By |
One of the most challenging parts of caring for someone with dementia is trying to handle something you don’t understand. That’s especially the case with sundowning, a condition common in the later stages of dementia and Alzheimer’s. Sundowning can leave everyone feeling frustrated, tired, and scared.
Sundowning is difficult to define, but the Mayo Clinic puts it this way: “a state of confusion occurring in the late afternoon and lasting into the night.” This might happen as soon as the sun begins to go down and the light changes. It might happen in the middle of the night, when darkness prevails. It might even happen when moving from a bright room to a dimly lit one.
According to Frontiers in Medicine, up to 66% of those with dementia will experience sundowning.1 Just as with anything else concerning dementia, how bad the situation gets will depend upon the person – and it might even depend upon the day. Some will have mild symptoms and can easily be comforted, while others might panic and have significant anxiety. Some will experience sundowning every evening, while others might experience it only occasionally.
Regardless of how often or how severe the situation is, sundowning can break a caregiver’s heart.
Why Does Sundowning Happen?
No one knows for certain why sundowning happens. However, scientists have found strong evidence that it occurs due to damage to the hypothalamus in the brain. When this area of the brain is damaged, it can affect the body’s circadian rhythm. When the rhythm is thrown off, sleep patterns can change.
The damage can also lead to confusion concerning the difference between night and day. As a result, someone with sundowning might believe they need to go somewhere at odd hours. For instance, someone who worked a nine-to-five job for many years might suddenly think they need to go to the office in the middle of the night.
Sundowning often lasts for a few hours. However, this can vary from day to day. Some might experience the confusion and agitation late into the night, which disrupts their sleep, which can make the problem worse.
Additionally, when sundowning goes well into the night, it disrupts the sleep of caregivers as well. When sundowning begins, usually in the middle stages of dementia, it can signal a more difficult time on the horizon for a family caregiver.
Symptoms of Sundowning
Sundowning has many symptoms, including confusion, agitation, anxiety, and irritation or even anger. It can also lead to fear or outright panic.2
What one person experiences might be entirely different from what another person does; that being said, there are certain things that tend to be more common among those who are sundowning.
· They might begin to wander and pace. They might even try to leave the room or the house.
· Some will ignore directions, even if they make it clear that they hear those directions.
· They might become aggressive if prevented from leaving the house or the room.
· Some seniors become very clingy with their family caregiver and follow them around everywhere.
· They might make a variety of sounds, including shouting, muttering, or moaning. They might make repetitive sounds.
· They might also make repetitive motions, like rocking back and forth.
· Hallucinations might come into play, and that can lead to delusions or paranoia.
· A sudden inability to fall asleep or stay asleep can be part of sundowning.
Can You Reduce or Prevent Sundowning?
When someone is sundowning, watch for patterns to emerge. You might quickly realize that by changing a few things in their day-to-day life, you can reduce or eliminate sundowning.
According to the Alzheimer’s Society, here are some things to consider when looking for the cause and working to change it.3
· Find the right stimulation. A senior who is in a busy or noisy environment might become overwhelmed, and that can lead to anxiety and agitation. That feeling can extend from the day into the night, leading to problems with sleeping and other disturbances. But on the other hand, being bored can make the mind wander, and that can lead to that “must do something” feeling that seems to accompany sundowning. Try to find a good balance for your loved one.
· Physical needs. Any physical need that is unmet can lead to sundowning. This includes thirst and hunger, pain in some part of the body, or simply being tired after a long day. It might even include being too hot or too cold. Once the physical needs are all met, sundowning might happen less often.
· Changes in the body clock. Damage to the brain can affect the circadian rhythm. But it can also happen if your loved one doesn’t get enough exposure to sunlight. Low levels of vitamin D are a common side effect of not getting enough sunlight, as evidenced by those who develop Seasonal Affective Disorder when the days become shorter. If your loved one can’t get enough natural sunlight, consider using UV light therapy at home. Ask their doctor if it might be okay to give it a try.
