What Does Sundowner Mean In Dementia

Why Does Sundowning Occur

Sundowning, orlate-day confusion, can occur for many reasons and come at any time. So dealing with it is often expected by dementia or Alzheimers caretakers, but knowing its coming and handling it are two very different things. Knowing the signs or what could cause it and preventing those scenarios can be the first step to calming someone down.

Here are a few things that contribute to sleep problems, anxiety, and sundowning in dementia patients.

Memory Care: How You Can Help To Manage Sundowners Syndrome

If someone you love suffers from Sundowners Syndrome, it can be very tough to know how to help. You may ask, what stage of dementia does sundowning start? Try using some techniques that trained memory care professional support dementia patients:

• Spot the patterns

If your loved one is experiencing memory loss, it may be hard for them to keep track of potential triggers for their Sundowners Syndrome. If you live with them, youre in an excellent position to notice any possible factors that seem to link to, or worsen, sundowning. For instance, they may be more likely to experience confusion or behavioral changes after drinking alcohol or excessive caffeine, eating too much sugar, or napping for too long during the day.

• Keep things calm

The Mayo Clinic recommends that you try to establish a calm evening routine. Keep TV and other stimulation to a minimum. Play familiar, relaxing music or a recorded meditation. Keep the lights on, including a nightlight at bedtime, to reduce shadows and anxiety. Simplify the surroundings and try to minimize physical and auditory clutter. Dont argue with the person when they are experiencing sundowning symptomstry to stay calm and be reassuring.

• Maintain a healthy routine

• Try distraction

• Talk to your loved ones doctor

Tips For Preventing Sundowning

There are a number of steps that you can take to prevent sundowning. Because there are many factors that contribute to sundowning, not all of these tips will work for everyone. It is best to keep a record of what does and does not work for your relative.

Mutsai suggested the following tips for trying to prevent sundowning.

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Hallmarks Of Lewy Body Dementia

Patients with LBD have the same memory impairments as those with Alzheimer’s disease, vascular dementia, and other types of dementia aphasia, apraxia, agnosia. So what makes LBD unique?

People with LBD also experience at least two out of three of the following symptoms:

• Visual hallucinations
• Fluctuations of consciousness

If your loved one has two out of three of the symptoms described above, this means they meet the criteria for LBD.

Regulate The Sleep Cycle

Regulating the sleep cycle is an important, but sometimes complicated, part of helping a loved one with sundowners manage their symptoms. Research suggests older adults need as much sleep as young adults or about 7 to 9 hours each night. Some things you can do to help promote normalcy in sleeping patterns include:

• Stick to routines and structured activity. Maximizing activities earlier in the day and avoiding napping can help your loved one fall asleep faster and sleep more soundly at night. Any challenging or stressful tasks that must be completed should be done in the morning or early afternoon. Additionally, sticking to routines can bring comfort and predictability to seniors, which can reduce confusion or agitation.
• Adjust the sleep environment and simplify surroundings. Avoid having too much sensory stimulation in the place where your loved one sleeps, as too much stimulation can cause anxiety and confusion. Remove any excessive visual, physical or auditory clutter. Keeping your loved ones room cool, calm and dark can help promote sound rest.
• Modify lifestyle behaviors. There are several lifestyle changes you can suggest to your loved one in order to help them stay on track for healthy sleeping patterns. These include: avoiding tobacco, caffeine, and alcohol getting some form of light exercise or movement during the day and refraining from using electronic devices during the hours leading up to sleep.

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Tips For Reducing Sundowning

• 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 problemsRead 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.

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Talk With Their Doctor About The Best Times To Take Medication

Some prescribed medications may come with side effects that trigger sundowning, especially if theyre taken in the late afternoon or evening.

So if you are noticing that your loved one is experiencing sundowning regularly, check in with their doctor and ask them when its best to take their medications to reduce possible triggers.

