Sundowning is a symptom – actually, a group of symptoms – that occurs in individuals with dementia usually at the end of the daylight hours. It results in increased agitation, confusion, mood swings, irritation and sometimes hallucinations and other undesirable behaviors.
“Although we don’t know for sure why sundowning occurs, we do know that the amount of daylight available plays a part,” says Cindy Wirth, Executive Director of Bridges® by EPOCH at Sudbury, a memory care assisted living community in Sudbury, MA. “It makes sense, then, that many people report their loved one’s symptoms worsening in the fall and winter. This can be frustrating, or worse, frightening for caregivers and family members, who may not know exactly how to handle these symptoms or redirect them to more positive behaviors.”
Our circadian rhythm – the body’s sleep-wake cycle – is dependent on natural light in order to stay “in shape.” When it gets disrupted, it causes sleep problems and winter blues or the more serious seasonal affective disorder (SAD). But this is not the only reason why a loved one’s dementia symptoms get worse over the winter. Other reasons include boredom, pain, cold and being cooped upside – just to name a few.
“As with everything related to dementia, your loved one’s actions and reactions stem from something that’s occurring to them,” Cindy says. “Instead of focusing on the symptoms themselves, look instead at what may be causing them. Does it occur at a certain time of night, for example, or does something happen right before that could startle, unnerve or otherwise throw your loved one into a tizzy? Is your loved one feeling cold, uncomfortable or in pain? It’s important to understand the why of the situation so you can start taking steps towards solving the issue.”
Here are some things you can do to help lessen the occurrence of sundowning in your loved one:
1. Keep to a regular eating and sleeping schedule. Yes, it’s common to feel more tired when there is less daylight. No, that doesn’t mean you should go to bed earlier. It’s important to keep a regular schedule throughout the year of meals and bedtime so that your loved one has a routine. Even if it gets dark at 5 p.m. in the afternoon it’s important to stay up during your regular hours so that your loved one’s sleep cycle doesn’t get disrupted.
2. Make sure that your loved one’s bedroom is set up for sleep success. As we age, it may become harder for us to get a good night’s sleep for one reason or another. Maybe your senior needs a recliner rather than a traditional bed. Perhaps the room is too bright, or too warm or too noisy. Keeping your senior’s bedroom a sanctuary for sleep will go a long way towards helping them get the rest they need (and, hopefully, lessen the sundowning symptoms they’re experiencing).
3. Keep caffeine and sugar to a minimum. Avoid giving your loved one anything too sugary or caffeine-filled in the late afternoon or evening. It’s also a good idea to avoid alcohol at all, because it can severely disrupt your loved one’s sleep.
4. Be sure your loved one gets enough activity during the daytime. Sundowning can occur if your loved one hasn’t had enough exercise or activity to “wear them out” during the day. It’s always a good idea to get some physical activity in, like a daily walk or an afternoon exercise session. This helps improve mood, regulates metabolism and wears a person out so they can sleep better at night.
5. Start a bedtime routine that includes shutting off screens. We all know that screens – tablets, TVs and smartphones – emit a particular light that can disrupt sleep and cause us to have difficulty at night. At the same time, people with dementia may not be able to follow a TV show or become incredibly agitated because they can’t separate reality from fantasy. Instead of winding the evening down by watching TV, initiate a routine that encourages calm and sleepiness. Play calming music or do an activity that doesn’t require a lot of energy but is pleasurable for your loved one.
6. Let the light in. In the mid to late stages of dementia, your loved one may become frightened or unnerved by shadows. Make sure that your rooms are well-lit so there aren’t dark and scary corners. Make sure that you let as much natural light in as possible, and be sure that there are night lights in the evening so that your loved one can navigate if they need to get up and use the bathroom. You may also wish to consider light therapy for your loved one to help reduce depression and improve mood.
7. Talk to their doctor. It’s possible that your loved one’s symptoms are caused by medication interaction or the need for different medications. It could also be a sign of another health issue that has just sprung up, especially if the sundowning has come seemingly out of nowhere.
8. Track your loved one’s behavior. As we mentioned at the beginning of the article, there is always a reason why someone is reacting in a certain way. Every senior has different sundowning symptoms, and different triggers affect different people in different ways. Keep a diary or journal handy so you can keep track of your loved ones symptoms and start to determine a pattern – which you can then use to craft a solution.
Sundowning can be a difficult thing for caregivers to deal with, and if you find yourself feeling stressed or anxious because of your loved one’s behavior, remember that you have resources available. Connect with a local memory care community like Bridges® by EPOCH at Sudbury to speak to professionals who understand what you’re going through. They may have options and suggestions that can help ease your job and make this winter a lot more manageable.
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