A Primer All About Sundowning

Are you caring for a loved one with dementia? You don't have to figure this out all on your own. Welcome to Truth, Lies Alzheimer's, the show that helps you reimagine a new relationship with your loved one, a relationship a little more free of stress and anxiety. Join host Lisa Skinner and her 30+ years of experience as she guides you on a new path to a better relationship with those you care for. Here's Lisa.

Hi everybody, welcome to another brand new episode of The Truth, Lies Alzheimer's Show. I'm Lisa Skinner, your host, and I am bringing you today a new episode that I really think it's time to kind of dive deep into and elaborate on because I know talking to people every day about Alzheimer's disease and dementia, there's a lot, a lot, a lot of confusion surrounding the topic of sundowning. So I'm going to give you a really in-depth description and overview of what it is and what it isn't. Hopefully this will be helpful because I know it's a very confusing topic. So sundowning is a phenomenon that commonly occurs in people with dementia, particularly with Alzheimer's disease, and does involve increased agitation, increased confusion, and restlessness in the late afternoon and evening. That's how it got its name. But that's not entirely the truth. I'm going to elaborate on that part in terms of it hap— it only happens in late afternoon and evening. That is not true. While the exact cause of sundowning is not fully understood, Several factors have been suggested to contribute to this phenomenon. So number one, there could be a disruption of their internal body clock. This, we know this happens. People with dementia may experience disruptions in their circadian rhythms, which regulate the sleep-wake cycle. As a result, they may become more confused and agitated as the day progresses and the evening approaches. And the disruption of their circadian rhythm also contributes to why a lot of people with dementia want to sleep during the day and they're awake all hours of the night. This is a true, this is a true fact. And the reason why is because of the disruption to their circadian rhythm. Fatigue and exhaustion throughout the day. People with dementia may become tired and fatigued, leading to increased confusion and agitation as their cognitive abilities decline. Reduced lighting and shadows. As natural light decreases in the evening, the presence of shadows and changes in lighting conditions can be disorienting for individuals with dementia, leading to increased confusion and agitation. Some people experience hormonal imbalances. And we know that changes in hormone levels, such as increased levels of the stress hormone cortisol in the evening, may contribute to sundowning behaviors. Then there's environmental factors. Factors such as increased noise levels, caregiver shift changes, and disruptions in routine can also contribute to sundowning episodes. Well, those things can happen any time of the day. They're not limited to the afternoon or the evening. This one too, sensory overload. Overstimulation from loud noises, bright lights, or crowded environments can overwhelm individuals with dementia and contribute to increased agitation and confusion, especially in the evening when fatigue levels are higher. But not limited to the evening. It can happen at any time of the day. Unmet needs can trigger the sundowning episode, which includes hunger, thirst, pain, or discomfort, can escalate in the evening when routines may change or caregivers may be less attentive. Addressing these basic needs promptly can help reduce the likelihood of sundowning episodes. They could be having a medication side effect. Certain medications, their timing or changes in dosages can potentially trigger or worsen sundowning symptoms. It's essential to monitor medication effects and discuss any concerns with your loved one's healthcare providers. They could have an infection or an illness. The presence of infections such as a urinary tract infection, a respiratory infection, or other illnesses can exacerbate symptoms of dementia and sundowning. Prompt identification and treatment of underlying health issues are crucial. Exhaustion and overexertion. Can trigger these behaviors. Physical or mental exhaustion from too much activity or exertion during the day can lead to increased confusion and agitation in the evening, but not limited to the evening. Emotional stress, anxiety, or changes in the environment such as moving to a new location or changes in their routine can trigger sundowning episodes. A lack of stimulation. Conversely, lack of mental or physical stimulation during the day can lead to restlessness and agitation in the evening. But of course, it can happen any time of the day. Engaging in calming activities or routines throughout the day may help reduce sundowning symptoms. Contrary to its name— this is where we're getting into this— contrary to its name, sundowning does not always occur precisely at sundown. While sundowning often refers to the increase in confusion Agitation and restlessness that commonly occurs in the late afternoon and evening. The timing and duration of sundowning episodes vary among