Tips To Minimize The Behaviors Of Sundowning
For some people with Alzheimers or other forms of dementia, the evening hours can bring increased agitation, confusion, and restlessness. Some may even experience hallucinations or energy surges. This unusual evening behavior is commonly known as sundowning or sundown syndrome and typically occurs as the daylight fades in the late afternoon and early evening.
Andrea Korsunsky, Director of Seniors At Homes Center for Dementia Care, says, Sundowning is more likely to affect those who are in the mid or late stages of dementia. And while doctors are not certain what causes sundowning, fading light appears to be the trigger.
If you are caring for someone that experiences sundowning, there are various ways to minimize the behaviors during this challenging part of the day. Below are Andreas top tips to manage the severity of sundown syndrome:
Tips For Managing Sundowning
There is not a simple cure for sundowning behaviour. The best thing that you can do is find ways of managing your relatives sundowning when it happens, and taking steps to prevent the agitation that they feel in the afternoon and evening. If your relative is feeling very restless or agitated, there are simple things that you can do to comfort them.
Mutsai Hove Bird recommends the following ways of managing sundowning.
Ways To Manage Your Loved Ones Sundown Syndrome
Does your loved one with Alzheimers or mid- to advanced-stage dementia regularly have a mini meltdown at night or increased confusion?
Its called sundown syndrome or sundowning, and its the name for a collection of disruptive symptoms that usually appear in the late afternoon, in the evening or into the night.
Behaviors may include agitation, anxiety, aggressiveness and yelling, as well as confusion, disorientation, pacing and wandering, according to a study published in Psychiatry Investigation.
Sundown syndrome is largely a mystery to doctors.
It can be alarming and stressful for both you and your loved one. Here are the common triggers to know as well as seven tips for coping.
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Minimize Their Stress At Night
Try to help your loved one stay calm in the evening hours. Encourage them to stick to simple activities that arent too challenging or frightening. Frustration and stress can add to their confusion and irritability.
For example, try to avoid noisy groups and loud noises if possible, as well as doing any chores that might be overwhelming for them. Older adults are more sensitive to noise, according to a 2018 study.
If they have mid-stage or advanced dementia, watching television or reading a book might be too difficult for them in the evening. Instead, consider playing soft music to create a calm and quiet environment. Some people also enjoy looking at photographs. It might also be a nice time for them to snuggle with a beloved cat or other pet.
Your loved one might experience sundowning as the result of changes in their circadian rhythm, which is their sleep-wake cycle.
Thats why adjusting the light in their home might help reduce their symptoms. For example, a 2011 research review found that light therapy can help reduce agitation and confusion in people with dementia.
So consider placing a full-spectrum fluorescent light about 3 feet away from your loved one for a couple of hours each morning.
Tips For Coping With Sundowning
Late afternoon and early evening can be difficult for some people with Alzheimers disease. They may experience sundowningrestlessness, agitation, irritability, or confusion that can begin or worsen as daylight begins to fadeoften just when tired caregivers need a break.
Sundowning can continue into the night, making it hard for people with Alzheimers to fall asleep and stay in bed. As a result, they and their caregivers may have trouble getting enough sleep and functioning well during the day.
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Assisted Living Facilities And Sundowners Syndrome
In some cases, elderly people with Sundowners syndrome may become too much for caregivers to effectively manage at home. If you find yourself doubting your ability to provide the best care and a safe environment for your loved one, you may want to consider moving them into an assisted living facility or another appropriate residential facility.
Improve Safety And Security
Help ensure the dementia patients safety by installing locks and safety devices as necessary. Take precautions to provide a safe space for your loved one at night so that you can get some sleep, even if they stay awake and wander. This includes removing or securing potentially dangerous items in areas that they have access to.
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Talk With A Senior Living Advisor
Our advisors help 300,000 families each year find the right senior care for their loved ones.
- Try to remain calm and avoid arguing. Instead, validate their feelings and let them know youre listening.
- Offer reassurance and let them know theyre safe and everything is OK.
- Distract and redirect them to favorite activities, such as listening to soothing music, having a snack, or going for a walk.
Dont be afraid to ask for help. Call your loved ones doctor if the signs become too frequent or difficult to manage. A doctor may be able to pinpoint additional triggers or offer different management techniques.
If youd like to explore additional care options, such as memory care, for your family member or loved one, our Senior Living Advisors are available to help.
Canevelli M, et al. . Sundowning in dementia: Clinical relevance, pathophysiological determinants, and therapeutic approaches. Frontiers in Medicine
Understanding and Minimizing Symptoms of Sundown Syndrome posted by Dana Larsen
Nall, R. . Whats to know about Sundowners syndrome? Medical News Today.
How Can I Prevent Sundowning
There might be some things you can do to prevent sundowning and lessen the severity. Try the following:
- Make sure your loved one gets enough rest at night.
- Avoid caffeinated drinks after the morning.
- Avoid drinking too much alcohol.
