A doctor’s advice for an Alzheimer’s patient with ‘sundowning’

Q. My father suffers from Alzheimer’s disease. He and my mother live in their home and have required little outside help and support. Recently, however, my father has stopped sleeping and he becomes very agitated at night. I’m very concerned, not only for him but for my mother. I’ve done a lot of research on “Sundowning,” as it’s called, and have spoken with professionals but none of their recommendations or the suggested remedies have worked.

We’ve hired a caregiver to help at night time. This enables my mother to sleep but it’s expensive and does little or nothing for him. Does this ever go away? If not, what can we do to make it more livable? Carla B., New York, NY.

A. You’ve described a classic case of “sundowning,” a common problem in dementia patients, characterized by lack of sleep and high levels of anxiety and delirium. As you have observed, his behavior impacts the safety and well-being of your mother as well as family caregivers. You are smart to get additional help at night.

How long will it last? According to Dr. Barry Baumel, Division of Cognitive Disorders at the University of Miami School of Medicine, “sundowning usually occurs in the intermediate phase of the disease and will many times pass as the disease progresses. Just like there are many theories as to why sundowning occurs, there are many different approaches to effectively treat it.”

Here are Dr. Baumel’s suggestions:

▪  Make sure that the lighting during the day is bright and full. At night time, leave a little night light on so there is just enough light to see should your father awaken.

▪  As much as possible, keep your father active during the day since Alzheimer’s patients naturally tend to have less motor activity during daytime hours.

▪ Make sure his Alzheimer's medication, (such as Aricept, Exelon or Razadyne) is given in the evening. This may help improve the disturbed sleep-wake cycle.

▪  Adding a little Melatonin may also help induce sleep at night. Dosage range should be determined by your father’s doctor. He should avoid napping during the daytime, if possible.

For additional reading, Dr Baumel recommends: "The Alzheimer's Action Plan" by Dr. Murali Doraiswamy. It includes a chapter on the treatment of anxiety and sleeplessness.

Nancy Stein, Ph.D., is the founder of SeniorityMatters.com, a local caregiver advisory and referral service for South Florida seniors and their families. You can contact her at nancy@senioritymatters.com.

This story was originally published October 16, 2014 at 2:15 PM with the headline "A doctor’s advice for an Alzheimer’s patient with ‘sundowning’."