Dementia care consultant Christy Turner offers guidance on how to deal with sundowning.
A better tomorrow starts with a good night’s sleep. This is one of most commonly ‘prescribed’ health recommendations, but is inherently vague in meaning. What exactly does a good night’s sleep mean? According to the National Sleep Foundation, these are the four components: 1) Taking 30 minute or less to fall asleep; 2) Only waking up once per night; 3) If you do wake up in the middle of the night, you fall back asleep within 20 minutes; 4) You’re asleep for at least 85 percent of the time you spend in bed. But, these criteria aren’t always easy to satisfy — especially not for those living with dementia. Not only do people with neurodegenerative diseases have to cope with the disturbed sleep that is associated with aging — they often are also contending with syndromes like sundowning.
Sundowning refers to the worsening of behavioral and emotional issues among dementia patients as daylight begins to fade. Seasonal changes can influence sleep schedules and depression, particularly among people with dementia. Researchers believe the syndrome is triggered by a disruption of circadian rhythms – a person’s internal biological clock – which regulates the sleep-wake cycle. Mood disorders are often a consequence of disrupted circadian rhythms, as seen in people with jetlag, those working overnight shifts, or when we transition from Daylight Saving Time back to Standard Time.
Dementia care expert Christy Turner told Being Patient that “our body uses environmental cues like the sun to identify what time of day it is and what we should be doing. Almost nobody feels great after Daylight Saving Time stops anyway, and when you add a neurodegenerative disorder on top of that, it’s even more challenging for the person.”
Sundowning is a collection of symptoms – including agitation, confusion and irritability – that can range from mild to severe. “It’s commonly referred to as a meltdown, where it’s this mounting frustration that just bubbles over. People might become so frustrated that they’re throwing things or maybe grabbing at their hair. Some people do have a problem with hallucinations or sometimes delusions that are distressful,” Turner explained.
She says keeping as much daylight as possible in the house is a great way to keep your biological clock in check. If you don’t live in a particularly bright location, you can buy lightbulbs that mimic daylight, avoiding fluorescent lights frequently used in offices. Another strategy is sticking to a consistent schedule, especially as it gets later in the day.
“The witching hour is typically right around dinner time, so that period right before dinner time, around 3:30 p.m. or so, and on from there is when it can start,” Turner said. “What will often happen is that caretakers want to start cooking dinner and the person with dementia is sort of left to their own devices.”
Instead of giving them space during this time, she recommends engaging the patient with activities that can help keep them on track, all while giving them a sense of purpose. Engaging someone with dementia with things they enjoy throughout the day will also prepare their body for a good night’s sleep, she said. Think about it: How well do you sleep after a boring day without much cognitive or physical exertion?
Oftentimes, Turner added, sundowning can lead to pacing and emotional meltdowns. In these instances, ensuring the person’s safety is the top priority. Once the caretaker sees they are not in harm’s way, Turner recommends supervising from a distance, giving the person space as opposed to confronting them head-on, which could escalate their anger.
“Keeping people as independent and active as possible for as long as possible is really important,” Turner said. She suggested, for example, taking long walks with the dog or going to the park. “Expending that energy helps them get to that place later in the evening where they’re ready to go to bed.”
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