The problems that occur when the sun goes down.
Unless you care for or live with a loved one who has dementia, you may not know exactly what sundowning is. “[Sundowning] is a phenomenon where patients with dementia have behavioral disturbances that peak, that seem to get worse, over the course of the day. They get worse in the late afternoon or early evening,” says Norton Neuroscience Institute neuropsychologist Brandon Dennis, PsyD. While it is a common condition amongst dementia patients, it causes both they and their loved ones considerable stress and anxiety.
Pat Scott, a Louisville resident who was a caregiver to her mother Neola Brooks for a decade, coordinates a number of support groups for caregivers of Alzheimer’s patients. Caregivers report that patients who experience sundowning “can get anxious, they can get mean, they can cry, or they may pace around the house. A lot of the caregivers will say [patients] get really agitated toward the evening,” she says.
Alzheimer’s disease and its symptoms are varied based on the person. “If you’ve seen one Alzheimer’s patient, you’ve seen one Alzheimer’s patient,” Pat says, and this is the case when it comes to sundowning. She says some patients want to sit in a dark room in the afternoon or early evening, while others want to get out of the house.
Every individual has a circadian rhythm, which is an internal clock of sorts that helps humans regulate when they sleep, wake, and do everything in between. Dr. Dennis says normal aging changes a person’s circadian rhythm. “People over time have reduced sleep time, more arousals and awakenings, and they spend more time in lighter sleep,” he says. Alzheimer’s and other forms of dementia change circadian rhythms even more to where they become disabling.
Sundowning is not a dementia symptom that comes and goes. “It won’t be a spotty behavior,” Dr. Dennis says. Patients are more likely to experience sundowning if they have moderate dementia. While someone with severe dementia may still have sleep disturbances, that person often doesn’t have the motor or verbal abilities to express agitation or restlessness as they once did.
The agitation or anxiety associated with sundowning can become a feedback loop between the patient and his or her caregiver. A dementia patient who is agitated may stress out a caregiver, who is tired from a day of tending to the needs of the loved one. This may cause the caregiver to become agitated, which then makes the patient more agitated. Dr. Dennis says many dementia caregivers have full-time jobs and children of their own, which means they are likely tired at the time of day when sundowning behaviors occur.
When Pat was caring for her mom, who experienced sundowning, she would use redirection to help reduce agitation for both her mom and herself. “She liked to watch Christian videos or Elvis Presley videos. If she got really upset, I’d say, ‘Come on, let’s watch this.’ It would divert her attention to the TV,” she says. She says it is important for caregivers to have some options in their toolbox to use as distraction. “You find out what ticks their boxes, what things they like to do,” she says. That may be looking through photo albums and reminiscing. It might be reading them a book or listening to music. Pat’s mother was in pretty good physical shape and had enjoyed line dancing prior to her diagnosis. “I could put country music on; she could barely remember her name, but she could remember those steps,” she says.
While younger people may take over-the-counter or prescription medications to help them sleep or regulate their sleep-wake cycle, pharmaceuticals can make dementia patients groggy and more confused than they already are. Dr. Dennis recommends increasing physical activity and ensuring meals are eaten at regular times during the day. He says Rozerem, a medication for insomnia, shows some promise, but more studies need to be done, and it may not be as effective as researchers hope for sundowning symptoms. While dementia itself impacts sleep, he says it is always a good idea to go back to basics, ensuring that the room temperature is cool, there are no TV, phone, or pet distractions, and that the mattress and pillow are of good quality.
Caregivers whose loved ones experience sundowning may find comfort, support, and resources by contacting the Greater Kentucky and Indiana chapters of the Alzheimer’s Association (https://www.alz.org/kyin). Pat uses her experience as a caregiver to help others understand the disease, tend to their loved ones, and manage their own stressors. “You have to realize the disease is controlling them; they have no control over themselves. Your duty as the caregiver is to try to calm them down and redirect,” she says.
By Carrie Vittitoe
P.S. Here’s another article you may be interested in: Sharing A Home – Preparing For When Family Moves In (part 1 of 2).
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