For most people, the evening is a time to relax. We finish the business of the day and begin to wind down, preparing for a restful night.
But for many individuals with Alzheimer’s disease, the late afternoon and early evening are when symptoms are most pronounced. Individuals become agitated and restless; they are irritable and easily upset. This syndrome is known as Sundowners Syndrome, or Sundowning, and for the individuals who experience it, as well as their caregivers, evening becomes a time of frustration and disorientation, often making it impossible to get a good night’s rest.
Doctors are not certain what precisely is to blame for these changes in the behavior of Alzheimer’s and dementia patients. Some possible explanations are the disease damages the internal clock of the patient, causing a disruption in the wake/sleep cycle, and creating a sense of confusion. Another possible explanation is the changes in lighting create shadows the brain has difficulty identifying. As a result, the individual becomes frightened and disoriented, unable to interpret the changes in their surroundings. Some individuals even seem to have difficulty distinguishing their dreams from reality, which further exacerbates the situation. These changes, combined with the already challenging symptoms of the disease, can be nothing short of exhausting to family members who already are struggling to manage the devastating effects of the illness.
While there is no easy solution to these late day difficulties, families can, with a little extra effort, develop strategies to make this time of day more manageable. For some families, simply sticking to a regular schedule can be helpful. Keeping the individual occupied with pleasant activities during the day can help ensure they are ready for a restful evening. Then, an early supper, a relaxing bath and comfortable pajamas can be gentle reminders that the day is coming to an end and it is time to wind down. Drawing shades and blinds, and turning on lights inside the house before sunset can help avoid the shadows the Alzheimer’s patient’s brain may have difficulty interpreting. Keeping the environment familiar and comfortable can also help; a cozy chair and a little time snuggling with a favorite pet may be just the kind of calming evening activity to help avoid the usual agitation that comes with the day’s end.
Other techniques for managing Sundowning include monitoring the individual’s diet (limiting caffeine and large amounts of sugar during the late hours of the day) and controlling noise (reducing loud activities and television or radio noise in the evening). Of course, not every technique is going to work for every patient, so one may have to rely on trial and error to see what works best. It is a good idea to track behavior by making a list of what seems to trigger certain responses late in the day. Does a day filled with activity seem to help, or are behaviors worse when the patient is unusually tired? Does an afternoon nap tend to make it harder for your loved one to settle down for the evening? Pay close attention to how behaviors change from one day to the next, and what kind of activities lead up to those changes.
Basically, it may simply boil down to coordinating the day’s activities to accommodate the difficulties that come with Sundowning. Engage in most activities and outings early in the day, before the effects of Sundowners begin to manifest, and keep the day’s end free of any over-stimulation.
Be extra patient in the latter part of the day, remembering your loved one is not being difficult deliberately. An extra measure of kindness and understanding can help assure your loved one that they are safe and secure, and set the tone for a peaceful, relaxing evening.
Miller is caregiver coordinator for LTCA of Enid Area Agency on Aging.