Sundowning Syndrome
As promised, this newsletter is about what people in the Alzheimer's/dementia care industry commonly call "sundowning." This is an umbrella term that is used to describe a perceived state of confusion at the end of the day and into the night by a person suffering from dementia.
Typically observed is confusion, anxiety, aggression and a propensity to ignore directions; pacing or wandering is also common.
Piggybacking on my last newsletter, these symptoms do not call for drugs. There is no underlying psychiatric issue that will be cured by ingesting an anti-psychotic. The only thing that will help is an understanding of why this time of day wreaks so much havoc. Although the exact cause is unknown, there are factors that most professionals agree aggravate late day confusion such as:
* Fatigue
* Low lighting
* Increased shadows
* Disruption of the body's "internal clock"
* Difficulty separating reality from dreams
Tips for reducing sundowning:
* Try to maintain a predictable routine for bedtime, waking, meals and activities.
* Plan for activities and exposure to light during the day to encourage nighttime sleepiness.
* Limit daytime napping.
* Limit caffeine and sugar to morning hours.
* Keep a night light on to reduce agitation that occurs when surroundings are dark or unfamiliar. (Sundowning is thought to be related to changes in the body's circadian rhythms, or the sleep-wake cycle. Keeping your home brightly lit in the afternoon and evening may help reduce the symptoms of sundowning syndrome. According to studies published in Clinical Geriatrics, people who were exposed to more light late in the day showed less agitation. Light exposure helps your body recognize the difference between day and night.)
* In the evening, try to reduce background noise and stimulating activities, including TV viewing, which can sometimes be upsetting.
* In a strange or unfamiliar setting, bring familiar items - such as photographs - to create a more relaxed, familiar setting.
* Play familiar gentle music in the evening or relaxing sounds of nature, such as the sound of waves.
* Talk with your loved one's doctor if you suspect an underlying condition, such as a urinary tract infection or sleep apnea, might be worsening sundowning behavior.
* Encourage exercise even if it is a 10 minute walk.
In a facility setting, often times sundowning occurs when there is a shift change. At that time, it may signal that it is time for a resident to leave work and pick up their kids or engage in the routine that they were accustomed to in the past. This would explain wandering. Their inability to carry that task out could explain the anxiety and crying out. During a shift change, often structured activities are put on hold as well making it difficult to redirect and channel this energy. | 