individuals with dementia. It can begin in the late afternoon around sunset or later in the evening, depending on various factors such as an individual's internal body clock. Their level of fatigue, the environmental stimuli, and their overall health. Some individuals may experience sundowning symptoms consistently at a particular time each day, while others may have more unpredictable patterns of onset. It's important to note that sundowning is a complex and multifaceted phenomenon influenced by So many different factors, and the timing of symptoms do vary from person to person. Caregivers and healthcare providers should observe and track the patterns of the sundowning, of the sundowning episodes in individuals with dementia to better understand and manage these behaviors effectively. Establishing consistent daily routine, creating a calming environment, and addressing potential triggers can help reduce the frequency and the severity of sundowning episodes regardless of the exact time they occur. So we know that person-centered care, which is a holistic approach that focuses on the individual's unique needs, preferences, and abilities, Help manage sundowning in individuals with dementia. Person-centered care solutions aim to address the specific characteristics and triggers of each person to provide personalized care and support. And here are some of the things that you can offer that will be considered person-centered care. You wanna establish a consistent routine, creating a daily routine that aligns with the individual's preferences and habits. For example, when they were in the prime of their life, were they used to taking a shower in the morning? Or maybe when they got home from work, they would take their shower in the evening. So whatever they were accustomed to, you should follow that same pattern. And not try to change it. Consistency in daily activities, in their meal times and bedtime routines, can help promote a sense of security and reduce their anxiety. To reduce confusion, you might try dimming the lighting, use soft bulbs, because this can help create a relaxing environment and may reduce agitation. Encourage physical activity. Engage the individual in light physical activities during the day to reduce restlessness and promote better sleep at night. Outdoor activities and exposure to natural light can also help regulate the sleep-wake cycle. Provide meaningful engagement, and you can do this by offering activities that the individual enjoys and finds meaningful, such as reminiscence therapy, art therapy, and sensory stimulation. Meaningful engagement can help reduce feelings of isolation and boredom, which may contribute to them having sundowning episodes. Creating a calm environment. Is so essential. And you can accomplish this by minimizing noise, minimizing distractions, and minimizing clutter in the environment to create a peaceful and soothing atmosphere. This is very true. Clutter does trigger people's sundowning episodes. Use familiar objects and cues to provide a sense of familiarity and security. And then you always, always, always want to communicate effectively. Well, what does that mean? I'm gonna tell you. Use clear, simple language. Use nonverbal cues to communicate with the individual. Offer reassurance, offer validation. And offer emotional support. All of these things can help reduce anxiety and confusion. So by incorporating person-centered solutions tailored to the individual's preferences, abilities, and triggers, caregivers and healthcare providers can effectively manage sundowning behaviors and improve the overall well-being of individuals with dementia. You can collaborate with the individual, with their family members, and a multidisciplinary care team who can help develop a comprehensive and individualized approach to address sundowning symptoms effectively. One of the things that I recommend is you try to limit sugary foods that— because they are known to affect sleep patterns. And also, you want to promote restful sleep. You can do this by establishing a calming bedtime routine that includes activities like a warm bath, a gentle massage, like a hand massage, or reading to promote relaxation and prepare the individual for sleep. Ensure the sleeping environment is comfortable, quiet, and conducive to restful sleep. Now, keep this one in mind: limit stimulating activities. In the hours leading up to bedtime, avoid activities that may be overstimulating, such as watching intense television programs, or engaging in mentally taxing tasks. Instead, opt for the calming and relaxing activities to help wind down. Offer emotional support. Again, that includes validation and reassurance to individuals experiencing sundowning symptoms. And one of the ways you can do this is acknowledge their feelings and offer comfort. To help reduce their anxiety and distress. Consider incorporating therapeutic interventions such as music therapy is a great one, but not really loud music that'll kind of get them to want to be dancing later, later in the afternoon, in the evening. It should be calming and soft music. In the latter part of the day. Pet therapy is great for relaxation. Aromatherapy, which promotes