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Chapter 6

Strategies for Dealing with Sundowners Syndrome (aka Sundowning) in Seniors

You are awoken at 2:00 a.m. by the hallway light shining underneath your bedroom door and the sound of shuffling feet.

“Not again …”, you grumble. Your father is standing outside your bedroom door looking confused. “Dad? Where are you going?” you ask. Your father looks blankly, mutters something, and waves you off.

Dad has Sundowners syndrome (aka sundowning or sundown syndrome). He can’t tell the difference between day and night, nor understand, “Dad, it’s 2:00 a.m. and you should get some sleep!

What to do When Someone is Awake All Night with Sundowners Syndrome

sleep mask

Here are 12 tactics to try tonight if your mom or dad is up all night from dementia-related Sundowners:

  1. Turn on some familiar, calming music. Soothing low-tempo music from your parent’s younger days can sometimes help and online playlists are easy to find.
  2. Massage. A slow hand massage, foot massage, gentle head rub or back rub can be soothing. Warm some lotion between your palms and then give a light-pressure massage.
  3. Aromatherapy. Mix a little lavender oil with lotion or body oil (do not use straight from the bottle) and apply to the person’s temple or wrist. Avoid putting it on their fingers, as this can burn if they touch their eyes. Even a familiar perfume or cologne can help.
  4. Offer some Melatonin. If you have this “jet lag” remedy in your medicine cabinet and it’s early in the night, give a moderate dose (0.3 to 1.0 mg). Melatonin is safe to use, however typical “drug store” dosages are very high so you can cut it in half or a third to get under 1.0 mg. Ideally, you want to offer melatonin 2 hours before bed time.
  5. Do NOT give antihistamines and nighttime medicines. Over the counter drugs like Benadryl, Tylenol PM or NyQuil are known to accelerate cognitive decline, which will make sundowning worse. They will also make your parent woozy and more likely to fall.
  6. Cool the room. Lowering the bedroom’s temperature below 70 degrees can help your parent return to sleep. A cooler room may allow you to add another blanket, since the weight of a blanket can help people feel calm.
  7. Distract. Any distraction may be just what a person with Sundowners syndrome needs to forget about wandering through the house and then directing them back to bed. Pets can make for marvelous distractions as they never judge or question a person for still being awake at 2:00 a.m.
  8. Dim bright lights. Bright lights can play havoc with a person’s internal body clock. When it begins to get dark inside or outside, this can be a signal for a person to prepare for going to bed. If the lights are turned up, their body typically responds to believing that it is still daytime.
  9. Stay calm. Although you’ve been woken up for the fifth time, it’s important to stay calm. If you are on-edge, the person with Sundowners syndrome may mirror you and become on-edge as well.
  10. Avoid arguing. If your parent believes something is true, even when it’s not, there will be no point trying to convince them of anything different.
  11. Offer food or water. They could be legitimately hungry or thirsty. Perhaps a trip to the bathroom is required? Afterwards, steer Mom or Dad gently back to bed.
  12. Check for pain. Ask your parent or spouse if they feel any pain and to point out the area where the pain exists. It’s also quite easy to look at their facial expressions and posture. Both of these tips can help indicate if a person is hurt.
  13. Be reassuring. Mom or Dad may need to hear that everything is okay. Offer a soothing hug. If they need to pace, don’t try to stop them. Instead, just stand by and be ready to intervene only if necessary.

