“Sundowning” is a state of increased agitation, activity and negative behaviors, which can happen late in the day through the evening hours. It used to be thought that Sundowning was caused by the lowering light and shorter days. However, research now indicates that being overly tired may have more to do with Sundowning. Here are some suggestions on how to minimize the negative behaviors associated with Sundowning:

1)
Make sure that your Loved One is well rested: I know that this is easier said than done. It does help though if you can get your Loved One to take a nap just before their normal period of Sundowning. If they cannot or will not nap, an hour quiet time (reduced stimulation and activity) will work. Turn off the TV, turn on some soft music and then sit and do a quiet activity such as painting or sketching. Sit and talk quietly with you loved one for an hour as it can help to make them relaxed.

2)
Limit outings and activities to the morning hours: Generally the individual with Alzheimer’s disease is better able to tolerate outings, activities and increased stimulus during the earlier part of the day. Plan your trips to the grocery store, involvement with kids, visits to day care and so forth during the earlier part of the day. This should be followed with a time of decreased stimulus and quiet time to allow your Loved One to wind down and relax.

3)
Decrease the length and amount of stimulus: Even during the earlier part of the day the individual with Alzheimer’s disease can only tolerate so much stimulation and commotion. Take steps to eliminate over-stimulation such as television, children, and any noise making item, quick movements and many things going on at one time. Sometimes excessive stimulation cannot be avoided. When that happens, allow your Loved One to have a quiet area to retreat to.

4)
Identify and minimize physical discomfort: Other types of physical discomfort can also play a part in Sundowning. Hunger; being wet or soiled, feeling cold/hot and other sources of discomfort can increase agitation, especially in the late afternoon and early evening. Light snacking during the day can be helpful. Apples and other fruits can help replace lost energy – even if your Loved One is pacing back and forth, that does not mean they have an endless supply of energy. Make sure that your Loved One’s personal needs are attended to and that the climate is at a comfortable level.

5)
Identify and treat medical ailments: Many ailments can contribute to Sundowning and agitation. Arthritis can be one of the most common causes. An over-the-counter painkiller as recommended by your Loved One’s physician before the time of Sundowning might be of great benefit. Urinary Tract Infections, flu / colds, asthma, allergies and other conditions are all medical ailments that can contribute to Sundowning. It is always a good idea that when your Loved One first begins to exhibit Sundowning or when Sundowning becomes common to take them to the doctor to make sure that there is nothing ailing them.

6)
Be observant to possible causes: Many times there are triggers to agitation leading to Sundowning. I now find that the noise from a hand phone tone can affect me more when I’m Sundowning so It’s best to set the phone to just a vibrate mode. Provide your children with a separate area to play as quietly as possible. Mirrors can also become a trigger as well due to light reflections. Watching to see what is going on, what events are happening and who is present prior to Sundowning can help reveal some causes (and solutions).

Sometimes no matter what we do Sundowning will happen. If we cannot prevent it we can help lessen it or at least make it less unpleasant for our Loved Ones and those around them.

7)
Provide a private “time out” space for your Loved One:

8)
Keep the house as quiet as possible to avoid aggressive Sundowning episodes, turn off unneeded lights, turn off the TV/radios and either go to a quiet corner or go and sit outside for a moment but always be close at hand.

9)
Check with the doctor: If Sundowning is particularly troublesome; you may need some extra help with prescription medication. Talk with the doctor to let him know of the behaviors, time of day and how you’re Loved One is behaving before Sundowning. He may be able to help you by prescribing a medication to help ease the symptoms.

Medication is a last resort and may take several attempts with different drugs and doses to find the right one that will work for your Loved One.

If medication does not help, do not become discouraged, relay the information to the doctor and he may either adjust the dosing or change the medication.

10)
Keep things simple: Keep the surroundings as simple as possible. Be sure your Loved One’s walking paths are clear from clutter and obstacles. Low furniture such as coffee tables and footstools can make it difficult for your Loved One and become a source of frustration. Keep knickknacks to a minimum and the tops of tables, television shelves and other surfaces as clear as possible.

Mirrors and pictures can often become unfriendly visitors that the individual with Alzheimer’s disease cannot understand. Complicated, noisy appliances are also frustrating to them.

Avoid changing things once you have things simplified since changes of any kind can be extremely frustrating for someone who has dementia.

Barry Pankhurst ©

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