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Factors That Aggravate Sundowning

Because individuals with Alzheimers or other forms of dementia can become easily disoriented, they are often more susceptible to sundowning and the challenging behaviors associated with it. While the exact cause of sundowning is unknown, some factors tend to worsen symptoms. These aggravating factors can include:

• Lack of sleep, fatigue, or mental exhaustion
• Caffeine and alcohol close to bedtime
• Faded light, low light, and increased shadows that cause confusion and fear
• Upset in their circadian rhythms, confusing day and night
• Underlying health issues, such as an infection, discomfort, or pain
• Stress, depression, or boredom

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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Get Exercise And Sunlight

Getting physical exercise and being in the sunlight each day can also help with sundowning and dementia sleep issues.

Physical activity doesnt need to be anything intense. It can be as simple as taking a walk outside each morning and each day after lunch, which will also provide an opportunity for sunshine.

Participating in regular physical activity can help your loved one use energy which promotes nighttime drowsiness. Being in the sun can help reset their internal clock and get them back in normal sleep rhythms.

Dementia and sundowning strategies ultimately come down to increasing the likelihood of nighttime sleep and decreasing their risk of agitation.

Now that you know more about sundowning and some ways to alleviate it, lets look at a question many family caregivers have, How long does sundowning last in dementia individuals?

Develop A Daily Routine

Maintaining a schedule throughout the day helps orient patients and alleviates anxiety that may arise during twilight. Washing up for dinner and putting on pajamas can be helpful indicators that the day is winding down.

Plan more activities during the day such as walks, crafts, and visits to keep your loved one awake and engaged. A person who naps most of the day is likely to be more awake at night. If your loved one is tired and less lucid by the afternoon or evening, plan simple and soothing activities during those times to keep them occupied so they dont want to nap. An upbeat movie or TV show or some pet therapy can have a calming effect while keeping them awake. If they dont wish to participate, dont argue with them. Instead, continue trying to appeal to their interests to find something that eventually works.

Try to prevent excessive commotion during the times they normally become more agitated. Be aware of certain times, people, places, or activities that seem to trigger difficult dementia behaviors. Notice patterns in your loved ones sundowning to help you avoid these triggers and adapt their routine to support a peaceful environment.

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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.

Understanding The Different Stages Of Dementia & The Causes Of Sundowners

Sundowners Syndrome is triggered by fading light. Doctors are still not sure why Sundowners Syndrome occurs, but there are several factors that seem to exacerbate it:

• Low lighting and shadows in the evening
• Fatigue, or a disrupted body clock
• Infections, such as a urinary tract infection
• Excessive hunger or thirst
• Depression or boredom

Any physical cause that increases the patients difficulties in distinguishing dreams from reality can make it more likely for them to experience Sundowner’s.

Read Also: What Is The Earliest Age For Dementia

Schedule Activities Or Appointments Around Sundowning

And lastly, once you indicate when or how sundowning behavior begins, make sure to schedule appointments or activities around that. If their sundowning gets really bad before the sun even sets, dont have them jumping right from a stimulating activity to bedtime. Also, if they dont get adequate sleep, dont schedule appointments too early in the morning.

The Early Signs Of Sundowning: A Little Afternoon Irritation Or Something More Serious

The nights are the hardest.

Nights can seem very long for family members who care for people with Alzheimers disease or other types of dementia. That is because many people with dementia are sundowners, which means they become agitated and confused when the sun goes down.

Symptoms of sundowning are subtle in the early stages of the condition, but become more evident as the syndrome develops.

About one in five people with Alzheimers disease will experience sundowning, according to the Alzheimers Association. Sundowning is not a disease, but rather a group of symptoms that many people with Alzheimers or other forms of dementia develop in the late afternoon or evening.

Sundowning can be especially exhausting for people with Alzheimers disease and their caregivers, as the condition can cause profound confusion, anxiety and wandering behaviors throughout the night every night starting in the late afternoon. The condition can cause extreme changes in sleep patterns for everyone in the household, complicating daily schedules and straining interpersonal relationships.