· Reacting to others. Those who have dementia often don’t realize what is upsetting other people, and react to negative emotions as though they were the ones who caused them. A family caregiver who is tired and grumpy might be enough to upset a person with dementia, and that can lead to sundowning. This is one reason why it’s so important to take good care of yourself, including making arrangements for respite care and paying close attention to your own physical and emotional needs. The more “settled” you are, the more settled your loved one might be.
· Sensory impairment. Those who have trouble with failing vision or hearing might become agitated, especially as the sun goes down and the lighting or atmosphere changes. Making sure the lighting in the home is bright can help avoid the confusion or even fear that can come along with sundowning. Hearing aids can help those who have trouble hearing. And remember, those who are suffering from any sort of sensory impairment can benefit from a medical alarm (personal emergency alert system) to keep them safe and secure.
· Mood disorders. Those who have anxiety and depression before they develop dementia are likely to carry those problems into their golden years. In addition, those who are suffering from hormonal changes brought on by a variety of chronic conditions or medications can be more likely to experience sundowning. Making sure the mood disorders and hormonal conditions are well-controlled can help prevent evening confusion.
· Not enough sleep. This is an interesting catch-22. Sundowning makes it harder to get good sleep, but the lack of good sleep makes sundowning worse. It could be helpful to speak to their doctor about mild sleep aids, such as melatonin, which have been shown to help keep some seniors on a good sleep schedule. Be careful about naps, as these can upset the sleep cycle and make sundowning more common. Keep in mind that if someone is using melatonin or other sleep aids, they are at a higher risk of falls. An alert for elderly adults can help provide peace of mind.
· Feeling isolated. When someone with dementia feels as though they are all alone, they are more likely to develop irritation, confusion, and fear. This can be incredibly difficult for caregivers, as you never want the person you love to be alone – but if you are a sole caregiver and you have other responsibilities outside of your loved one, you might not be able to be there all the time. When sundowning comes into the overall picture, it could be helpful to start looking into at-home care or other ways to ensure your loved one has someone with them at all times.
· Side effects of medications. Some medications can lead to issues that look like sundowning, such as agitation, insomnia, confusion, and more. And if someone is already dealing with sundowning, medications might make the problem worse. Pay close attention to the labels of the medications your loved one is on and make note of their behavior whenever they begin a new medication.
· Physical illness. If someone is feeling awful, they might start showing the symptoms of sundowning. For instance, seniors who develop a UTI often show marked changes in behavior, and in some that can be bad enough to mimic dementia and all the problems that come with it. If sundowning begins suddenly, especially if it doesn’t seem to be tied to dementia, it’s time to talk to the doctor about ruling out physical ailments.
How to Ease Sundowning
To ease sundowning, start by learning what the triggers are. This can take some time, so be patient as you sort through the life changes that might be causing this. In some cases, the triggers are easy to spot, such as a person who starts sundowning when they have had an overwhelmingly busy day.
When someone starts to wander, pace, or try to get out of the house at night, it’s important not to argue with them. Yes, you must keep them safe, and that might mean making them stay inside. But at the same time, offer reassurance and make sure all their needs are met. Tell them that you understand this is difficult for them. Sometimes the validation and reassurance can be enough to calm them.
Distraction might also help. This might take some trial and error. For instance, does an episode of their favorite television show occupy their mind enough to alleviate sundowning? Or do they need to listen to music as they go to bed? Do they want to talk, and if so, what topic calms them the most? Even some light physical activity, such as a gentle walk before preparing for bed, can be enough to soothe the symptoms.
Speaking of preparing for bed, be careful what you offer your loved one before shut-eye. Avoid drinks with caffeine late in the day, such as coffee, tea, or sodas. Avoid alcoholic drinks as well, as they can add to anxiety and confusion.
Finally, seek out all the help you can get. From choosing the right button alert with GPS in case your loved one begins wandering to opting for respite care to give you a breather, taking care of yourself can have positive effects on everyone around you. When sundowning begins to happen, the calmer you are, the more likely it is that you will be able to help your loved one in the best possible way.
