Sundowning

The Many Challenges of Sundowning

Exactly what is “sundowning”? I have been asked that question many times. First, I’ll tell you what it is not. It is not a medical term, a disease or a syndrome. It is a symptom of dementia and occurs just as the sun begins to go down each day.

Regardless of where the dementia victim is living, they become more confused, restless and insecure late in the day. Experts believe one of the possible reasons for this phenomenon may be due to a lack of sensory stimulation as the light changes intensity in their environment.

If you were blind, for example, you would be especially sensitive to the routine noises of the morning, noontime and the decrease of those noises at night. These patients feel the same way because they are handicapped in a different way. Familiar and secure sounds lessen as the day draws to a close and the security that those sounds provide, disappears in the shadows. They become more frantic and exasperated in trying to restore their sense of familiarity. Just as a small child is afraid of the dark or of being left alone, the dementia victim, who cannot verbally express their fear, will begin to pace and perform repetitive motions instead. They regress to childlike behavior and this is why they will scream, throw things, call out for help, spit, kick, bite, cry, curse, ask repetitive questions and try to “escape”.

This may be why they appear to have their days and nights “mixed up”. They tend to sleep very well during the day because they are relaxed; secure. Also, researchers found that people with dementia had an increase of these symptoms during the winter months and daylight savings time changes. The patients got up at night to urinate, eat or drink with more frequency at these times.

End of day fatigue also plays a major role in adding to increased agitation and aggression. It’s almost as if they start each morning with an emotional tolerance bank account full of energy, toleration, cooperation and compliance. By the end of the day, after they have had to cope with trying to sort out what was real, what was true, coping with their fear and just surviving they become “overdrawn”. They have no more to give and because they no longer have any sense of social awareness and they are exhausted, they have a catastrophic emergency.

Helpful tips to help you with your loved one

1. Keep them active in the morning and if you have to lay down next to them to get them to take a nap after lunch, then do so, at least until they fall asleep. If they rest during the day, they will have more in their “bank account” to draw from in the evening.
2. Pay special close attention to ensure they get to the bathroom when needed in the evening, have water to drink so they aren’t thirsty and that they do get full at suppertime. Many times, they will have a much more difficult time expressing their needs in the evening which will lead to increased agitation.
3. Try to get into the habit of taking them outdoors after supper each evening for a change of scenery and fresh air. This can be calming; to even sit in a swing and watch the children play outside.
4. Keep the noise from the TV to a minimum. Put some nature music or light jazz on softly and bring them the coloring book and crayons.
5. Close to bedtime, give them a light snack and some warm milk. They will associate this with bedtime.
6. Put them to bed at the same time every night. No rich sweets or caffeine either.
7. Ask their doctor for a nighttime aid to help relax them and then give it to them 45 minutes before you want them to be asleep.
8. Make sure that they are surrounded by a great deal of light in the room they are in prior to bedtime. Have a lamp or a nightlight on all night. You would think the light would have the reverse effect and keep them awake, but it doesn’t. I have found that they will sleep all night, without waking up at all, if I keep a lamp on.
9. When you put them to bed, hug them, kiss them and stroke their hair as you softly whisper something like “I love you so much, you are wonderful and mean so much to me. I’ll fix you a delicious breakfast in the morning. Now, you get some sleep, I’ll be in the next room. I love you, goodnight.” Do not close their door but do close their closet doors.

Just try each one of these strategies until you find one that works. Every person is different and their set of challenges are unique, but they are all in dire need of someone who cares enough to explore on their behalf.