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Question
Shortly before my mother was diagnosed with dementia, she started staying up practically all night and catnapping during the day. She seems to really come alive in the early evening, getting very restless and agitated, sometimes to the point of screaming and lashing out physically at everyone. Why does she do this, what causes it and what can I do about it?
Answer
Most dementia patients suffer from what is known as “Sundowner’s Syndrome”. Late in the day, usually after dark, they become even more restless, suffer from heightened insecurity and confusion. The many symptoms that accompany dementia such as lack of concentration, suspiciousness, paranoia and even combativeness are heightened as the day wears on and fatigue sets in. They get tired more often and are much more difficult to work with or direct then. There are “day noises” that have been common to them all of their lives so they feel more secure when it is light outside so it is easier for them to sleep because of this. However, at night, many of these familiar sounds cease and they tend to become frightened. If their room is dark, it can cause them to panic because they may not know where they are, how they got there and who is lurking just outside their room. They will get out of bed and seek out the light to feel more secure. If you leave a night light on, you may see an increase in the length of time they sleep at night. Another reason for the increase in agitation is because they cannot adequately communicate their needs such as having to go to the bathroom or being hungry and thirsty. Sometimes, they may be feeling depressed and no longer have the ability to communicate the need for companionship. At least there is a chance of someone giving them food and water, taking them to the bathroom or lovingly touching them if it is daylight and they see others around them. But, when it is dark outside, in the house or their room, their perception is that they are the only person who seems to exist in their world. If they wake up all alone and they can’t communicate their needs, it brings on overwhelming anxiety and sometimes, a catastrophic reaction.
For example, imagine this: You are blind and there is no one around you in your hearing that speaks your language. No one can help to guide you to the bathroom and you really need to go right now. You have no one in the world that knows you anymore; you are lost. If you truly closed your eyes and tried to imagine what I just described, then you have an inkling of the sheer terror the dementia victim feels, especially in the night. Here are a few suggestions.
1) Put a nightlight in their room and either a bedside commode or a nightlight in the hall and bathroom, to light their way, if they still are able to get up and toilet themselves. If not…
2) Put a nightlight and an open intercom or baby monitor in their room, and put the mate for it next to your bed.
3) Make sure your loved one takes an early afternoon nap. If they won’t lie down, try lying down with them on their bed and snuggling. Tell them that you need to be held like they held you as a child and that you can’t go to sleep without their arms. Have soft music on low and you may get faster results
4) If your loved one is not in jeopardy of falling and wants to pace or wander all through the house, let them. When they finally get tired, suggest they rest. Portable gates can help keep them out of unsafe areas. All you have to do is secure them a little higher than you would for a baby or use two in the door jam rather than one.
5) Try keeping a television on low at night, all night, but not on anything violent. Try a Christian network. The voices and low light may be just what your loved one needs to help them start sleeping longer periods.
6) As a last resort, ask your doctor for something to help your loved one sleep at night. Give it to them as late as possible so its effects will last. Do not expect them to sleep more than six hours at a time in the early stages of dementia. In later stages they will sleep more than they are awake.