The Many Faces of Dementia: Sundowning
April 23, 2013
"Sundowning" by definition is a state of increased confusion and/or agitation, frequently negative behavior and activity that usually happens late in the day into early evening. It is thought that lowering of sunlight light and in the winter, shorter days may be a cause. More current research suggests that being overly tired may be the prime contributor to the agitated behavior along with perhaps the inability to deal with stress. Agitation may be exhibited as simply as being grumpy to pacing to hitting something or someone.
There are a number of techniques that can be tried to reduce sundowning behavior. Remember that what works for one person with a dementia may not work for another person.
When we first opened our Alzheimer's care home, we received sage advice from an experienced person in the care giving business. The recommendations included: using "daylight" light bulbs in the living area with dimmers turning the lighting up high mid-afternoon and then leaving them on high until just before or after dinner. That simple change made all the difference in the world. Other adjustments included: after lunch short naps, games, walking and other physical and mental activities. We found that the more active the person was, along with bright afternoon interior lighting, not only reduced sundowning, but the person slept better at nights.
Other things to try:
“Remember that what works for one person with a dementia may not work for another person.”
1. If afternoon activities seem to overtax the person with sundowning behavior, move the activities to the morning and try it for a week or so — if the person is comfortable with the timing. Once again, it should be stressed that different things should be tried, perhaps for a couple of days or a week and if found ineffective, something else should be tried.
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2. Try early after lunch naps and if sleep doesn't come, a quiet time with music before the sundowning comes on may work.
3. People with a dementia frequently can't express themselves, thus discomfort from a cold, asthma, Urinary Tract Infections, or other infections may be the causes of agitation. If the onset of sundowning is rapid, think first about physical discomfort and visit a doctor.
4. Noise, perhaps from a dishwasher run in the afternoon can be a source of agitation as well as a loud television or radio.
5. Reaction to non verbal cues from the caregiver who may be worn out later in the day may be a cause of agitation.
6. Try to maintain a set routine particularly in the afternoons. Routines, in general, tend to reduce confusion. Remember, confusion can come from many forms of negative stimulation: visual, physical and auditory. Soothing music, holding or rubbing a persons hand as in a massage can be very relaxing — but not always.
7. Avoid stimulants and big dinners. Avoid nicotine and alcohol, and restrict sweets and caffeine consumption to the morning hours. Better yet, eliminate caffeine. In most cases, the person with a dementia won't taste the difference. Have a large meal at lunch and keep the evening meal simple.
8. Plan more active days. A person who rests most of the day is likely to be awake at night. Discourage late afternoon napping (maybe a brief one just after lunch) but not napping in the later part of the day. Plan more challenging activities such as doctor appointments, trips and bathing in the morning or early afternoon. Encourage regular daily exercise, but no later than four hours before bedtime.
The bottom line: While sundowning may be a part of dementia, be creative; think carefully about reasons for agitation and confusion. Sometimes the simplest remedy may reduce or eliminate this difficult behavior period.
For more information and articles, contact Tor Eckert at 530-277 0879 or email firstname.lastname@example.org.
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