Expert: Paula Damgaard - 3/9/2009

Question
My mother is 89 and she lives with me and a caregiver for her.  She cannot sleep, she has sundowners which starts about 4:00 PM and just escalates all night.  She has slept 3 nights in 3 weeks.  She naps during the day but is up all night combative and undresssing.  She is on Depakote and Zyprexa and ativan but nothing settles her down at night.

Answer
Lorraine, unfortunately demented people are just like children.  Give them a 5 minute nap in the day and they are good to go!  Hard as it is going to be and sometimes seem cruel, you must keep her up ALL day, not even a 2 minute catnap.  Until you exhaust her all day she will continue to do this.  Also make sure that you keep every light on in the house in the evening,  you want to stimulate "Day", their sundowning correlates with the decrease in activities and the "settling down" time of evening. So avoiding that sometimes helps as well.

You may also try giving her melatonin around 6pm at night, that has sometimes worked.  You can get it at a health food store, just be careful to read the ingredients on the back to make that it is mostly melatonin. Should be the first ingredient.  

Also we sometimes try Trazadone on our patients here in the clinic.  You could ask her doctor about whether or not this would be an option.  

It is very hard to get these patients to "settle down" at night. The drugs that we have to use, don't know that they are only supposed to work at night, so what you get is a "drugged" patient all day.  This besides not being nice for them, also subjects them to increased falls and other side effects.  Sometimes you have to keep medicating them until you get them to be "drugged" and then back the dose down to where they are "livable".  Hard thing to do sometimes with these patients cause they can't really voice what is going on.  

I hope this helps.  I know this is hard.  Just remember activity activity activity.  Paula