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How to Deal with Sundowning
Categories: Brain Disorders | Posted: 5/22/2013 | Views: 4808

What is Sundowning?

Some people with Alzheimer’s Disease have a cluster of symptoms known as “sundowning.” Basically, sundowning is when a person’s agitation, confusion, neediness, and behavioral symptoms seem to get worse in the late afternoon when the sun is typically setting.

 

Researchers do not yet know for sure what causes this issue – but have noticed that it tends to occur most in the middle stages of the disease progression, it causes a great deal of stress for the person and the caregiver(s), and is correlated with an increased likelihood of night wandering and other sleep disturbances.

Cause

No known cause, but there are two main theories. One is that the part of the brain that regulates our daily sleep and waking rhythms is also impacted by the disease. The evidence for this is that when a person takes a hormone tablet of Melatonin, the symptoms of sundowning tend to improve. Melatonin is a hormone released normally by our bodies to regulate our sleep-awake cycles.

The other theory is that 4-7 tends to be a “witching hour” in many households when dinner needs to be prepared, people are coming home from work hungry and tired, and children come home from school. Some households simply have more variety of mood and increased general activity at this time and this may be difficult for someone who feels confused. Also, the person who has grappled with the confusion of Alzheimer’s Disease all day may be feeling cranky and tired as well.

Symptoms

  • Increased desire for attention
  • Restless or anxious
  • More confused
  • Angry outbursts or increased signs of frustration
  • Tends to occur after 4pm
  • Associated with night wandering and other sleep disturbances

How to Deal with Sundowning

  1. Limit the noise and activity level of the household during this time if possible by adjusting meal time, keeping the person in one location on a simple task or to watch a favorite show in another room if there is a lot of chaos at that time. Some people take turns taking the person for a walk at that time or also decide it is better to order out food or make other such changes to make this “witching hour” less stressful.
  2. Offer reassurance and comfort in your tone to the person. While you may be also feeling stressed at this time, any angry tone or sign of your impatience is only likely to make the person more agitated.
  3. Make sure the person is getting outside daily – particularly in the AM –for sunlight. This tends to help our bodies adjust to the time of the day. Also, limit caffeine intake to morning – and discourage naps in the afternoon.
  4. Talk to your doctor about anything he can check to ensure the person is sleeping well through the night. While this may include medication, it can also include checking for bladder problems waking the person at night, side effects of the medications they are already taking and potentially rescheduling these to ensure better sleep, etc.
  5. Some people believe that Melatonin improves symptoms, but no formal studies have been done yet. Although this is an over-the-counter supplement, you should contact your loved one’s doctor before giving a person this hormone as it could potentially interact dangerously with other medications that he or she may be taking. When and how much of this supplement to take should also be decided by a physician as many things impact older patients differently than what is recommended on the label of such products. Generally, other types of sleeping aids you can buy over the counter are not recommended for this problem.Make sure the person gets enough exercise and activity throughout the day. This may improve the quality of sleep at night.

While you cannot entirely prevent sundowning symptoms, some of these tips may help ease the severity.

 

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