- Try to help your loved one get plenty of sunlight during the day by sitting by a window or going out for walks.
- Exercise every day.
- If a nap is necessary, make it short and early in the day.
- Plan some activities throughout the day but not too many.
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What Is Sundown Syndrome
Before we look at how to help sundowners sleep or care approaches for sundowning, lets answer the question, what is sundowning in dementia?
Sundowning in dementia patients is a term used to describe a sudden state of confusion or behavior change. It often occurs in the late afternoon/evening, making dementia in the evening seem worse than at other times.
Unfortunately, experts arent exactly sure what causes sundowning. Some factors that may increase someones risk of sundowning include:
- A disrupted internal clock
- Being too tired or having too much energy
You can tell that your loved one experiences sundowning if they exhibit a quick increase in any of the following symptoms during the evening:
- Anxiety or worry
- Pacing or wandering
- Aggression or anger
In addition, because sundowning happens in the evening near bedtime, sundowning can affect the individuals ability to sleep at night. And in turn, affect a caregivers nighttime sleep.
Dementia sleep issues, like sundowning, often leave caregivers tired, frustrated, and wondering how to help sundowners sleep.
Maladaptive Response To Environmental Factors
Cohen-Mansfield et al.58 studied the temporal pattern of agitation and fatigue in nursing home residents with dementia. According to this study, only a minority of agitated nursing home residents, especially those with higher baseline level of agitation, showed increased intensity of agitation after 4:00 PM. This finding was not in agreement with widely accepted notion about temporal relation between sunset period and peak in behavioral disruptions including agitation. Patient’s confusion, as a manifestation of sundowning, may be a result of the chronic fatigue and disturbed sleep-wake cycle.60 Afternoon fatigue, caregiver fatigue, and overstimulation in the environment, as well as shifts change around 3:00 PM when there is more noise and general chaos, all are contributing factors to sundowning.61,62 High level of activity in the morning hours and during the day may cause afternoon or evening fatigue, and then lead to increased irritability and agitation in demented patients.63
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Prescribed Medication Wearing Off
If your relative takes prescribed medication at a fixed point in the day, it may wear off in the afternoon or evening.
It is important to remember that a person with dementia being distressed is not necessarily sundowning behaviour. They may be trying to communicate a specific need to you, such as pain or constipation.
How To Deal With Sundowning
Watching a loved one becoming irritated, upset, hyperactive or demonstrate other behavioural problems can be distressing, but its important to remember that they are not in control of their actions. There are also lots of things you can try to minimise sundowning symptoms.
Every person with dementia is unique, and it may take a while to find out what works best for your loved one. Keeping a detailed diary of your loved ones behaviour can be a useful way of identifying triggers and managing symptoms.
Maintain a positive routine
The most important thing to do is to ensure that your loved one has a routine tailored around sundowning behaviour to eliminate it as far as possible.
To this end, it is helpful to draw up a timetable or schedule, ensuring that busy activities and outings are arranged for the morning when your loved one is feeling at their best. Once you have a routine in place, its essential to stick to it.
During the afternoon, try to engage your loved one in calming activities that dont require too much thought. The aim is to undertake simple and engaging activities at this time, ones that arent too stimulating. Make sure that any clutter is tidied away, as this can cause aggravation later in the day.
Stay calm
Raising your voice or becoming angry will only worsen the situation, so try to remain calm, no matter what the provocation. Speak in clear sentences, dont try to rationalise with them and keep reassuring them that everything is ok.
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Offering Familiarity And Comfort
People who have dementia appreciate being surrounded by comforting persons, thoughts, and things.
These usually help one to cope with some of the challenging issues that crop up as they are dealing with the illness.
Whether the person is living at home or at an assisted facility, ensure that they have all the items they cherish.
Loved ones should also try and visit them often to keep them company and keep them smiling. This also helps to combat stress a move that can lessen sundowning symptoms.
Tips For Caring For Someone With Sundowning
Sundowning syndrome is not a simple condition, but it is a common occurrence that many loved ones and caregivers struggle with. While you may not be able to stop sundowners syndrome completely, Nisson provided seven ways you can help prevent, reduce symptoms and best cope.
1. Look for triggers
Certain activities and environments can trigger your loved ones sundowning, things like fatigue, loud noises, discomfort, taxing activities or changes in environment or caregivers. Use your smartphone or journal to track what triggers or worsens symptoms so you can avoid situations that promote agitation and confusion.
2. Create structure in the day
Daily routines can help your loved one feel safe by minimizing surprises and reducing anxiety and confusion. Offer structured meaningful activities earlier in the day, including physical exercise and movement.
3. Get outdoors
Take a walk and get some sunlight and fresh air. Sunlight can help set their internal clock as well as help reduce pent up energy.
4. Support good rest
Fatigue and lack of sleep can worsen symptoms. Alternate activity with brief periods of rest and ensure your loved one gets a good nights sleep.
5. Limit stimulation in late afternoon and evening
Lower lights, limit caffeine intake, close curtains or blinds, minimize noise and reduce clutter. Use soothing scents like lavender and soothing touch when appropriate.
