Can We Stop Mom Sundowning?
By Frena Gray-Davidson
It’s called sundowning because, traditionally it tends to begin around sunset. It’s the agitation time, which affects many who have dementia. It typically continues for a couple of hours and then may pass. It is most likely to start in late afternoon, although some people begin earlier and others reported as starting in the morning.
That’s untypical. It’s also untypical that someone begins agitated behavior in late afternoon and then continues all night long, but it happens. Whether that should really be called sundowning is something for a medical expert to decide. If I were a caregiver to someone with dementia whose behavior included agitation all night long, I’d be getting the help of a good psychiatrist.
Families tend to attribute everything to Alzheimer’s dementia, whether it is or not. You have other conditions as well. You could have Post Traumatic Stress Syndrome and Alzheimer’s. You could have flashbacks and Alzheimer’s. So it’s very important not to blame everything on the dementia.
Sundowning needs a multi-faceted approach because we don’t know exactly what causes it. We can make good guesses though.
Five Possible Causes of Sundowning:
1. Fatigue
2. Hunger
3. Dehydration
4. Disorientation
5. Loss of purpose, belonging and sense of security
In my 20 years of working with people with dementia, Alzheimer’s and other dementias, I’ve learned that we can make affective care plans for sundowning. Each plan is particular to each person, but every plan should include some or all of the following.
The Sundowning Care Plan:
1. Study the typical pattern of your person’s sundowning
2. To decrease fatigue overall, encourage sleeping later and having a nap after lunch, if possible
3. Give a nutritious snack of, for example, banana bread and a sliced apple about an hour before normal sundowning time
4. At the same time, give a natural juice drink and plenty of water
5. Listen attentively to the feelings expressed by your person during time of agitation to learn what emotional issues are unresolved
6. Remember that, in sundowning, this person expresses real issues with which we can help
7. Plan for diversion at the expected sundowning time and increase emotional support
8. Use environmental support — music they love, lavender oil diffused into into the air (notably effective in reducing emotional stress responses)
9. Understand that agitation can be contagious and that your best contribution is to stay calm
I have been able to recommend this approach to care units, which have found very positive responses from the plan. I and many other family members have found it very affective at home.
It is definitely possible to reduce sundowning time and intensity and even to eliminate it altogether. While you’re working on those results, remember anyway that sundowning tends to reduce and eventually disappear as dementia progresses.
As a caregiver, not as a doctor, I can assure you that we can do a great deal to help as caregivers. However, not all caregivers can do this and that’s okay too. Caregivers can only do what they can do. We are all human and it is out of our humanity that family caregivers undertake the heavy task of caring for a family member with dementia needs.
One last suggestion: it is not usual that sundowning involves violent acting out or extravagant fear reactions. Such manifestations suggest a deeper psychiatric issue. Please don’t hesitate to see mental health specialists if you have questions.
Frena Gray-Davidson is a longterm Alzheimer’s caregiver and her latest book is “Alzheimer’s 911: Hope, Help and Healing for Caregivers”, available from Amazon. Frena presents dementia seminars nationally and internationally. Go to her website at www.alzguide.com and sign up for her free monthly online newsletter for caregivers. Email her at frenagd@gmail.com
For information about care and assistance for a loved one in the Santee CA area, visit www.inhomecaresandiego.com.
Original: Always Best Care Senior Services – San Diego California (CA)