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Dementia

Sundowning: How to help your loved one

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Have you heard of Sundowner’s Syndrome? Sometimes it’s called Sundowning, and it’s usually associated with people who have Dementia or Alzheimer’s. For those people, sundowning can be a time of increased memory loss, confusion, agitation or even anger. For the family members who care for them, it can be a painful and exhausting experience.
What causes Sundowning?

  • Too much activity towards the end of the day can trigger sundowning. Even shift changes can lead to anxiety and confusion for those in a memory care facility.
  • Fatigue is also a common factor. Perhaps they are tired from the activities of the day, or even the sudden lack of activity after dinner can be a contributor.
  • Too much sleeping during the day and inactivity can also disrupt a good night’s sleep.
  • When the sun goes down, shadows may increase and the amount of available light makes already challenged vision that much more difficult to see.
  • Hormonal imbalances can cause disruption in the internal biological clock. This imbalance can lead to confusion between waking and sleeping hours.
  • Even wintertime and its shorter days can make sundowning worse for some people. This is also an indicator that the syndrome may have something to do with Seasonal Affective Disorder, a common type of depression caused by lack of exposure to natural sunlight.

How can you help reduce Sundowning symptoms?

  • Sticking to the same schedule every day can help your loved one feel more calm and oriented. If a routine much change, try to adjust them gradually and with as small of an impact as possible.
  • Adjusting the lighting in their room or home could also help with sleep and wake cycles if their circadian rhythm gets out of sync. According to the a research review published in Psychiatric Investigation, some studies suggest light therapy to reduce agitation and confusion in people with dementia.Placing a full-spectrum fluorescent light a few feet away from your loved one for a couple of hours each morning could help with sundowning symptoms. Even brightening the lights may help. when they feel confused or agitated.
  • Walking in the park and other activities during the day might improve their sleep at night and reduce sundowning symptoms.
  • Consuming large meals, caffeine, and alcohol can also interrupt the sleep patterns of someone with Sundowning symptoms. Limiting evening food to a healthy snack or a light meal might help them rest easier, too.
  • Encouraging evening activities that aren’t too stressful can help reduce confusion and irritability. If they have mid-stage or advanced dementia, watching television or reading a book could be too difficult. Try playing soft music to calm and soothe them. Snuggle time with a family pet could also help reduce stress.
  • If a loved one has moved into a hospital or assisted living facility, furnishing their space with some of their treasures like a favorite blanket, and family photos, can help ease the transition and help with sundowning symptoms.
  • Medication may be helpful in some cases of sundowning, especially when it’s associated with depression or sleep disorders. Consulting a physician is important since some medications may actually disrupt sleep patterns that can make symptoms worse.

Looking for patterns of sundowning in your loved one can help you identify the triggers.Track behaviors and activities with a journal or smartphone app to learn what makes symptoms worse or better. Once you know which activities or environments are triggers, it’s easier to avoid those situations and events.
Managing a loved one’s symptoms can be exhausting for the caregiver, so it’s important to take good care of yourself. Be sure to eat a well, get regular exercise, and get plenty of sleep every nights. It’s okay to rely on other family members or seek respite care so you can take regular breaks.

The Behaviors of Alzheimer's

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There are three stages to Alzheimer’s and many behaviors that go along with the disease. As a caregiver, it’s important to understand what these behaviors are so that we can know what to expect as the disease progresses.
Aggression and Anger
This can be a reaction caused by frustration due to not being able to communicate effectively about their needs, or perhaps, they are in pain or experiencing physical discomfort. A person with Alzheimer’s also can have irregular sleep patterns and they may be tired, which can in turn, make a person more quick to anger. Sometimes an over stimulating situation such as loud noises or crowds can cause aggression. A possible side effect of medication can also be to blame.
As a caregiver,  try to identify the immediate cause of the behavior. Did something happen just before the outburst? Is the person in pain? Urinary tract infections are not uncommon in Alzheimer’s patients, so it’s important to rule this out as a cause of the stress.
Anxiety and Agitation
A direct result of Alzheimer’s is the inability to process new information.So, when their normal routine is interrupted and situations change, a person may experience profound anxiety and agitation. For example, there will most likely come a time when the patient must be moved out of their own home and into a home with a caregiver or a nursing home. This can cause fear as they are trying to understand and process the new routine. Caregivers may also change, or if new visitors or house guests arrive, they may experience anxiety with these changes.
It’s important listen to the patient and talk with them to help them understand what is going on. Again, don’t be dismissive of their feelings. Create a calm environment for them and tell them that they’ll be safe. Taking them outside for a short walk can also help calm their nerves.
Depression
Depression is very common among people with Alzheimer’s, especially during the early and middle stages. However, it can be difficult to diagnose. Symptoms such as withdrawing from friends, social activities and hobbies are common.
Caregivers can assist by creating a normal routine based on the best interest of the patient. For example, exercising early in the morning, celebrate special occasions and small successes, prepare their favorite food and let them help prepare for as long as they are able. Alzheimer’s patients, dare I say like everyone, want to feel like they are contributing to something and need to be reassured that they won’t be abandoned.
Hallucinations

When individuals with Alzheimer’s have a hallucination, they see, hear, smell, taste or even feel something that isn’t really there. They usually occur in later stages of Alzheimer’s.
If a loved one is hallucinating, it’s important to evaluate the situation. Will it lead to dangerous behavior and cause harm to you or themselves? What is causing the person be afraid? Try to reassure them that they are safe and acknowledge their feelings.Distracting them by turning on lights, changing the conversation or listening to their favorite music can also help.
Memory Loss and Confusion
The beginning stages of Alzheimer’s brings a mild case of memory loss and confusion such as difficulty recalling events and understanding full conversations. The later stages brings greater memory loss including names and faces of family members, and the purpose of basic utensils such a pen or a fork. These more severe changes are some of the most difficult for family members and caregivers to witness.
Caregivers can help by remaining calm in a given situation, sharing photos and not being condescending when the patient doesn’t recognize someone or doesn’t know what a fork is used for. Even going back in time with them when they think they are somewhere else, can having a calming effect on them.
Repetition
A person with Alzheimer’s may say or do something over and over. They may ask the same question that you just answered. People with dementia who ask questions repeatedly may be trying to express a specific concern, ask for help, or cope with frustration, anxiety or insecurity.
They may be trying to communicate with the family member or caregiver about something. If they do ask the same question repeatedly, you may need to answer the question over and over. Or, if they are still able to read, you can try writing down the answer so they can be reminded of whatever it is that they are nervous about. They may also be bored. If so, you can try a change of scenery for them or go for a short walk.
There is an old saying that goes something like, “You may not remember what someone said, but you’ll never forget how they made you feel.” Your support and understanding of a person with Alzheimer’s will always be appreciated.
 

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