Sundowning

It’s about 4:00 PM.  Dad has been in the living room watching some TV and it dawns on me that it’s getting late in the day – time for some extra trouble.  Sure enough, when I peek into the living room, Dad is wrapped in one of the hanging curtains, looking fearful.
 
“Oh!  good!” he whispers to me. “they haven’t seen me yet but I know they are out there.”  His eyes dart around room as he clutches the curtain tighter. Yesterday he did not know who I was and tomorrow it will probably be something else – he changes so much as the day draws to a close and the sun goes down.
 
Sundowning, Sundowner’s Syndrome, are references to a condition that is seen in many forms of dementia, particularly in Alzheimer’s Disease.  Briefly stated, it is a very noticeable increase in levels of agitation, anxiety, confusing and behavior problems.  Many Caregivers report frequent episodes of hallucination.  The changes in a person with dementia who is suffering with Sundowner’s can impact the level of care and quality of care by significantly increasing the actual workload while at the same time multiplying internal stress.
 
Glenn Smith Ph.D., of the Mayo Clinic lists four common factors that might “aggravate late-day confusion:

  • Fatigue
  • Low lighting
  • Increased shadows
  • Disruption of the body’s internal clock [1]

 
There is no known cure for the symptoms call Sundowning but there are care techniques that can help. Most professionals working with Dementia patients stress the need for a reduction in stimulating activities late in the day.  Reduce intake of caffeine or other stimulants in general. Use background music that is soothing and perhaps recognizable. For instance, an 82-year-old today may have really enjoyed the music of Frank Sinatra in his heyday, or Sarah Vaughn etc.  Many Caregivers find that increasing inside lighting as daylight decreases can help.  (This would help eliminate shadows as well.  A secondary set of light fixtures that can be switched on later is not very difficult to install.  Trying to reduce anxiety and help your loved one feel safe and protected is your goal.  Becoming familiar with routines and identifying possible “triggers” can help eliminate some factors that complicate caregiving.  For instance – if you notice that Dad becomes frightened toward the end of the day, consider the surroundings – is he alone as the light fades?  Are their external noises that are more noticeable later in the day?  Try to figure what areas might be modified to lessen the behaviors.  Above all – DON’T ARGUE.
 
A person with dementia lives in an altered state of reality which is more and less noticeable from day to day and hour by hour – sometimes seemingly minute by minute.  Arguing or trying to correct those altered memories and frustratingly bizarre conversations is useless.  In the example leading into this article, trying to convince Dad that no one was trying to get him would not work.  A better approach to that situation would be to try and convince him that you would take care of the situation.  You might need to become an actor – a policeman, ghostbuster, space hero – whatever the situation called for.
 
I once had a wife of a Colonel call me in the middle of the night.  She was beside herself and had been trying to convince her husband that he did not need to report to duty – especially not in his dress uniform.  I asked her to put the Colonel on the phone and in my best commanding voice barked at him that “plans have changed.  Stand down, everything worked out just as you predicted…”.  The Colonel simply said “yes sir” and hung up.  I wondered what the outcome of this call was and was gratified when the Colonel’s wife called the next morning and told me that the former officer had very carefully removed his uniform, hung it back up himself and gone back to bed.
 
Responding in character might be difficult for you and another technique that can help is re-direction.  Trying to distract your loved one long enough to re-direct their mind toward something calming can sometimes work.
 
If sundowning behaviors become so pronounced that you are unable to handle them, speak to your Physician about some form of medicine.  It may make your loved less alert in general but that may be trade off to prevent daily doses of real terror and/or anxiety.
 
For more information about Sundowning and dementia in general, contact the Alzheimer’s Association in your area or visit http://www.nia.nih.gov/alzheimers.
 
The information and suggestion in this article are not intended as medical, legal or financial advice.  You should always consult with your own professionals.
 
[1] Diseases and Conditions, Glenn Smith Ph.D. – www.mayoclinic.org/diseases-conditions/alzheimers-disease/expert-answers/sundowning/faq-20058511