Sundowning

Sundowning Affects the Body’s Sleep-Wake Cycle

Sometimes, an individual with Alzheimer’s or dementia experiences increased confusion, anxiety, agitation and disorientation starting at sunset which continues late into the night. This is commonly referred as ‘sundowning’, a syndrome that affects the body’s sleep-wake cycle (monitored by the body’s biological internal clock). The circadian clock monitors sleep/wake hours, metabolism, digestion, hormonal cycles and other physiological patterns based on darkness and light. But there are no definitive proofs supporting the role of circadian clocks in aggressive behavior.

Causes

1. Tiredness and exhaustion after a hectic morning trying to withstand unfamiliar or disturbing environmental factors.
2. Too little or too much light
3. Sleeplessness, disturbed sleep or too little sleep
4. Pain (people start overreacting when effects of pain medications start wearing off)
5. Boredom due to lack of activity or loss of routine in people who were active
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Tips to Caregivers
Caregivers must be alert and cautious in the late afternoon and early evening for any signs/symptoms of sundowning such as yelling, anxiety, pacing back and forth or wandering. When the individual shouts or shows signs of fear, try talking to the person calmly and reassure him/her that everything is normal. Try these tips to soothe the person:

• Minimalize noise, clutter or the number of people in the room
• During agitations or fearful situations try distracting the person with simple activities (such as folding towels), entertainment (familiar TV shows but not news as it might portray something negative) and snacks (a fruit or drink of their choice).
• Ensure proper lighting inside the house-too bright light can overstimulate the person while too dark lights can scare them due to shadows.
• Never physically control a person. Allow him/her to move back and forth under your supervision.
• Minimize agitation or stimulation of the person during the late-evening hours by minimizing TV volume or loud music. Keep children away from them as much as possible as kids are unpredictable and may shout or create tantrums any time.
• Try maintaining a calm environment at home. You can read a book together, play some soothing music or take a walk to keep the individual’s restlessness under control.
• Always be smart to schedule doctor appointments, bathing, going out or any other mandatory activity in the morning hours when the person with Alzheimer’s is relaxed and much alert.
• Ensure that the individual eats a fulfilling meal during lunch time and takes a light dinner meal.
• Exercising can help a person with dementia to sleep. Restrict sleeping hours during daytime and see to that the individual is exposed to ample sunlight. Exercising can also delay or prevent Alzheimer’s in people who are at an increase risk. Read more on exercising and how it helps such people at www.firsteatright.com.
• Think. The person could be showing certain abnormal characteristics due to hunger, pain or requiring help in using the toilet.
  
  

Avoid:

• Serving caffeine, cola or other drinks with caffeine during late evening hours.
• Cramming the day with activities as this might cause exhaustion and tiredness.
• Serving alcohol as this leads to further confusion and anxiety.
  
  

Beyond trying all these tips if the problems still exist, get in touch with your physician. A doctor would be able to gauge whether sundowning is the result of pain, sleep disorder or a side effect of some medication. Medications used to promote sleep during the night in persons with dementia can cause dizziness, confusion and falls. Take care and ensure that these medicines are used only for the duration up to which they have been prescribed. Sundowning can affect the sleep routine of both, the dementia-affected person and his/her caregiver as well. As this syndrome starts late in the evening when the caretaker feels like resting or taking a break, it pushes the person to exhaustion impacting his/her next day energy levels due to disturbed sleep routines. If possible, people can rotate caretaking jobs among themselves and assure each other of solid resting times between caretaking.