Understanding sundowning
SUNDOWNING IS a set of dementia-related behaviours that occur at a similar period each day, most commonly around sunset, and which can last late into the night. The person may appear more agitated, anxious or fearful; they may become repetitive in their speech and/ or activities, or become aggressive, suspicious or demanding. They may appear to see, hear, or smell things that aren’t really there but may be very upsetting.
WHY DOES IT HAPPEN?
Although a great deal is still unknown about sundowning, one cause may be the disruption to one’s circadian rhythm, particularly in the winter months when we have less access to natural light.
The timing may be significant — such as a memory of exhaustion at the end of the day, or perhaps this was when they collected their children from school. It can be helpful to acknowledge this part of the person’s earlier life.
In some cases, the person may be communicating a basic need that hasn’t been met, such as pain, discomfort, toileting, cleanliness, hunger or thirst and these should be addressed in the first instance. It can be helpful to keep a diary of potential triggers.
WHAT CAN YOU DO?
Don’t argue — patience is key; raised voices or denial of the person’s truth can intensify the situation and they are less likely to follow your advice. Where wandering is an issue, if gentle persuasion is not working, it can help to leave the home and re-enter it.
Routine — A predictable daily routine may give the person with dementia a sense of purpose in, and control of, their life. Avoid challenging tasks in the evenings, but rather engage them in meaningful activities, such as listening to music, dancing, or looking at old photos. A phone call or recorded message from a loved one can be useful in helping them feel safe.
Don’t over-do it — too many activities can cause exhaustion, and daytime napping can be detrimental to a good night’s sleep.
Sunlight exposure each day can increase good mood and improve sleep.
If a person is repeatedly checking on switches and locks, it may help to have a list the person could tick off as they go, to reinforce the feeling of completion.
Set the scene — As daylight fades, switching on lights will help reduce disorientation and lessen disturbing shadows, which are often mistaken for
people. Make the bedroom or living space cosy and welcoming. The aroma of lavender or lemon balm can create a relaxing environment, as would soothing music.
A warm drink and a light snack can eliminate hunger and help the body to slow down.
Sensory issues — poor vision can cause a person to misinterpret what they see triggering anxiety and confusion.
There are many items on the market specifically created for people living with dementia, that can help to lessen their anxiety and agitation:
Hug by Laugh is a teddy with weighted arms and a music player in its tummy to play a favourite song or simulate a beating heart to reduce anxiety.
Twiddle muffs or fidget blankets are handmade sensory aids for keeping fidgety fingers occupied.
Fidget Widget tools allow the person to replicate a familiar action such as turning on a tap.
A full-spectrum lamp can replicate daylight.
SAFETY MEASURES
If you are concerned that the person will wander outside during the night, there are safety measures available that do not impact on their sense of independence, such as door sensors, baby monitors, sensor mats or trackers. A bracelet with name and a number can help identify the person if they become lost; there are dementia-specific ones on the market, but an engraved bracelet works too.
FINAL THOUGHTS
At PillarCare, we are familiar with the challenges for both the person affected by dementia and those around them. We promote positive risk where possible, working closely with all concerned to ensure independence and quality of life are maximised while offering professional support, empathy and our expertise in specialist dementia care.