Posted on Mar 4, 2020 in Alzheimers
As dementia becomes more advanced, behavior changes that are not easily understood often manifest and can be the result of a phenomenon known as sundowning.
These changes can be distressing both for the person suffering with Alzheimer’s and their loved ones.
Behavior changes can occur when the person is distressed, anxious, or trying to communicate their needs in some way. By identifying and understanding those needs, it’s possible to reduce symptoms of distress.
What happens if these behavior changes are caused by sundowning, though?
First, a quick definition…
Sundowning refers to the behavior changes that people suffering with Alzheimer’s have in late afternoon or early evening. Someone with more advanced Alzheimer’s might become confused, agitated and restless.
Someone who is sundowning may be upset and anxious, confused, disorientated, and suspicious of others. They often become demanding of those around them.
Sundowning symptoms become worse in autumn and winter when the light is low.
Someone who is sundowning might start shouting and screaming, become physically aggressive, start pacing, wandering, hallucinating, chattering to themselves, moving objects and furniture, and ignoring directions.
Another symptom of sundowning is an inability to sleep. A person displaying signs of sundowning may wake up and start immediately pacing around.
Although sundowning is not fully understood, it is thought to be caused by the change in lighting and increase in shadows. People with Alzheimer’s can hallucinate or find themselves visually impaired so they may find this distressing.
Another hypothesis is that changing melatonin levels causes a change in circadian rhythms. Your circadian rhythm, or sleep/wake cycle is your internal biological clock. This runs through cycles over 24 hours. Most people experience a lull in energy during the afternoon, just after lunchtime, and in the middle of the night between 2am and 4am. This is the natural cycle of circadian rhythm.
The National Institute of Aging recommends listening to your loved one and trying to determine if any needs are going unmet.
Some people when sundowning display behaviors that indicate that they need the bathroom. If you know the person well, you’ll soon become familiar with the signs. For example, someone may become aggressive and tense when they need the bathroom. Someone else might become verbally aggressive toward others if they are in pain. Their shoes might be too tight or maybe something is irritating them. Specifics vary so be patient and proactive.
You could also try calmly reassuring your loved one that you are there and that they are perfectly safe. You can sometimes placate a distressed person by engaging them in mindfulness techniques. Sit on a chair in front of them and hold their hand. Ask them to close their eyes and take some deep breaths. Breathe with them and count them through the breaths. Sometimes, you might find they will slip into a state of relaxation and even fall asleep. This method doesn’t always work but is worth trying.
You could also try other distraction techniques such as:
To help prevent or minimize sundowning, encourage your loved one to exercise and engage in fulfilling activities during the day. This will put them in a more positive frame of mind while increasing the chance of a sound sleep. If they slump in a chair all day with no interaction, they are much more likely to develop anxiety and, subsequently, sundowning.
As a person develops dementia, they can start living primarily in the past. For example, a man who used to go river fishing might see kingfishers flying through the room, or someone who played the clarinet professionally may think he is performing in concert. Be prepared for this behavior.
Unfortunately, many people have suffered trauma in their lives. They might have fought in the war or lost a child. Rogue events and circumstance can strike at any stage. If you are aware of their past traumas, you can get clues about what could trigger anxiety. If you find your loved one reliving painful experiences, try acting the role of a kind friend who understands what’s happening to them. Even if what they say doesn’t make sense, knowing what to say can placate them. Go along with the experience. Nudge them toward recalling happier memories.
Make your loved one feel as comfortable and safe as possible. Just as dusk draws in, pull the curtains and put the lights on to minimize long shadows. Keep them engaged with activities they enjoy. Perhaps you could give them a bath and then settle them down with a cup of hot tea, ready for bed. Avoid giving them alcohol or coffee in the afternoon as this can impair sleep.
Perhaps your loved one is suffering with dementia to the extent they would benefit from moving to a memory care facility. If so, we can help at Landmark Senior Living. We have four locations that offer dementia care, including our memory care facility in new mexico.
Whether you’re worried about sundowning or any other aspect of aging, contact us today and one of our friendly team will be delighted to help out.