Fall and Sundowning

From The Family Caregiver Newsletter

Fall and Sundowning 

“My Mom has dementia and I am bracing myself for her increasing anxiety and pacing through the house as the days get shorter and shorter. I think it is called Sundowning.” 
What can I do to reduce my Mom’s anxiety and my frustration?” 

Before we go to problem solving for Sundowning, we need to ask whether your Mom might have an infection.  Rule out a urinary tract infection, which is common in dementia, especially in women.  Has she been drinking enough water or juice?  Rule out dehydration. The urge to drink diminishes with dementia and dramatically affects mood and orientation.  Both infections and dehydration may look like Sundowning and can occur at the same time.   
Given the history of anxiety and pacing as the days get shorter, you should consider Sundowning, especially with a seasonal component.  Sundowning is marked by a state of confusion at the end of the day and into the night with possible increases in challenging behaviors.  Sundowning is, in part, the profound difficulty of a brain with dementia to convert melatonin to serotonin (night time brain chemicals to daytime brain chemicals). 

Most dementia experts and experienced caregivers suggest Sundowning can be helped by maintaining a predictable routine for the person with dementia, from the time they wake until bedtime.  Keep meals and naps on the same schedule.  In the evening, keep background noise and activities, such as TV, to a minimum.  Reducing environmental stimulation in the evening helps the person with dementia when they have the least amount of brain energy to navigate their environment. 
The following steps may provide additional help with someone with dementia who is showing signs of Sundowning: 
1. In midafternoon close the blinds and turn on the indoor lights.  The decreasing outside natural light triggers the brain to begin making melatonin (sleeping brain chemical) and also decreases the person’s serotonin (daytime brain chemical).  No wonder they get anxious and pace. They are losing important brain chemicals used to manage daytime activities.  
2. In late afternoon and early evening turn on more lights, perhaps more than you usually use. Some research suggests the extra light keeps their serotonin in active, daytime levels, which are required to interact, express their needs and to do their best.  
3. One hour before bed start turning off the lights.  Their brain will begin converting their serotonin into melatonin which will give them their best chance of sleeping.   

Please consider using timers to turn on and off the lights. You have enough to do, and this is a task you can delegate to a $10 gadget.  When the lights come on in the afternoon it can be your reminder to close the drapes. 

Here is one more technique using soft light and timers to help with Sundowning:   

4. During the dark days of winter set timers to turn on soft lighting when your care receiver would usually wake up. The early light helps their body turn the melatonin (sleeping brain chemicals) into serotonin (awake brain chemicals).  The extra light gives the person with dementia an extra boost of brain chemicals even before they get out of bed. 

Sundowning, like all challenging dementia behaviors, requires professional help.  Seek help.  Find a support group, call the Area Agency on Aging, or talk to your primary care practitioner.   

This article is a service of the Family Caregiver Support Program at the Lewis-Mason-Thurston Area Agency on Aging.  Call (360) 664-2168 or go on-line (www.lmtaaa.org) for more information about how our program can help unpaid family caregivers. 

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