by Wendy Pester~
As the dog days of summer begin to wane, and we look forward to the beautiful colors of foliage and crisp autumn nights, many who care for a loved one struggling with dementia (such as Alzheimer’s Disease) are not necessarily looking forward to the early sunsets that lie ahead. Dementia patients often suffer from a psychological phenomenon known as Sundowning Syndrome and the fall and winter months don’t lend well to this syndrome.
Those afflicted with Alzheimer’s (and other forms of dementia) will experience Sundowning during the hours prior to their normal bedtime. Symptoms can begin as early as 3:00 p.m. and last through the evening, causing a disruption in sleep. In most individuals Sundowning is more prevalent during the mid-stage of Alzheimer’s, and may begin to diminish as the disease progresses to the late stage.
If caring for someone with a dementia who exhibits increased confusion, paranoia, anxiety, agitation, and pacing, wandering and verbal or physical combativeness during the late afternoon and early evening, they are most likely going through their Sundowning phase. However, it should be noted that a urinary tract infection can also be at the root of these behaviors, or exacerbate behaviors. Once a UTI is treated with antibiotics, the exacerbated behaviors will subside.
“She’s stealing my panties” Those suffering the paranoia associated with dementia and Sundowning are convinced others are stealing their belongings and will hide what they perceive as important objects, including money. A few years back while working with a client suffering severe Sundowning I was on the receiving end of multiple punches and stomps, not to mention the barrage of foul language. Lucy (not her real name) insisted someone was breaking into the apartment late at night to steal her undergarments. Nightly, Lucy would barricade her door with chairs, a trashcan and tea cart to prevent the thief from entering while she slept. Unfortunately, Lucy rarely slept because the Sundowning phase triggered such agitation causing her to pace, curse and cry for hours. She only felt safe when I would sit holding her hand and gently rubbing her forehead. These symptoms are not only overwhelming for us, but just as upsetting for the individual suffering with dementia.
What can you do to help ease the situation? If possible, try to establish a consistent daily routine and consistent sleep schedule. In the late afternoon keep the room(s) brightly lit, play soft music, preferably some of your loved one’s old favorites. It’s best to play a CD or TV music channel as opposed to a radio station because the interruption of commercials or DJs will break the calm. If you can increase daily activities and exercise this may prompt an earlier bedtime. Be sure that nap time is regular and monitor that naps are not much more than an hour, don’t allow napping too late in the afternoon. Decrease the amount of afternoon caffeine consumption; this includes coffee, tea, chocolate and soda. Use gentle, therapeutic touch to help reduce anxiety (gently rub the back of the neck, shoulders or hand). Using the Validation/Therapeutic Fibbing/Redirecting technique is often successful. Assess the environment, could they be hungry? thirsty? hot? cold? in pain? have heartburn? gas? need to be toileted? Those suffering with dementia cannot communicate what is wrong so instead they may pace, repeat “I want to go home” fidget with their hands or an object, become aggressive or agitated. By pinpointing the trigger of the behavior, we can address the issues and help return calm to the situation. There are medications that can help with the anxiety and agitation, so speak with your loved one’s doctor about these behaviors, there’s no need for either of you to suffer unnecessarily. More importantly, try to remain calm. Those suffering with dementia have no control over their words or actions. We need to help them over the humps by being supportive, calm and understanding. We need to remind ourselves constantly, it’s the disease and he/she has no control over their behaviors. And, for your own well-being, seek out a local Alzheimer’s Support Group.