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How To Manage Sundowning In Dementia

How Do You Manage Sundowning In Dementia

Dementia and Sundowning: Tips to help you manage sundowning

Coping with Sundowning

  • Reduce noise, clutter, or the number of people in the room.
  • Try to distract the person with a favorite snack, object, or activity.
  • Make early evening a quiet time of day.
  • Close the curtains or blinds at dusk to minimize shadows and the confusion they may cause.
  • People Also Asked, At what stage of dementia does sundowning occur?

    It can occur at any stage of the disease but it tends to peak in the middle stages of dementia and lessens as the disease progresses. Sundowning often affects the persons quality of life and it can be exhausting for the caregiver.

    Also know, what is Sundowners in dementia patients?Sundowning is a symptom of Alzheimers disease and other forms of dementia. Its also known as late-day confusion. If someone you care for has dementia, their confusion and agitation may get worse in the late afternoon and evening. In comparison, their symptoms may be less pronounced earlier in the day.


    What Signs Should I Look Out For

    The symptoms of sundowning typically occur between the hours of 4:30 p.m. to 11 p.m. and may be worse during the fall and winter months when the daylight hours are shorter.

    As a caregiver, some signs to look out for include:

    • Signs of fatigue or unmet needs, pain or discomfort
    • Agitation, anger or irritability
    • High levels of anxiety
    • Pacing or wandering;;

    The duration of these symptoms can stop abruptly, change and fade over time, which can be very difficult for caregivers to manage. If you are caring for a loved one experiencing sundowning, you may wonder how to cope with these symptoms.

    Frequently Asked Questions About Sundowners Syndrome

  • What Are the Early Signs of Sundowners Syndrome?Sundowners syndrome causes a wide variety of behavioral changes that, in the early stages, can be subtle and inconsistent. Early signs of sundowners syndrome include restlessness, agitation, irritability, and mental confusion in the elderly at night. The patient may also appear disoriented, or they could become more suspicious or demanding. As the condition progresses, these symptoms may become more pronounced and may progress into more serious behavioral disturbances including extreme agitation, emotional outbursts, anxiety, paranoia, and hallucinations.
  • What Causes Sundowning?Doctors and researchers have not yet identified a clear cause for sundowning, but it may be related to the body’s internal clock and worsening dementia. Dementia typically causes progressive confusion and difficulty with processing and reasoning skills it can also change the body’s internal clock that differentiates between day and night. When the body’s internal clock is disrupted, it can lead to confusion and exhaustion which may exacerbate mental and behavioral symptoms commonly seen in sundowners patients.
  • When Does Sundowning Occur?The symptoms of sundowners syndrome typically develop between the hours of 4:30 in the afternoon and 11 at night. Symptoms start to develop as daylight begins to fade and may become progressively worse as day turns to night.
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    Where Did The Term Sundowning Come From

    When I worked in long-term care as a nursing assistant 30 years ago, night shift was expected to get a portion of the residents up before the end of their shift. This resulted in some people getting up at 5 or 6 oclock in the morning and staying up for at least 12 hours. These residents would be exhausted by supper time. They would also be sitting in the common area, with other tired residents who would be crying out. The exhaustion plus the noise caused some residents to become very upset and agitated. These residents would try to leave the area . Nurses and physicians who worked in long-term care noticed the uptick in these behaviors during late afternoon and early evening, and the term sundowning was born.

    How To Deal With Sundowning

    How to Manage Sundowning Behaviors in Seniors with Dementia

    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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    Practical Tips On Preventing Sundowning

    • Follow a routine during the day that contains activities the person enjoys
    • Going outside for a walk or visiting some shops is good exercise
    • Limit the persons intake of caffeinated drinks. Consider stopping the person from drinking alcohol altogether. Caffeine-free tea, coffee and cola are available, as is alcohol-free beer and wine
    • Try and limit the persons naps during the day to encourage them to sleep well at night instead
    • Close the curtains and turn the lights on before dusk begins, to ease the transition into nighttime
    • If possible, cover mirrors or glass doors. Reflections can be confusing for someone with dementia
    • Once you are in for the evening, speak in short sentences and give simple instructions to the person, to try and limit their confusion
    • Avoid large meals in the evening as this can disrupt sleep patterns
    • Introduce an evening routine with activities the person enjoys, such as: watching a favourite programme, listening to music, stroking a pet etc. However, try to keep television or radio stations set to something calming and relatively quietsudden loud noises or people shouting can be distressing for a person with dementia.


    Tips To Manage Sundowning

    While it may not be possible to completely end sundowning, there are a number of ways to lessen its impact. Try any or all of these tips to help your loved one feel less confused, anxious, or fatigued.

