With the transition into autumn, darkness comes earlier. Especially once daylight savings is upon us. This is a time of year when people with brain changes due to dementia might be even more likely to experience Sundown Syndrome, or Sundowning as it is often called. Following is my recent blog post about Sundowning that is will be used to create an upcoming Caregiver Education video. I hope you find it helpful.
It’s late afternoon. The sun is just starting to set. You’ve had a long day as a dementia caregiver, and you know that it’s about to get longer. Because, sometimes, the person you care for exhibits symptoms of sundowning, or Sundown Syndrome, as it’s sometimes called.
Sundown Syndrome is not a disease itself, but rather a set of symptoms that sometimes accompany a dementia diagnosis, and typically happen late in the day. Sundowning can get worse when seasons change and days grow shorter. Symptoms can include agitation, anxiety, confusion. The person might pace, shout, or argue. They could react to things that they hear or see that are not really there.
Sundowning typically begins later in the dementia disease progression, and frequency of episodes can vary widely.
Always be sure to let your doctor know about any sudden, unusual changes in the way that the person you support experiences and reacts to life, because these could indicate a deeper issue that requires medical attention.
What Causes Sundowning?
Sundowning can result from confusion that stems from memories of what used to happen late in the day. Afternoons were the time to pick up kids from school. Start making dinner. Leave the office. There can be a sense that there is something I am supposed to be doing now, but I can’t recall what it is.
Sundowning can be due to physical discomfort like hunger, thirst or pain, where the person is not able to identify the source of the discomfort, so instead, they act out. The person might be overstimulated or overly fatigued if it has been a busier day than usual, or overly bored if the day was without stimulation or socialization.
The person you care for might be reacting to a day that varied from their routine, and included new people or places.
Because sundowning often happens when daylight is fading, there is some thought that it has to do with brain changes from dementia that interfere with one’s internal clock, especially if the person is also experiencing nighttime wakefulness.
How do we support a person who is Sundowning?
Remember that as hard as sundowning is on the caregiver, it is equally hard if not harder on the person with dementia. So take a breath before responding and check-in around your own anxiety level. Meeting another person’s anger and anxiety with your own will only make things worse. There is some evidence that caregiver stress and anxiety can actually contribute to sundowning in the person they are caring for.
If they are able to, ask the person you support to tell you what’s wrong, and demonstrate that you are listening to them by reflecting and validating their feelings. Instead of shouting at them to stop, or to calm down, acknowledge their emotion and, if known, what caused it. ‘You’re really angry because someone moved the book that you’ve been reading. I would be angry too. I’m going to stop what I’m doing right now and help you find that book because I know it’s really important to you.’
Remind them that they are safe, and that you care deeply about them. Can you take their hands and invite them to join you in some deep breathing, or distract them with a favorite activity?
How do we prevent sundowning?
While we may not be successful, there are certainly things we can try. Do your best to keep a predictable routine around waking up, eating meals, performing daily activities and going to bed at night.
If you can, plan activities that might be disruptive for early in the day when a person is likely to be the most fresh.
Plan enjoyable activities to begin just before the time that sundowning usually starts. Get out the art supplies. Put out a snack. Watch a favorite program. Put on well-loved music. Go for a walk.
If at all possible, try to get outdoors for at least a little while each day. Sunlight, fresh air and exercise can all be helpful. Even sitting by an open window for at least a little while each day can be helpful.
Light therapy has been proven to help reduce sundowning in some people. Especially when the days are getting shorter, consider turning lights on earlier, perhaps installing some bulbs that mimic sunlight. Be mindful of shadows produced by lighting that could contribute to confusion and anxiety.
Make an effort to support the best nighttime sleep habits possible. Limit daytime napping, avoid caffeine after the morning, and reduce or eliminate alcohol, which greatly interferes with sleep patterns. If you are in a habit of watching TV in the evening, make sure that viewing options are not overly stimulating.
Talk to your doctor about medications if changes in the environment don’t seem to be working. Melatonin taken just before sundown has been shown to be helpful for some people.
Thank you for looking for solutions to help with Sundowning. Remember that caregiving is hard, you are doing the best you can, and we are here to support you. Take good care! Allyson
