Living with Mom Sundowning

My is 95 and has lived with us for 12 yrs. After a bout with pneumonia in the hospital she acted the same way when she came home. I have her on Celexa and it has worked wonders! It comes in 10mg which made her very lethargic so I cut them in half so she gets 5mg every AM at breakfast. She became more interested in TV, reading and interacting with the family. I would suggest that you try Celexa. (generic name)
She is now dealing with arthritis in her ankles and is up nearly all night complaining that her ankles “burn”. Fortunately, I have nighttime help to be with her. She has all her faculties and gets around fine with a walker, but being up all night continues to be a problem. I am just thankful that I don’t have to be up all night. I also promised her I would not put her in a nursing home.
Hope this helps. You are not alone. Take Care of yourself.

As caregivers for our Aunt Betty (89) we believe the cause of her Sundowners’ symptoms is stress. In Aunt Betty’s case we infer the cause of her stress has been a lack of stimulation, the loneliness and boredom – and just the general weakening and deterioration of body and mind – that accompanies old age.

We also infer Betty has been suffering from hormonal changes and hormonal in-balance and that this hormonal change is basic to stress. (See Hans Selye, M.D., and his book, “The Stress of Life,” available on Amazon.com and in many libraries). Selye provides a unique definition of stress showing that stress brings on hormonal in-balance and this leads to mental and emotional symptoms. Our hormones directly effect our neurotransmitters, most notably our “serotonin” neurotransmitters, that determine our sleeping habits, moods and emotional behavior.

With Aunt Betty we have found that these hormonal changes and their symptoms have been stabilized by (1) working with her internist to regulate her sleeping habits. Aunt Betty had her nights and days turned around and was often up half the night and, understandably, very tired and confused during the day. So her internist prescribed an anti-psychotic medicine that she takes at bedtime to insure she gets, at least, eight hours of sound, uninterrupted sleep.
In Aunt Betty’s case, her internist selected a light dose, 25mgs, of the anti-psychotic, Seroquel; and, for her that light dose proved satisfactory. A suitable amount of Seroquel is almost guaranteed to work b/c it attaches to the the histamine or sleep recepters in our brain. After two or three weeks of taking the drug consistently at bedtime, she turned her nights and days back around and her mind began to clear.

And (2) by working to get Aunt Betty to accept a high protein diet. Getting Aunt Betty to change her diet has been very challenging b/c these sundowners are often in a “shut down mode,” have pretty much given up on life, and have little or no appeitite. But our spending more time with Aunt Betty, getting her out to eat in restaurants, etc., has helped improve her appetite, but she is nowhere near where she needs to be with her eating.

Hospitalization has often resulted in making these patients worse, and our Aunt Betty is so determined to die at home any kind of institutional living is not an option anyway. But getting her to take a sleeping drug like Seroquel and to work toward changing her diet has required developing trust with her caring internist and trusted and loving family members. In our case, we hope to involve a very caring professional aide to help in Aunt Betty’s care.

Our on-going goal for Aunt Betty, despite her reluctance, is a high protein diet that should include plenty of eggs, milk and milk products (as in yoghurt, eggnog, cottage cheese, many kinds of cheese (including some of the more old-fashioned cheese spreads), ice cream, milk-based soups and custards, a glass of white milk at bedtime with her Seroquel tablet, etc. Also, liver and glandular meats, muscle meats, fish and fowl, yeast, wheat germ, soy flour, and a few nuts.

In addition with each meal Aunt Betty requires a 500mg tablet of Vitamine C; 100mgs of pantothenic acid (also known as Vitamine B5); 2mgs of Vitamine B2; and 2mgs of Vitamine B6. Once Aunt Betty’s Sundowner symptoms begin to ease up, she can reduce (but not totally discontinue) the amounts of these supplements.

The combination of the trusted, patient, and loving care of Aunt Betty’s internist and niece and nephew-in-law, the Seroquel induced regular sleep, the somewhat-improved High Protein Diet, and the supplements have helped inch Aunt Betty’s adrenal glands towards “kicking in” to produce the body’s natural steroids needed for a healthy body, mind, and emotions.

In this sense, the body chemistry of Aunt Betty, a Sundowners patient, is similar to someone suffering from any number of mood and emotional problems; similar even to one of our most severe mood illnesses, such as, Bipolar Disorder (aka “Manic-Depressive Illness”). The mood changes and symptoms of Sundowners patients are very much like those suffering from “Manic-Depressive Illness” and the cause and treatments appear similar as well.