  • Remove causes of confusion.;For some people, sundowning issues can result from optical confusion. For example, one woman was convinced, on a nightly basis, that strangers were trying to break into her room. After doing some detective work, her caregiver was able to figure out that the problem related to headlights moving across Venetian blinds. By adding light-blocking curtains to the room, she was able to remove one major cause of anxiety.
  • Plan activities during daylight hours. Increasing activity during daylight hours can help get the circadian rhythm back on track. Take a walk during the day, get outside in the sunlight, and avoid late afternoon naps.
  • Keep a consistent schedule.;As much as possible, help your loved one to create and follow a regular daily routine. Knowing what is coming next can help lower anxiety and increase a sense of being in control of the environment.
  • Maintain familiar surroundings.;Because people with dementia can be very difficult to care for, many are living in assisted living or nursing home environments. While there is no way to make a new setting “just like home,” it is always possible to bring and visibly display familiar objects, photos, and furnishings. Familiarity can help calm people who are experiencing sundowning symptoms.
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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.

    What Are The Medical Causes Of Sundowners Syndrome

    Sundowning: Preventing and Managing

    No one, as of yet, has been able to determine the exact cause for Sundowners syndrome. Findings from researchers show that a persons brain works differently throughout the day. If youve ever found that you have more energy to tackle a project in the morning, youre not wrong to do so! The brain will typically work best in the morning . However, it slows down and becomes more tired later.

    A tired brain doesnt always help a person with sundowners fall asleep. As the light dims, people with sundowners syndrome may display more symptoms .

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    Ways To Reduce And Manage Sundowning Symptoms

    1. Go along with their realitySometimes, a person with dementia will experience a different time in their lives, like when they were parents of young children, going to work, waiting for their parents as a child, or something familiar from their past.

    If this happens, do your best to go along with their reality. Trying to force them back into our reality wont work and will only cause upset or anger.

    It may help to engage them in an activity thats similar to whats happening in their mind.

    For example, if theyre waiting for someone to come home, do something they would have done in that real situation. Maybe they would be making a snack, preparing dinner, or straightening up the house.

    Think about their routines and activities when they were younger and brainstorm activities that would fit the situations that feel familiar to them.

    Later, if needed, you could use a therapeutic fib to transition out of that activity and redirect their attention somewhere else.

    For example, if theyre waiting for their mom to pick them up from school, you could help them get ready by gathering up their school bag, using the toilet, and getting their jacket.

    If doing that slowly isnt enough of a distraction to transition to another activity, you could say that their mom called and said she would be a bit late so she asked that they went ahead and had a snack while waiting.

    During and after the snack, youll have more opportunities to transition to other enjoyable activities.

    Encourage Trips Outside While It Is Light

    Spending time outdoors in the natural light is a good idea for people prone to sundowning.

    If a person’s body clock is distorted, they may expect it to be light when it is not. Making sure a person has been in the natural daylight when they can means they are less likely to feel confused about the time of day, or that they have not been outdoors for a while.

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    At Sundown The Demons Get Riled Up

    Many people enjoy the sunset. Sunsets are picturesque, and they usher in the beginning of evening after a day of labor. Families congregate in the early evening around dinner, chatting and sharing in their daytime activities. For the most part, we look forward to sunsets that transition us from our relatively hectic daytime goings-on to unwinding with family, dinner and subdued pastimes or hobbies, before eventually relaxing into sleep.

    It is naturally not so for those who experience sundown syndrome. For them, sunsets and the evening hours can be associated with heightened dread and scorching anxiety, as opposed to the calm and relief many of us feel.

    Sundowning syndrome throughout the day

    Preventing And Managing Sundowning

    NDC Sundowning Managing Protocol

    Distressing to the resident and difficult for caregivers to manage, sundowning typically occurs between 4:30 and 11:00 p.m. This state of increased agitation and restlessness has been observed in up to 20 percent of persons with moderate to moderately severe dementia.1 It resembles delirium because there is a rapid change in behavior. Unlike delirium, it happens every evening at the same time for the same resident without a change in physiological condition. Manifestations present as disordered cognition, attention, sleep-wake pattern or psychomotor behavior and include visual hallucinations, resistance to care or redirection, disoriented verbalization, wandering, aggression and reversed sleep-wake cycle.2 Sundowning, like delirium, may contribute to falls, injury to others, attempted elopement and removal of medical devices.

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    Where To Get Help

    If you are concerned about the worsening behaviours of someone you care then always seek guidance from your doctor to eliminate an acute infection or provide guidance around other possible non-pharmacological and pharmacological strategies .

    Likewise, watch for sundowning in early-stage dementia or rapidly worsening symptoms, both of which may suggest delirium.

    If you are at home or working in a nursing home and are concerned about the behaviours of people with dementia then you can phone The Dementia Behaviour Management Advisory Service which is a government funded national service. They can provide confidential advice, assessment, intervention and education over the phone for caregivers and aged care workers 24 hours a day, 7 days a week, simply phone 1800 699 799.

