Picture the sun dipping below the horizon stretching shadows across the landscape. This time of day can signal the beginning of a perplexing and tough stretch known as sundowning for a person with dementia. It goes beyond a brief bout of unease; it's a battle that can leave the individual and those who care for them feeling swamped and unsure.
Understanding what is sundowning in dementia and how to handle its impact can transform the experience bringing peace and ease to an otherwise tricky situation.
In this post, we'll dive into what is sundowning in dementia and how you can help manage sundowning with kindness, understanding, and other different approaches.
What is Sundowning in Dementia?
Sometimes a person dealing with dementia may behave in ways that are tough to understand in the early evening. This is called “Sundowning”
In simple terms, later in the day, you might notice changes in a person's behavior. Some common behaviors of people with dementia are increased distress, agitation, and experiencing hallucinations or delusions. This can make it difficult for them to get enough sleep, and it's known as sundowning.
It's important to note that this phenomenon is not solely linked to the sun setting and can occur at any stage of dementia, although it's more common during the middle and later stages.
Causes of Sundowning in Dementia
Sundown syndrome affects individuals coping with dementia - a complicated issue stemming from various sources. Knowing what causes this problem, dementia stages can assist caretakers and family members in offering help during this tough period.
- Biological Factors
The body's inner timekeeper, the circadian rhythm, is key in controlling our sleep-wake patterns. Dementia patients might face disturbances in this rhythm, which can lead to bewilderment and unrest as the sun sets.
Also, shifts in brain chemicals, like lower amounts of certain neurotransmitters, might play a role in bringing on sundowning symptoms.
- Environmental Factors
The surroundings can also affect people with dementia as the day moves forward.
Low light, more shadows, and less daily activity can make people anxious and confused. Not having a routine or too much stimulation during the day can also make sundowning worse making it harder to unwind as night gets closer.
- Psychological Factors
Feeling scared, anxious, and frustrated can get stronger in the late afternoon and evening for people who already have trouble thinking. When someone can't recognize places they know or remember what just happened, it can lead to more emotional stress.
Such psychological factors can create a cycle where anxiety worsens sundowning symptoms, making it even more challenging for the individual to find peace as the day ends.
- Medications That Cause Sundowning
Some medicines used to treat dementia symptoms or other health problems can make sundowning worse by accident. Drugs that affect the brain, like sleeping pills or antipsychotics, can mess up sleep or increase confusion if people take them late in the day or at night.
To prevent sundowning well, it's key to know the possible side effects of these drugs and to work with doctors to adjust doses or when to take them.
- Sundowning in Dementia
Sundowning has a strong link to dementia, but it can be more or less severe for different people. As dementia gets worse, the brain finds it harder to process and react to things around it. This makes it tougher for people to deal with changes in their surroundings and how they feel inside.
This drop in mental sharpness, along with the other elements we talked about, sets up a situation that brings on the signs of sundowning. As evening approaches, people might feel worked up, mixed up, and unable to settle down.
Symptoms Of Sundowning
A cross-sectional study of patients with dementia was conducted at the Department of Human Neurosciences of Sapienza University of Rome between June 2019 and April 2020. Out of the 152 recruited patients with dementia, 34 exhibited sundowning. The most common manifestations of sundown syndrome were irritability (15%), agitation (15%), and anxiety (14%). Let’s talk about these symptoms in detail:
Mood changes
As the day progresses, you may see sudden shifts in mood in a person with dementia syndrome. They become more anxious, depressed, or frustrated as the evening begins. Such mood changes happen quickly and might seem out of proportion to what’s going on around them. This emotional volatility can be distressing for people experiencing it and their care providers.
Confusion
Things can get confusing for some people as the sun goes down. They might start to forget where they are, what time it is, or even who the people around them are. When this happens, they can get scared or frustrated, and it becomes tough for them to tell others what they need or understand what's happening.
Agitation
Agitation often accompanies the confusion associated with sundowning. The individual might become restless, pacing back and forth, fidgeting, or repeatedly asking the same questions. This agitation can escalate into more pronounced behaviors like shouting or resisting care, which can be challenging for caregivers to manage.
Hallucinations
Some individuals experiencing sundowning may start to see or hear things that are not present. These hallucinations can be quite vivid and frightening, adding to the person's overall confusion and distress.
Additionally, hallucinations can take many forms, from seeing imaginary people or animals to hearing voices or sounds that are not real. Understanding that these experiences are not grounded in reality can be challenging for the person.
