Do you care for someone with Alzheimer’s Disease or another dementia?
Do they experience increased confusion, restlessness and responsive behaviors later in the day?
This Q&A is for you.
1) What is Sundowning?
Sundowning can be a symptom of Dementia and refers to late afternoon, early evening when the person living with dementia can be more activated . This can manifest as pacing, wandering, increased confusion, anxiety, agitation and aggressive behavior. One of the common theories for sundowning is as late afternoon and evening approaches the natural light decreases, leading to shadows and a misinterpretation of their environment. This comes at a time when the person living with dementia is likely tired from earlier day time activities and has a decreased ability to cope with stress.
2) Does everyone with Alzheimer’s disease or other dementias experience Sundowning? What are some signs and symptoms to watch
out for?
Not everyone who lives with dementia experiences sundowning. There are other BPSD — Behavioral & Psychological Symptoms of Dementia — they may experience as well. Check out this great resource: Responsive and reactive behaviours | Alzheimer Society of Canada
2) What can family caregivers do to make the afternoons and evenings more comfortable? I.e. are there things people can do to minimize the side effects of Sundowning?
Increase lighting in the environment they are living in , especially the room they tend to be in late afternoon. Consider the use of a SAD (seasonal affective disorder) lamp like ones found here: Litebook. Have physical activity planned for them at this time of the day or an activity that they find enjoyable. Keep a routine.
3) Are there certain things that make Sundowning worse?
Yes, dark living environments, including having blinds or curtains closed. Having caffeinated drinks and high sugar foods in the afternoon. Having no physical or meaningful activities late in the day- boredom. Napping during the day.
4) When should I see a doctor or another medical specialist about my care recipient’s Sundowning?
Consult a Dr. if the person living with dementia becomes verbally and physically aggressive or is trying to leave their home/environment in an unsafe manner, and no other strategies have helped. There are prescription based medications like anti-psychotics that may be helpful. Consider the use of Melatonin (available over the counter) at night time to help regulate circadian rhythms
5) Are there any care-giving supplies and/or products that can help provide peace of mind? Or make dealing with Sundowning easier? If so, what are they?
Provide comfort items such as a favorite sweater, blanket, pillow, or memory book (photo album, scrapbook). Encourage activities such as snuggling with a pet, watching TV shows, or listening to relaxing music. Use essential oils like lavender, rose and chamomile along with a hand massage.
Client Example: An 80 year old lady with Alzheimer’s Disease , living with her spouse, started to experience sundowning. On a home visit all the blinds were closed during the day – her spouse was afraid of heights and they lived on the 18 floor. I worked with the spouse to overcome his fear of looking out the window to enable the blinds being open as soon as his wife woke up and closed once it was dark out. He was also giving her chocolate and ginger ale as an afternoon snack; we changed this to cheese and crackers and chamomile tea . We increased walking in the mid-afternoon followed by a 4 pm TV program that she enjoyed the Young and the Restless . She started taking Melatonin at night as well titrating up to 3 mg to help restore her sleep pattern. These and more changes lead to a decrease in her sundowning , so that it was manageable and aided in avoiding placement in Long- Term Care.
Please reach out for more tailored tips, coaching and counseling on how best to manage and improve the quality of life for those living with dementia.