Fortunately, nighttime restlessness, confusions and irritability do not last forever. Sundowning signs and symptoms tend to peak during the middle stages of dementia and then diminish as the condition progresses.

Early Signs and Symptoms of Sundowning

Change in Personality at Twilight

Shadowing

Fatigue and Frustration

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Can Medication Cause Sundowning

Side effects of both prescription and over-the-counter medications may cause behavior changes in people with dementia. For example, medications used to treat incontinence, depression, or insomnia may increase agitation in someone who has dementia.

If your loved one is showing signs of sundowning, its a good idea to discuss their medications and potential side effects with a doctor.

Are Medications Used For Sundown Syndrome

There is limited information about the effectiveness of medication in easing sundowning symptoms. In some cases, especially when symptoms are associated with depression or sleeping disorders, medication may be helpful. However, be sure to discuss possible side effects with your loved ones doctor. Some medicines may increase the chance of dizziness, falls, and confusion, according to the National Institute on Aging.

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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.

Sundowning And Care At Home

Alzheimers and dementia can be difficult conditions to live with, not just for your loved one but also for the extended family. Thats why more and more people are turning to live-in carers to help with loved ones who are in the late stages of dementia.

Employing a highly experienced and compassionate caregiver can be a relief to families who are struggling to cope with the demands of the disease, and the peace and calm that a skilled carer can bring to a household are beneficial for everyone.

Live-in carers can provide a range of dementia care services, from simple companion care to the specific demands of dementia. They remain calm under pressure and can cope with emergency situations, making them a great option for families who are concerned about residential care for their loved ones.

They can provide genuine support throughout the day and night, which can make a significant difference for families who are finding things challenging.

Even if you think that you are coping well with your loved one, a period of live-in respite care can be helpful for anyone dealing with the particular demands of sundowning, allowing you to return from a short break or holiday refreshed and ready to face the challenges ahead.

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The Most Effective Sundowners Syndrome Treatment Strategy

• Paying for Care for Seniors with Sundowners Syndrome

Does your loved one experience marked changes in attitude, energy, and mental stimulation that seems to correlate with the sun setting and nighttime falling? They could be experiencing sundowners syndrome a common condition in people as they continue to age. Problems with circadian rhythm and sleep patterns often affect older people, and if your loved one is experiencing problems in the late afternoon/early evening, it could be sundowners.

How To Cope With Sundowning

Family care partners and professional caregivers alike get frustrated with dementia-related behaviors that are barriers to providing care and improving quality of life for the person in their care. Behaviors associated with sundowning are particularly difficult.

Keep a care journal to help identify your loved ones major triggers. When you have a challenging day, think through what environmental stressors may have been at play. When it comes to caring for someone living with dementia, remember that structure and routine are your friends!

• Was the daily routine off?
• Was there a new visitor ?
• Was there a new noise in the mix, such as nearby construction?
• Was there a change in medication or a missed dose?
• Did the person eat differently?
• Was there a change in bowel elimination or urination that may indicate a problem?

Helping the person in your care cope with the effects of sundowning requires great effort. Finding the right combination of environmental adjustments is specific to the individual. Try these practices:

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Seeking Treatment Is Important

It is important to seek help from experts and assistance from friends and family. Managing sundown syndrome requires flexibility and creativity as well as a lot of patience and empathy. Often it takes trial and error to discover triggers in your senior before you can find solutions. Every person with dementia reacts differently to triggers and treatment, so you will have to try one thing at a time.

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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Ways To Ease Sundowner Syndrome Symptoms

Mood swings, restlessness, and confusion are all potential signs that your loved one has sundown syndrome, a group of symptoms seen in over 20% of patients with Alzheimers disease.

Coping with Sundowners Syndrome symptoms can be a challenge, but there are some non-medical ways to alleviate the symptoms and give your loved one the support they need.