Alicia Seaver is the Vice President of Memory Care Operations for EPOCH Senior Living and a Certified Memory Impairment Specialist. Every month, she addresses a specific issue related to memory and memory care. If you’re interested in hearing about a particular topic, please send a note to [email protected].
Q: Now that fall is here, I’ve noticed that my mother’s dementia gets worse during the late afternoon. She seems more confused and upset than usual, and she’s not sleeping as well. Why is this and what can I do to help her?
A: Most of us look forward to fall as a break from the sweltering summer heat and a chance to enjoy apple cider or a pumpkin spice latte. But the changing seasons can also bring extra stress and strain for those with dementia and their caregivers. Many family members notice that their loved ones’ symptoms worsen when daylight starts to fade, and can continue well into the night.
This is known as sundowning, which usually manifests in the late afternoon and early evening and is characterized by increased confusion, agitation, delusion and anxiety. Although we don’t know for sure why sundowning is triggered, many experts believe it has something to do with the body’s circadian rhythm (or, the sleep-wake cycle). Our circadian rhythms are affected by daylight and darkness, and when something occurs to cause changes to those rhythms – like when days start getting shorter during the fall months, or when we suddenly “fall back” an hour for daylight savings time – this can confuse our bodies and our minds.
However, sundowning doesn’t always (or only) occur because of shorter days. There are many factors that can trigger sundowning in your loved one, such as boredom, depression, being overly tired, being in pain, being hungry or thirsty, needing to use the bathroom – the list is seemingly endless.
While every person’s situation is unique, there are some things you can easily do in order to help prevent sundowning symptoms in your loved one, such as:
- Reducing distractions present in the room, such as ambient noise, number of people or extemporaneous clutter
- Making sure the room is well-lit in order to minimize shadows, and closing curtains when darkness falls
- Checking to make sure that your loved one is not experiencing any unmet need by offering snacks, asking if they need to use the toilet, etc.
- Suggesting an activity during the evening, such as a simple task like folding napkins or reading a favorite book out loud
- Being calm and collected if your loved one becomes agitated, listening to his or her concerns and reassuring him or her that everything is okay
- Distracting him or her with a favorite object or snack, or otherwise redirecting their energies when you notice them becoming agitated
- Having an established nighttime routine that your loved one (and you) can rely on
- Making the evening hours calm and quiet so that bedtime is a smooth and easy transition
Very often, a person with dementia may exhibit sundowning symptoms because they’re not getting enough exercise or mental stimulation (or, conversely, they’re too tired or getting too much mental stimulation – as mentioned earlier, the list is endless). That’s why it’s important to make sure your loved one gets some sort of exercise or physical activity every day and practice good sleep hygiene. Being exposed to at least 15 minutes of natural sunlight each day can help reset the body’s natural circadian rhythm. Avoid naps during the day if possible (if that isn’t possible, do your best to keep them to less than half an hour). Avoid serving anything with caffeine or alcohol, especially later in the day, and don’t try and pack too many activities into a single day.
If your loved one’s sundowning persists even when you’re following these tips, I suggest seeking medical advice. A physician may be able to identify the root cause of the sundowning, such as a sleep disorder, an unrecognized pain, a side effect of medication your loved one is taking or an undiagnosed illness.
Sundowning can be distressing for everyone involved, but it’s important to remember that it’s not happening in a bubble. There is a reason why your loved one is acting this way, and by taking steps to understand triggers and mitigate the situation, you will find ways to reduce the incidence of sundowning and help keep your loved one happy, calm and content all throughout the day and night – even as the seasons change.
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