaze*, have been reading posts. Even tho we are going through this awful disease my heart goes out to all of you who have been where we are now.
I'm not going to add anything,it would just be repeating everything everyone has written.I don't like having anyone going thru what I've been going thru but it does help to know I'm not alone in my feelings and thoughts.I have to wonder,will I have a life when this is over,or will I even survive my spouse.The "sundowning" gets unbearable,maybe because by then I am sundowning myself. Does anyone else feel the sundowning effect themselves?
I didn't feel the sundowning had the same type of effect on me. But, having to live with Lynn when he was sundowning sucked the ever loving life right out of me!!! It was a very difficult part of our journey. Is your LO on medication to help ease the anxiety and symptoms?
He takes 1 1/2 Zoloft in the AM.Maybe I should change it to early PM.
Nikki 6 hours ago
I am not sure? But I would speak with his doctor about it. Seroquel was the only medicine that helped Lynn. Another thing I found was for Lynn it did help if I turned on lots of lights in the afternoon. best of luck!
jang 5 hours ago
I feel trapped by the sundowning. It can start as early as noon and can go till 7. That means any outings are difficult and I don't like to expose others to the joys of our life. I don't even like to have workers here then as I think it is unfair to put them in a position that drives me crazy.
jang, I know how you feel, I don't have to subjects anyone to my crazy life right now either. My sundowning "zoo" starts anywhere from noon to 3 depending on what he did or didn't do in the morning.
I love you, Sunshyne. You give thorough, well researched, intelligent info. I'm fairly new to this nighmare and your answers are so very helpful. Thank you. Don't stop posting, you are needed.
Since my earlier post hospice nurse observed DH and his sundowning. BP was sky high, now I give 2 pain pills and 1 ML of liquid ativan around 5ish. Sometimes I have to give meds again 11pm. The danger was that he might have stroke from high bp and he was also combative.
What an idiot. It never occurred to me to wonder if what happened in the morning had any affect on sundowning. I considered it a separate entity. I will start making notes to see if there is a pattern.
mothert, just noticed your post of July 29. I don't think Sunshyne is posting much here any more, although I "see" her often on the AA message boards, where she posts as JAB. I think you can e-mail her at alzcarer@gmail.com. Hope this helps.
Divvi, I try to be like an elephant (big ears, small mouth) rather than a hippo (big mouth, tiny ears), but I'm definitely keeping an eye on y'all. I'm "old" enough to remember the dirty dozen but young enough not have been one. <gg>