Sundowning: Triggers, Symptoms & How to Manage It

Does your loved one’s mood take a nosedive, or do their behaviors become more challenging, as nightfall approaches? Do they often wake during the night, causing you to worry about their safety or lose much-needed sleep yourself? Did you know there’s a term for this neurological condition and specific tasks you can take to minimize its effects? “Sundown syndrome – commonly called ‘sundowning’ – usually begins to affect people with mid- and late-stage dementia late in the day or in the early evening,” says Michelle Straughn, Executive Director at YourLife™ of Tallahassee, a Memory Care community in Tallahassee, Florida. “The loss of sunlight can trigger restlessness, confusion and anxiety, but the good news is there are many ways family caregivers can relieve these and other symptoms without resorting to medication.” In this post, we’ll share more about sundowning and nonpharmacological interventions you can use to keep your loved one’s spirits up when the sun goes down. SUNDOWNING: COMMON SYMPTOMS & TRIGGERS According to the Alzheimer’s Association, some studies indicate that sundowning triggers distress in as many as 20 percent of people with memory loss, while others experience drastic impacts on their sleep schedules. Symptoms vary, depending on the type of dementia and which stage of progression the person is in. For those with Alzheimer’s, for example, nighttime restlessness usually peaks mid-stage and diminishes as the person enters late-stage Alzheimer’s. SYMPTOMS • Confusion, fear and disorientation • Anxiety and irritability • Suspicion or paranoia • Dramatic mood swings • Aggressive or angry behavior • Pacing and wandering • Resistance to advice or redirec¬tion • Restlessness or sleep disorders TRIGGERS • Lack of schedule or routine • Reduced light and increased shadows that cause confusion or fear • Vision problems • Depression • Extreme mental or physical fatigue • Reactions to nonverbal cues from exhausted and frustrated caregivers • Visual and auditory hallucinations • Shocks to one’s internal body clock, especially in fall or winter months • Lack of activity and increased napping during the day • Lack of sunlight, Vitamin D, and natural serotonin production during the day • Lack of melatonin production, which is vital to sleep • Hunger or thirst • Pain or discomfort • Caffeine or alcohol near bedtime SOOTHING YOUR LOVED ONE IN THE MOMENT When your loved one begins sundowning, try these tips for preventing their symptoms from escalating: • Ask if they need something. If they cannot express themselves verbally, make sure they are comfortable and consider when they last had something to eat or drink. • Assess the environment. Do they “see someone” in the room? Find and remove the source of confusion. Shine light on shadows and cover reflections in windows and mirrors. • Redirect. Offer them a snack, ask them to help fold a load of towels, turn on their favorite music or go for a walk. • Speak in calm tones and use soothing touches. Hold their hand, rub their back or give them a gentle hug. • Avoid arguing; instead, validate their feelings and reassure them that everything is okay. • If it is safe to do so, allow them to pace. NONPHARMACOLOGICAL PREVENTION & MANAGEMENT TIPS ENVIRONMENTAL: • During the day, pull open window coverings for maximum exposure to bright light. • At dusk, close the window coverings and keep the home well lit. This will help to reduce shadows, eliminate confusing reflections, and reduce feelings of depression or agitation associated with darkness. • Minimize stress. Create a quiet evening routine that will calm and prepare them for sleep. Avoid challenging activities that may cause frustration or irritability close to bedtime. • Decorate your loved one’s space with items, fabrics, textures and colors that bring them joy and peace. • Know what they are watching on television. Some TV or movie scenes and images could be confusing or upsetting. • Make a comfortable and safe sleep space. Keep your loved one’s room at their preferred temperature, install nightlights, appropriate door and window locks, and use a bed sensor pad and motion detectors to alert you when they get (or fall) out of bed or are wandering. BEHAVIORAL: • Maintain a schedule. Help your loved one stick to a regular routine of meals, wakefulness and bedtime. Routine and structure help your loved one know what to expect and also contribute to a more restful night’s sleep. • If your loved one’s circadian rhythm is off, try “resetting” their internal clock with bright light therapy. • Adjust eating patterns. Avoid large, heavy dinners that make sleeping difficult or uncomfortable. Keep evening meals simple and easy to eat. • Eliminate caffeine and alcohol, especially late in the day. • Make outdoor physical activity and exercise part of your loved one’s everyday routine. • Keep daytime naps short, and earlier rather than later in the day. WHEN TO SEE A DOCTOR “While many sundowning symptoms can be successfully treated without medication, it’s important to remember that some symptoms also identify with other conditions that might require medical treatment,” says Michelle Straughn from YourLife™ of Tallahassee. “If nonpharmacological interventions aren’t working, or if several symptoms are present at once, a doctor’s visit is recommended.” For more tips on how to soothe your loved one and keep them safe when the sun goes down, call YourLifeTM of Tallahassee’s life enrichment team at 850-250-5671. --- Inspired ● Engaged ● Fulfilled If someone you love is living with memory loss, you want the very best for them. You’ll find it at YourLife™ of Tallahassee. Because Memory Care is all that we do, we have the unique ability to focus all our energy, attention and resources into creating an environment that caters to each resident’s needs, preferences and abilities while providing unequaled peace of mind and support for families. We see each resident as an individual because we understand that each resident has their own story. Using this idea, we develop personally inspired care plans that value and support each person’s independence while creating beautiful days. No matter how much care they need, our team of attentive, caring YourLife™ Personal Care Specialists can provide assistance with all activities of daily living while providing reminders, guidance, support and cues. Even better, residents and their families experience true peace of mind knowing that expert care is on site 24 hours a day, seven days a week. Our personal touch doesn’t stop at our care. In fact, it’s only just the beginning. We create days that leave residents feeling Inspired. Engaged. Fulfilled through our signature programming, YourStory. With individual experiences centered around each resident, engaging outings, services and amenities, activities, dining and more, we create opportunities to learn and pursue new endeavors. At YourLife™ of Tallahassee, everything was designed for you, but it is defined by you, creating a lifestyle that makes every day a joy. Contact us to learn more! Call us at 850-250-5671 for more information or to schedule a virtual visit today.