    Observe And Minimize Triggers

    Keep an eye out for fatigue and other symptoms that seem to spur sundowning behaviors. The transitions that occur during the afternoon and early evening can be particularly distressing for Alzheimers and dementia patients. This could mean a shift switch in nurses, a change in commotion, more people around, or nutritional triggers. To help manage these issues, cut down on caffeine and sugar later in the day.

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    How Common Is Sundowning

    Medical literature about sundowning estimates that it occurs in as few as 2.4 percent of people to as much as 25 percent. But if a person has received a diagnosis of dementia the most common type of which is Alzheimer’s that range increases dramatically, from 2.4 percent to 66 percent.;

    It is unknown whether gender or race factor into whether someone is more likely to experience sundowning, meaning it is an equal opportunity syndrome, according to current medical knowledge.

    Sleep And Damage To The Scn

    How to Spot & Manage Sundowning

    People spend a third of their lives in the physiologic state of sleep, which is finally starting to get the attention it deserves from medical experts because it is clearly tied to health. Restful sleep is like a powerful medicine. Sleep or lack of it can impact those who experience sundowning.;

    As those with dementia age, damage begins to occur to SCN, which is positioned very deep in the brain beneath the hypothalamus. Data indicates that this is a sleep-promoting center and that it is affected by light and temperature, along with certain kinds of neurotransmitters, like melatonin.;

    Our brain produces melatonin, and evidence indicates that melatonin helps induce and maintain sleep. Melatonin is a protein that is triggered by darkness, so as darkness falls, we get more of it. As light occurs, it fades out. People lose melatonin as they age.;

    Some experts believe a risk factor for sundowning syndrome may be damage to the SCN, causing a loss of volume and neurons. With this damage cellular physiology and metabolism is also lost. All these factors could contribute to the experience of sundowning.;

    Unfortunately, it is not yet known how to avoid damage to the SCN, but that could be on the horizon.;

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    Sundowning Advice For Carers

    Sometimes what seems like sundowning could be the person trying to communicate a need. This could be needing the toilet, feeling hungry or being in pain. Think whether something thats happened during the day has affected them. If they seem agitated, try to calm them by distracting them, perhaps talking about a favourite memory or event they enjoy thinking about.

    If they remain agitated, it could be that they have a need that is not being met. For more information;see;Communicating.

    Read about other sleep problems

    Get advice on other sleeping problems,;as well as what support and care is available for a person with dementia and sleep disturbance.

    How Do You Manage Sundowning

    How to Help Someone Who Is Sundowning

    You may ask, What is Sundowning and why does it happen?

    Sundowning is a group of symptoms that occur in someone with memory loss that can start around dinnertime and continue into the night. Although the exact reason why sundowning happens is not known, researchers believe its a disruption in circadian rhythms in other words, a disruption to a persons natural body clock.

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    Common Symptoms Of Sundowners Syndrome

    In the early stages of sundowners disease, symptoms may be subtle, inconsistent, and difficult to notice. Early signs of sundowners syndrome include restlessness and agitation, irritability, confusion, disorientation, suspiciousness, and becoming demanding. As the condition progresses, these symptoms become more pronounced and more regular.

    At their peak, sundowning symptoms typically develop in the late afternoon, and they can go long into the night. Some of the most common symptoms of sundowning include the following:

    • Anger
    • Rocking
    • Trouble Sleeping

    When it comes to sundowning, the timing of onset varies from one patient to the next and symptoms can often interfere with sleep. Sleep deprivation can then trigger ongoing episodes of sundowning while simultaneously contributing to other symptoms of dementia.

    How To Manage Sundowning In Dementia

    Sundowning with Dementia and Effective Coping Strategies ...

    Does your elderly have Dementia or Alzheimers? Do you notice significant behaviour changes in them during the late afternoon or early evening? In medical terms, this gets referred to as sundowning. The term means a state of confusion occurring in the elderly in the late afternoon period and spanning into the night. The fading light often tends to trigger it, and the symptoms worsen overnight and get better by morning. Though you may not be able to prevent it completely, however, you can manage it better and discuss the symptoms with the doctor.

    The Symptoms of Sundowning

    If your elderly is sundowning, then you will notice them getting

    • Anxious
    • Disoriented
    • Demanding

    They may also end up yelling, pacing around the house and hearing things that are not taking place.

    The Causes of Sundowning

    There are no such causes of sundowning. However, some scientists indicate that it may be happening because dementia impacts the body clock. The area in the brain that signals when you are awake, or sleep gets affected by Alzheimers and causes sundowning.

    In general, some conditions that can trigger sundowning include

    • Too Tired
    • Less light and more shadows in the home towards evening
    • Unable to distinguish between dreams and reality

    Ways to Manage Sundowning

    Once you notice the above symptoms, discuss it with the doctor. Meanwhile, to make it manageable for you and your elderly try the following

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