What is Sundowning Behavior and what can be done to deal with it?
Sundowner’s syndrome is a condition that affects individuals with dementia or the early stages of Alzheimer’s disease. As the day progresses and the sun begin to go down, symptoms of increased confusion, agitation and restlessness occur. Some individuals may show signs in the early afternoon. As the evening progresses, a person may become increasingly negative, irrational, confused and at times, physically aggressive.
It is not understood as to why this syndrome occurs. It was believed by researchers to be a malfunction in the brain’s internal awake/sleep clock (circadian rhythm). Another theory that is more widely considered today : a person with dementia becomes tired and instead of the body and mind starting to relax to rest for nighttime, the brain becomes over stimulated. The changes in the loss of cognitive abilities and the ability to process may increase the stress in a person with dementia that they are not able to process. This overstimulation causes a person to become irrational, confused and at times, physically aggressive.
As a family caregiver dealing with a family member that is experiencing sundowner’s is very frustrating and exhausting.
It is important to know that that there are things that a family caregiver can do to manage and cope with Sundowner’s syndrome. The different approaches to managing this condition may include medications, environmental and behavioral approaches.
While medications may be suggested by your health care provider to decrease the agitation, assist with sleep, or address depression, it is important for the family care giver to include behavioral and environmental management for a more successful outcome.
It is also important for a family caregiver to be aware that some individuals with dementia may experience a paradoxal effect to the medications they are prescribed. This simply means that a medication that is supposed to calm down a person may actually increase their agitation and confusion. This happens most often in individuals that have the Lewy Body type of dementia.
The most important factors that a family caregiver can control are the environment. The most important factor with a person with dementia is to develop a consistent routine. Change can be overwhelming as a person loses the ability to do everyday tasks. It causes stress and makes it increasing difficult to handle as the day goes on.
More on Sundowning behavior
A daily routine should include time outside or exposure to the sunlight or a bright light to establish awake and sleep cycles. Activities should be planned so that the most stressing and demanding be done as early in the day as possible. As the day progresses, the activities should be less stressful.
A short nap, after lunch, may help to refresh a person. Long midday or evening naps should be avoided. If at all possible, an afternoon walk or pleasurable activity to help keep the persons energy level up is important.
As the afternoon progresses, creating a calm and quiet environment is very important. Developing a routine of pulling down shades or drawing the curtains to create a nighttime environment is important to developing the awake/ sleep cycle. The evening should be a time of calm – the noises in the home should be kept at a low level.
Many family members do not realize how distracting TV or loud noises can be. This is a time for soft music, the phone should be turned down and the fewer the distractions the better. If it is possible to decrease the activity in the home or have the person in a room where there are will be limited interruptions by other family members. Evening is a time to engage in quiet activities, such as looking at old photos or discussing times of childhood memories.
Developing a routine bedtime ritual is very important in this stage of dementia. Consistency and routine are crucial, no matter what occurs in the daily agenda, especially at bedtime. It is recommended that this routine be started as soon as the last meal of the day is finished.
Taking care of some one that is suffering from Sundowners is exhausting for the caregiver. It is so important that the family caregiver take care of themselves and get plenty of rest, as well. This is a time when a family care giver may need to seek help from others to successfully maintain their loved one at home.