Dementia and Sundowning: Tips to Help You Manage Sundowning

Summary

In this video, Dr. Natale addresses a question from a viewer about sundowner syndrome, a common challenge for people with dementia. She explains the symptoms of sundowning, such as confusion, agitation, and anxiety, which typically worsen in the evening. Dr. Natale shares practical tips for caregivers to help manage these symptoms, such as maintaining routines, ensuring proper sleep, reducing stress, and creating a calm environment. She also advises caregivers to consult with doctors about medication options if behavioral strategies don't work, and highlights the importance of monitoring sudden changes in behavior for potential health issues.

Takeaways

• 😀 Sundowning is a term for a range of symptoms, including agitation, confusion, and anxiety, that typically occur in the late afternoon or evening in people with dementia.
• 😀 Sundowning is most common in individuals with moderate to severe stages of dementia and can lead to sleep disturbances and wandering.
• 😀 A regular daily routine is essential for minimizing anxiety and agitation in people with dementia, helping to create a sense of structure and predictability.
• 😀 Adequate sleep balance is crucial; too much or too little sleep can exacerbate sundowning symptoms, and caregivers should avoid stimulants close to bedtime.
• 😀 Caregivers should incorporate self-care routines to manage their stress and prevent it from influencing the behavior of their loved ones.
• 😀 Engaging in enjoyable activities during times when agitation typically occurs can help reduce the intensity of sundowning symptoms.
• 😀 Tasks such as doctor appointments or bathing should be scheduled earlier in the day when the person with dementia is typically more alert and less agitated.
• 😀 Proper lighting in the home, particularly in the evening, can help reduce confusion and anxiety by improving visibility and making the environment easier to navigate.
• 😀 Creating a calm environment through soothing music, aromatherapy, or gentle touch can help to de-escalate agitation and anxiety in people with dementia.
• 😀 Keeping a journal of behavior patterns, including timing and triggers of sundowning, can help caregivers identify patterns and effectively intervene in managing symptoms.

Q & A

What is sundowning or sundown hour syndrome?

Sundowning, or sundown hour syndrome, isn't a diagnosis but a term used to describe a variety of symptoms people with dementia can experience, particularly during the late afternoon, evening, or nighttime. Common symptoms include agitation, confusion, anxiety, pacing, aggressiveness, disorientation, mood swings, hallucinations, and unusually demanding attitudes.

At what stage of dementia does sundowning usually occur?

Sundowning most commonly occurs in individuals with moderate to severe stages of dementia. It is not exclusive to a particular stage, but it becomes more noticeable as cognitive impairment progresses.

What are some potential causes of sundowning?

One theory is that the brain of someone with dementia has to work harder to process their environment, especially later in the day. As the day goes on, the brain becomes more fatigued, leading to increased agitation, confusion, and anxiety as the person struggles to distinguish reality from past memories.

What is the relationship between sleep and sundowning?

Maintaining a balanced sleep schedule is crucial. Too much or too little sleep can exacerbate sundowning symptoms. Caregivers should aim to ensure that their loved one gets a good amount of sleep, avoiding stimulants like caffeine, nicotine, and alcohol before bedtime.

How can caregivers help their loved ones with sundowning symptoms?

Caregivers can help by creating a consistent routine, ensuring adequate sleep, incorporating enjoyable activities, managing stress, and maintaining a calming environment. Other strategies include using bright lighting in the evening, incorporating soothing activities, and keeping track of patterns in behavior to better anticipate and manage symptoms.

Why is establishing a daily routine important for individuals with dementia experiencing sundowning?

A structured daily routine helps provide a sense of security and predictability, which can reduce anxiety and confusion. Research shows that organized schedules, with room for rest and enjoyable activities, can lessen the likelihood of agitation and anxiety in people with dementia.

How does caregiver stress affect sundowning behaviors?

Caregiver stress can directly impact the behavior of individuals with dementia. If caregivers are stressed, anxious, or frustrated, their emotional state can influence their loved one’s agitation and anxiety. Practicing self-care and managing stress is essential for both the caregiver's well-being and the well-being of the individual with dementia.

What types of activities should caregivers schedule for their loved ones with dementia?

Caregivers should include enjoyable activities throughout the day that are not solely passive, like watching TV. It's especially helpful to schedule these activities around times when the person tends to become agitated. Caregivers should also aim to schedule more challenging tasks, such as medical appointments, earlier in the day when their loved one is functioning better.

How can lighting impact sundowning symptoms?

Good lighting is crucial because individuals with dementia often struggle to perceive their surroundings accurately at night. Poor lighting can lead to confusion and anxiety. Keeping the home well-lit, especially in the evening, and even exposing the person to bright light earlier in the day, can help reduce sundowning symptoms.

What role does environmental relaxation play in managing sundowning?

Creating a calm environment can help alleviate sundowning symptoms. This includes listening to soothing music, using aromatherapy, offering hand massages, and reducing loud distractions. Caregivers should avoid violent or loud TV shows at night, as they may be misinterpreted by individuals with dementia, leading to increased agitation.

When should caregivers consult a doctor about sundowning symptoms?

If behavioral interventions and environmental changes do not alleviate the symptoms of sundowning, caregivers should consult a doctor. In some cases, medications may be prescribed to help manage the symptoms, but this should only be considered after trying non-medication strategies.

How can caregivers detect underlying issues that might contribute to sundowning?

Caregivers can keep a journal to track patterns in their loved one’s behavior, noting the time of day, surroundings, and activities leading up to the sundowning symptoms. If a sudden and significant change in behavior occurs, caregivers should seek medical advice, as it could indicate an underlying issue, such as an infection.