Sundown Syndrome And A Breath of Fresh Air

By

Editor's Note: As many of our readers know, Sundowning (or Sundown Syndrome) sometimes affects people who have Alzheimer's disease and dementia. Rita Altman, VP of Memory Care for Sunrise Senior Living, is an expert and recently put some of her expert tips on how to respond to symptoms of Sundowning to "virtual" paper in the form of a blog.  Rita writes that you should, "observe for emotions and behaviors, Look for the unmet need, Respond with empathy, Don't forget about vitamin D and Maintain a routine." For additional insight and detail around these tips, we've posted Rita's original blog below.

“Sundowning,” formally known as Sundown Syndrome, is characterized by a series of behaviors and emotions that become apparent in certain seniors when the sun begins to go down in the late afternoon or evening. The fact that the majority of people diagnosed with dementia experience trouble with sleeping (i.e. bouts of insomnia, irregular sleep patterns, etc.) suggests that sundowning can often occur in persons with dementia. There are some researchers that question the existence of sundowning and consider the disruptive behaviors in individuals with memory loss that occur late in the day as simply an escalation of their daytime behaviors.

If someone suffers from the tell-tale signs of what is still most commonly referred to as sundowning, here are some ways we can respond to it:

Observe for emotions and behaviors

If your loved one with memory loss becomes noticeably more sad, angry, frustrated or anxious as daylight wanes, despite following a normal daily routine, you may want to speak with a doctor. Emotions vary greatly among those with sundowning – some people begin to feel saddened, while others might become suspicious or even experience visual or auditory hallucinations, causing them to become confused and frightened.

Look for the unmet need

Caregivers can be unsure of how to respond when their loved one with memory loss becomes increasingly confused and upset towards the end of the day. It’s always important to try to respond to the emotion, rather than the behavior, according to the Alzheimer’s Assocation. For example, a senior who shows symptoms of sundowning may be agitated for a seemingly unknown reason, but there is always an underlying cause, such as fatigue, hunger, pain, lack of stimulation or too much stimulation. If a loved one expresses increasing confusion or appears frustrated, spend a few minutes observing them to try to figure out what they need.

Respond with empathy

Ask them what is upsetting them and listen with empathy so they can sense that you truly care. 

Then do your best to respond to the need that they are expressing in their words or demonstrating in their actions. Attempt to match their emotion by taking on a similar voice tone or making a similar facial expression which will help your loved one to see and feel that you are entering his or her world, a common Validation technique.

Don’t forget about vitamin D

Dementia can affect the internal biological clock, a leading predisposition for sundowners. Exposure to daylight allows our bodies to receive the necessary dosage of vitamin D, thereby normalizing circadian rhythms responsible for steady sleep patterns. Try getting out for a walk during the day with your loved one, or sitting near a window to get some direct sunlight.

According to care.com, some people find that exposure to a full-spectrum fluorescent lamp for a couple of hours in the morning helps them to regulate their internal biological clock for optimal sleep patterns. Always check with your doctor to see if this is something you should use.

Maintain a routine

Encourage your loved one with memory loss to maintain the same daily routine, including mealtimes and sleep schedule, as much as possible to regulate the body naturally. Also, keep in mind that mood swings and irritability can occur in anyone who is chronically tired, or whose energy levels begin to wane as the day goes on because they are not receiving proper amounts of sleep to begin with, including the caregiver. Create a comfortable space to retreat to each night with a room free of ambient noise, lighting and bright computer or TV screens that stimulate the brain. Be sure to avoid stimulants such as alcohol, caffeine and nicotine as much as possible. Lastly, try not to jump to conclusions about sundowning without discussing it with a dementia care expert or visiting a doctor.

Rita Altman, R.N., M.S.N., C.V.M., is VP of Memory Care for Sunrise Senior Living, which provides seniors with services including companion living, independent and assisted living and short-term stays.  

Original post reprinted with permission from Sunrise Senior Living.