Do you know someone with Alzheimer’s disease or dementia that is complaining of sleep issues or nighttime restlessness? Have you noticed behavioral changes beginning at dusk that seem to last into the night? This person may be experiencing a condition known as sundowning. The term “sundowning” refers to a state of confusion at the end of the day and into the night. Sundowning has been known to cause a variety of behaviors, including confusion, aggression or a tendency to ignore direction. Wandering and pacing are also common symptoms that may occur.

Although scientists don’t fully understand why, studies show that up to 20% of persons with Alzheimer’s disease or dementia experience sleep changes and a mixed-up internal body clock. This seems to happen, along with changes in memory and behavior, as a result of the impact of Alzheimer’s on the brain. Sundowning is not a disease, but rather a variety of symptoms that tend to occur later in the day.

Factors that may aggravate sundowning symptoms include:

• Fatigue (both mental and physical)
• Low, or reduced, lighting
• Increased shadows
• Disrupted routine

Through their experience in caring for persons with Alzheimer’s or dementia, the caregivers at First Nations Home Health have found some tips to help reduce the evening agitation:

• Plan more active days - take a walk or engage in other physical activity.
• Restrict caffeine consumption to the morning hours.
• Reduce the background noise and stimulating activity, including TV viewing, in the evening.
• Keep distractions to a minimum.
• Limit activities during the late afternoon and early evening to those that are simple and relaxing.
• If pacing or wandering occurs don’t use physical restraint. Instead, allow the pacing to continue with your supervision. Interfering with this may cause an outburst or aggression.

If you have a family member or are caring for someone experiencing sundowning, it is helpful to document routines and look for patterns. Is it happening only at certain times of the day or when certain people are around? Do certain events trigger the symptoms? If you are able to recognize the ‘trigger’ you may be able to reduce the frequency of occurrences. Also, maintaining a regular schedule of meals, waking and bedtime routines is one of the most common coping strategies for sleep issues and sundowning and will allow for a more restful sleep at night.

Dr. Verna Benner Carson, President of C&V Senior Care Specialists, Inc. and a board certified clinical nurse specialist in psychiatric mental health nursing, recognizes the importance of knowing the person’s story or history. “This greatly assists the caregivers to provide meaningful activities that draw on old memories”, she said. Dr. Carson also believes that patience and flexibility are two of the most important qualities that a caregiver can possess, allowing the caregiver to work with the patient to provide calming situations and reduce any frustration or agitation. “Repetition which can drive caregivers to respond with irritation and anger can be easily redirected into repetitive activities such as folding laundry for women or sorting nuts, bolts, and screws for men”, she suggests.

Caring for a loved one with Alzheimer’s disease or other dementias can be very difficult. One great resource available is the Alzheimer's Speaks website. Founder Lori La Bey's goal is to shift the dementia care culture from crisis to comfort around the world by changing how we give and receive care.  Lori views the globe as one large cradle which is here to nurture those in need, as life ebbs and flows through the stages of aging. Lori, and Alzheimer's Speaks, hosts a variety of memory & Alzheimer's cafes, dementia chat webinars, and even a radio show to help those with dementia struggles and those who care for them.

First Nations Home Health understands how overwhelming and difficult it can be to care for a loved one with Alzheimer's or dementia and offers a comprehensive and effective Alzheimer’s and dementia home care program in our Alzheimer’s Whisperer program. This care program is a unique and effective approach to support those affected by Alzheimer’s disease and other dementias and their family. For additional information on dementias and caregiving, visit our website at www.firstnationshomehealth.com.