That pesky biannual time change wreaks havoc on all of us – it never ceases to amaze me how much one little hour can throw my body clock into a tizzy.
Anything that rough on us has to be exponentially more difficult for those living with dementia. The autumn change seems particularly challenging since it means the sun is setting so much earlier.
Sundowning is a term commonly used to describe a marked increase in confusion and agitation in dementia patients as evening approaches. Experts have long debated exactly what causes this phenomenon, but no one has a definitive answer.
Many believe the decrease in light is a big part of the equation, while others feel Sundowner’s may be due to hormonal changes occurring at night or even just simple fatigue. There are also those who think the symptoms could be caused by an accumulation of sensory stimulation from the day, causing an “overload” of sorts and resulting in stress and anxiety.
Six Ways to be Proactive
- Identify triggers. Limit outings, visits and other highly stimulating activities to morning or afternoon. Keep noise and commotion to a minimum in the evening; turn off the television and consider playing soft music instead.
- Avoid afternoon naps. Too much sleep during daylight hours can confuse the body’s circadian rhythms. Plan daytime activities and encourage light exercise to help expend excess energy in a healthy way.
- Watch their diet. Limit sweets and caffeine to morning hours. Some people also do better having their heaviest meal at lunchtime and opting for a light dinner.
- Maintain a consistent routine. Dementia patients do best when kept on a schedule. Routine and structure go hand in hand with a feeling of safety and security. Keep meals, showers, bedtime, and wake time as consistent as possible.
- Be cognizant of the environment. Clear excess clutter, which can contribute to the agitation caused by sundowning. Consider the fact that even seemingly benign objects like mirrors and photographs can frighten or confuse someone with dementia. Before dusk falls, close curtains and blinds and turn on as many interior lights as possible.
- Ensure their physical comfort. Hunger, thirst, and pain will increase anxiety and agitation. Offer a light healthy snack and be sure they’re hydrated without overdoing liquids close to bedtime. See that they are dry, and keep the room/house at a comfortable temperature. A sudden spike in agitation could also indicate the presence of a urinary tract infection or another ailment.
Tactics for When All Else Fails
It’s important to know that despite the best laid plans, sometimes there’s simply no avoiding it. It’s a fact – staving off Sundowner’s is one part art and one (or more) part luck. There are a few things that may help, though.
- Redirect. If you notice increased activity or pacing in your loved one during evening hours, attempt to redirect them to quiet activities such as working puzzles, folding washcloths, or listening to music. If they insist on pacing, allow them to safely do so; never try to physically restrain them.
- Provide reassurance. Speak in a soft, soothing tone letting them know that everything is okay. Avoid arguing – it will only make things (much) worse.
- Touch does wonders. A gentle massage or backrub, or even just sitting and holding his or her hand, can bring a sense of calm.
- Do your best to keep your cool. Patience can be in short supply at times like this, but remember your loved one will sense your stress, which often adds to their agitation.
- Seek help. It may help to keep a journal for a couple of weeks to try and identify patterns. If sundowning becomes increasingly problematic, discuss your concerns with the doctor. Medication may be considered as a last resort.
When frustration is getting the best of you (and if you’re human, it will), try to remember they are not acting out intentionally. Don’t take their words or actions personally.
The most important thing is keeping them safe; beyond that, it’s often best to follow their lead. Sometimes my mom didn’t want anyone talking to her but appreciated holding hands; at other times, she just wanted to be left alone to pace. And to be quite honest, there were moments where there was just no consoling her – those were the most difficult. A feeling of helplessness like nothing I’ve ever experienced.
It all comes part and parcel with the disease and all we can do is our best – whatever that is at the moment.
How have you dealt with sundowner’s? Can you offer any advice to other caregivers? If so, leave a comment. I’d love to hear from you!