relaxation and emotional well-being. All these interventions can have a calming effect and help reduce agitation. So I'm going to give you a few specific examples of person-centered and practical strategies to help manage sundowning in individuals with dementia. You can create a customized activity kit for them. You create personalized activity kits tailored to the individual's interests and hobbies. For example, if the person enjoys gardening, assemble a kit with small garden tools, seeds, and plant pots for them to engage in a calming and familiar activity in the evening. Sensory stimulation. I mentioned that before, but I'll give you examples of what that means. You can offer them items like textured blankets, scented lotions, or again, soothing music that the person finds comforting. This can definitely help reduce agitation and create a relaxing environment. There are memory boxes that you can create You fill them with meaningful objects or photographs from the individual's past, and this encourages reminiscence and also storytelling, which can provide a sense of continuity and connection, potentially easing sundowning symptoms. Therapeutic touch— that would be gentle touch such as hand massages or shoulder rubs. This can promote relaxation and emotional well-being. Incorporating therapeutic touch into the evening routine can help the individual unwind and feel comforted. You can go for a structured evening walk, um, which is taking the structured evening walk in a familiar surrounding to provide gentle exercise gentle exercise, and exposure to natural light. This can help regulate the sleep-wake cycle and reduce restlessness in the evening. We talked about this already, but aromatherapy can be hugely beneficial. You use essential oils like lavender or chamomile in a diffuser or as a massage oil to create a calming and soothing atmosphere. Aromatherapy, if you didn't know this, can help promote relaxation and improve the individual's overall well-being. Also, you can help by using visual cues such as clocks or calendars to help orient the individual to the time of day. Play soft, calming music or nature sounds. Those work. In the evenings. Allow them to have creative expression time. Encourage this through art activities like painting, drawing, or coloring. Engaging in creative pursuits can be therapeutic and provide a positive outlet for emotional expression. Tailor your communication strategies to the individual's preferences and abilities. And you can accomplish this by using familiar phrases, gestures, or visual cues to facilitate their understanding of what it is you're trying to communicate, which will reduce frustration during interactions. Encourage the individual to spend time outdoors during the day to receive natural light exposure. We know this can help regulate the sleep-wake cycle and improve mood and cognition. Make sure they stay hydrated. Ensure the individual stay hydrated throughout the day by offering water and other fluids regularly. Dehydration can exacerbate confusion and restlessness, so it is essential to monitor fluid intake. I mentioned this on another one of my shows. That people with dementia don't always even realize that they're thirsty. So if you regularly offer them fluids, they might be more inclined to accept it and drink it than trying to just make that decision on their own, especially if they don't know that they're thirsty. And then promote physical exercise. You can encourage light physical activities during the day, such as stretching, walking, or gentle exercises. Physical exercise can help reduce anxiety, improve sleep quality, and enhance their overall well-being. So hopefully that helps you have a little bit better understanding of what sundowning is. A lot of these symptoms that I discussed that actually were part of the sundowning explanation are very common behaviors that we see with Alzheimer's disease. So a lot of times they are sundowning without you even realizing it. But They are part of the disease. And I think it's important for people to really wrap their heads around that concept instead of maybe mistakenly thinking that they're just trying to be difficult and make your life miserable. No, that's, that's not the case in most situations. So I hope this has been helpful for you today to maybe separate the confusion from the reality of sundowning. I appreciate you being here with me today. I will be bringing you another new episode of the Truth, Lies Alzheimer's show next week. I'll be back. I'm Lisa Skinner, your host. And I look forward to having you here with me next week and as many times as you can in the future. So have a great rest of your week, and I will see you here next time. Bye-bye for now.

Thank you for listening to Truth, Lies Alzheimer's. We hope you found something in today's episode that helps. We understand that caring for a loved one with dementia can be the challenge of a lifetime, but you don't have to do it alone. If you're ready for exclusive access to even more great content and resources, head on over to Facebook and join Lisa Skinner's Minding Dementia support group. We're a community of like-minded caregivers, and we're here to help.