6. Be gentle
7. Seek support
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Maintain A Nighttime Routine
Individuals with dementia can greatly benefit from a routine in general. But a consistent nighttime routine is especially valuable when it comes to sundowning or a dementia patient waking up at night.
Your loved ones routine should involve low stress, low energy activities to help them relax and calm down before going to bed.
Youll want to avoid activities like watching TV or exercising. Its also best to stay away from caffeinated or alcoholic beverages in the evening.
Instead, some activities that can help sundowning in dementia patients include:
- Playing a simple card game
- Listening to their favorite music
- Talking about past memories
Ultimately, you want to suggest activities that will keep your loved one occupied and relaxed until they get into bed.
What Causes Sundown Syndrome In The Elderly
The causes of senior sundown syndrome arent clear.
Its possible that Alzheimer’s-related changes in the brain affect a person’s internal biological clock. These changes may lead to the progressive confusion of sleep-wake cycles.
Exhaustion caused by the lack of sleep that accompanies sundowners syndrome only serves to exacerbate the problem.
Senior sundown syndrome may be more likely in older adults who are:
-
Keeping an eye out for triggers
-
Encouraging regular exercise throughout the day and
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Sticking to a regular routine
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Medical And Psychiatric Conditions As A Contributing Factor
A vast variety of medical factors can contribute to temporally associated agitation. For example, some diseases in which pain is intense may initiate or worsen cognitive, affective, or behavioral disturbances in the late afternoon. Bachman et al.63 reported that agitation may be a manifestation of the response to temporal variation in pain. Mood variability in some demented patients may have predictable pattern, and in major depression worsening of mood in the evening hours , might possibly explain some cases of sundowning.63 It can be hypothesized that agitation and changes in activity in demented patients with depression may be manifested as sundowning taking into consideration difficulties in eliciting other symptoms of depression in cognitively impaired individuals.63 Some researchers theorize that hunger, changes in blood glucose levels after eating in patients with diabetes, or a drop in blood pressure after a meal , may bring on agitation and confusion in susceptible individuals.67
How Can Caregivers Cope With Sundowning
Unfortunately, even with the best efforts at prevention, most dementia caregivers will likely need to cope with sundowning symptoms at some point. Your loved one may shadow you or follow you around and closely observe or mimic everything you do. They might ask questions over and over or interrupt conversations. They may temporarily lose the ability to communicate coherently, and abstract thoughts may become especially difficult for them to comprehend. In severe cases, they may wander restlessly around their environment or try to get outside to escape.
Because people with dementia are difficult if not impossible to reason with, its crucial for caregivers to try to stay patient throughout episodes of sundowning. Even if you dont directly express your concern or irritation, its likely that your loved one will still pick up on your mood and frustration. Use the following tips to help you cope with and respond to these difficult behaviors:
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What Are The Symptoms Of Sundowning
Sundowning is a distressing symptom that affects people in mid to late-stage Alzheimers and other forms of dementia, and as the condition progresses, the symptoms tend to worsen. Those with dementia can become hyperactive, agitated and confused, and these symptoms can extend into the night, causing sleep disruption.
Sundowning effects people in lots of different ways, but common symptoms include:
- Confusion for example, asking to go home when they are home
- Anger shouting or becoming argumentative
- Extreme agitation becoming upset or anxious
- Emotional outbursts sudden mood swings
- Hallucinations hearing/seeing things that arent there
- Restlessness rocking, pacing or wandering
- Paranoia Becoming suspicious and hiding objects
- Insomnia Trouble sleeping
Its important to remember that as dementia progresses, a loved ones behaviour and the way they communicate with you will naturally change.
When these changes happen towards the end of the day, it can difficult to distinguish them from sundowning symptoms. Take a moment to talk to family members and carers about these changes to understand if there may be other reasons for them aside from sundowning.
Tips For Coping With Sundowners Syndrome
As the sun begins to set, have you noticed changes in a loved ones behavior? For those living with Alzheimers disease and other forms of dementia, its not uncommon to experience unpredictable agitation and confusion during this time of day.
Sundowners syndrome, also called sundowning or late-day confusion, is a group of symptoms that occur in someone with memory loss that can start around late afternoon and continue into the night. It can cause increased confusion, disorientation, anxiety, agitation, pacing and even wandering.
We know that most people living with dementia will experience behavioral symptoms during the course of their disease, particularly during the moderate stage of Alzheimers disease and earlier in other types of dementia, said Lori Nisson, a licensed clinical social worker and Family and Community services director at Banner Alzheimers Institute and Banner Sun Health Research Institute. They are working much harder to complete tasks and activities that used to come easily to them, so they are expending more energy and can wear out easily as the day progresses.
While there is no one explanation for its cause, factors that typically trigger changes in behavior include fatigue, disruption to the sleep cycle, boredom, restlessness or unmet needs, such as hunger, thirst or the need to use the restroom.
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