Importance of Keeping a Sundowning Diary
Well, keeping a diary can be the best option for both caregivers and patients dealing with dementia-related sundowning symptoms. Here’s why maintaining a diary is so important:
- Identifying Patterns
Keeping a sundowning diary enables you to monitor the times of day when symptoms worsen, along with the severity and duration of those symptoms. This can help in identifying patterns that may offer insight into the triggers and causes of sundowning.
- Monitoring Progression
By consistently documenting the sundowning symptoms over time, the diary can help you identify any changes or worsening of the condition. This information is important for caregivers and healthcare providers to effectively manage the individual's care plan.
- Communicating with Healthcare Providers
The detailed records in a sundowning diary can be extremely helpful when discussing the individual's condition with their healthcare team. The data can provide valuable insights into the person's experience and help guide treatment decisions.
- Tailoring Interventions
With a clear understanding of the individual's sundowning patterns, caregivers can develop more effective strategies and interventions to manage the symptoms. This may include adjusting the person's daily routine, modifying the environment, or implementing specific coping techniques.
- Providing Emotional Support
Keeping a sundowning diary can also serve as a therapeutic outlet for both the individual and their caregivers. The act of recording and reflecting on the experience can help process the emotional toll of dealing with this challenging condition.
Identifying Sundowning Triggers
- Environmental factors - Changes in lighting, noise levels, clutter, or unfamiliar surroundings can contribute to sundowning episodes.
- Fatigue and disrupted sleep cycles - Insufficient or poor quality sleep can exacerbate sundowning symptoms.
- Medication side effects - Certain medications used to treat dementia or other conditions may worsen sundowning.
- Stress and overstimulation - Busy schedules, visitors, or challenging activities can lead to increased agitation and confusion.
- Unmet needs - Hunger, thirst, pain, or the need to use the restroom can trigger sundowning behaviors.
Managing Sundowning Symptoms
Creating a Calm Environment
To manage sundowning symptoms in people with dementia, you need to set up a calm and soothing environment. This means cutting down on noise, mess, and stimulation in their living space in the late afternoon and evening when sundowning happens more often. Keeping a steady routine turning down lights, and making things cozy can help reduce the agitation, confusion, and distress that come with sundowning.
Behavioral Strategies
Using good behavioral strategies can have a big impact on how we handle sundowning symptoms. This might mean getting the person to do calm activities, like easy exercises, listening to relaxing music, or talking about happy memories.
When the person gets upset or confused, it helps to comfort them, show we understand, and point them in a different direction. Caregivers should pay attention to what sets off the person's symptoms and change how they deal with it based on that.
An article by the National Library of Medicine shows that non-pharmacological strategies that have been shown to produce significant benefits in the management of NPS in patients with dementia (e.g., music therapy, aromatherapy, caregiver education, multisensory stimulation) may potentially be effective also in reducing sundowning.
Medical and Therapeutic Interventions
Sometimes, doctors need to step in alongside changes to surroundings and habits. Talking to health experts, like doctors or therapists, can help find and tackle any health issues that might make sundowning worse. They might suggest tweaking medicines using light therapy, or other treatments to ease symptoms and boost the person's overall health. Working together with the care team is key to creating a fully tailored plan to handle sundowning.
Managing sundowning symptoms in individuals with dementia requires a multi-faceted approach. By understanding the potential causes and keeping a sundowning diary to identify patterns, caregivers can work to create a calm environment, implement effective behavioral strategies, and consider medical or therapeutic interventions, all while involving the individual, their family, and the care team.
REFERENCES
- https://alwayshomeconnected.com/blogs/news/common-behaviours-of-dementia
- https://alwayshomeconnected.com/blogs/news/dementia-stages
- https://www.alzheimers.org.uk/about-dementia/symptoms-and-diagnosis/anxiety-dementia
- https://www.jns-journal.com/article/S0022-510X(21)01700-7/fulltext
- https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/dementia-emotional-changes
- https://www.healthline.com/health/hallucinations
- https://www.medicalnewstoday.com/articles/what-stage-of-dementia-is-sundowning
- https://alwayshomeconnected.com/blogs/news/dementia-and-sleep
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5187352/
- https://www.agingcare.com/articles/could-caregivers-and-their-loved-ones-benefit-from-light-therapy-189163.htm