Read: Why Sleep is a Dementia Caregiver’s Secret Weapon

grandpa coloring with granddaughter

How to Prevent or Reduce Sundowners Syndrome

  1. Keep dinner light. Limit the amount of heavy foods and portion serving sizes at dinner. Adjust mealtimes to allow ample time to digest fully before bed time. Reduce or completely remove caffeinated drinks.
  2. Keep the person busy. Give your mom or dad a job to do. Assign any harder, more challenging work earlier in the day and then lighten the workload towards the evening. Try asking your parent to fold washcloths or to do an activity with a grandchild.
  3. Simplify surroundings. Consider everything in mom or dad’s room. What purpose does each item have? Donate or discard the unused extra chair or the dresser. Remove any mirrors, as your parent may not recognize their own reflection and become startled by an “intruder.”
  4. Keep things quiet. A peaceful environment is more conducive to helping someone fall asleep and stay asleep. Ideally, you will be going to bed at the same time your loved one does. However, if this is not the case, excuse any visitors, wear headphones to listen to the stereo, and limit any banging around. Reduce the amount of noise in the bedroom. Is your parent’s room facing a street with constant traffic flow? Perhaps the room is directly beside a noisy child’s bedroom. Do whatever you can to make their bedroom comfortable, calm and quiet.
  5. Stick to a schedule. Create a daily routine for what time meals are served, activities are planned, and bedtime occurs to help reduce Sundowners syndrome.
  6. Eliminate naps or take shorter naps. If a person is awake throughout the night, that person will be tired throughout the day. Naps may become necessary, however, try to keep naps short, perhaps to a half-hour or an hour.
  7. Limit sugar and caffeine intake. Candies may be tempting but hide the bowl away in the evening. Similarly, restrict the amount of caffeinated and alcoholic beverages consumed.
  8. Discourage strenuous activity or watching TV before bed. Exercise is better done during the day, rather than just prior to bed time. Action movies can get the heart racing and the evening news can be disturbing. To help discourage the temptation of tuning in while the senior is in bed, remove the television from their bedroom. Offer the option of a family video instead. Keep a good collection on-hand to choose from.
  9. Focus on safety. Install baby gates at the top or the base of staircases to protect a senior from falling down (or falling up) the stairs. Block entry into the kitchen with another baby gate. This will keep your loved one away from the stove and sharp utensils. Install a lock on the senior’s window(s). Replace or add new lighting along chosen wandering routes (even with a motion detector or nightlights).
  10. Declutter. People living in messy environments can experience heightened stress. If this is the case for your loved one, clean up his or her room. Organize items onto shelves, fold or hang clothing, close closet doors to “hide” the contents, and simplify the décor. You might consider painting the bedroom walls a more neutral color. Try taking a few minutes to make the bed before the senior retires for the night. A freshly-made bed will be far more welcoming and calming than a bed with blankets strewn over the top of it.
  11. See the doctor and check drug interactions. A doctor can do a complete medical check-up to diagnose any problems and advise on current medications to see if any are causing sleeplessness. Caregivers should keep a list of medications their care partner is taking and their dosage. Keep copies of the medical information provided by your pharmacist, which detail potential side effects. If you’re in a rush, use your cell phone’s camera to snap a photo of pill bottle labels and then show these pictures to the doctor.

Instant Download: Medication List

smiling older woman

What are the Signs and Symptoms of Sundowners Syndrome?

Sundowners syndrome can be a tricky thing to put a finger on, as it does not have just one symptom. Any person living with Sundowners will experience or show numerous symptoms. These symptoms will become more obvious and more frequent in the late afternoon or evening.

Milder symptoms can include:

  • Agitation (showing signs of anxiety or nervousness)
  • Increased confusion (appearing lost or bewildered)
  • Anxiety (worrying or becoming fearful)
  • Pacing (wandering throughout the house)

There are also more serious signs and symptoms of Sundowners syndrome. These include:

  • Aggressiveness (striking out verbally or physically at you)
  • Disorientation (being confused even in their familiar surroundings)
  • Mood swings (being calm one minute and being angry the next minute)
  • Making demands (insisting on matters)
  • Hallucinations (seeing things or people that aren’t there)

Seniors can experience sundowners syndrome at all stages of Alzheimer’s. With Alzheimer’s or other dementia cases, sundowning symptoms typically peak at mid-stage dementia and then lessen.

When a person is up and awake overnight, that person will feel more tired, be more irritable, and lose concentration the following day. Those with Sundowners syndrome can be affected in other ways as well, such as:

  • Decreased melatonin production
  • Disruption of circadian rhythms
  • Increased fatigue
  • Increased mood disorders and fluctuations
  • Increased “me-time” and more attention required during the day

What Are the Medical Causes of Sundowners Syndrome?

No one, as of yet, has been able to determine the exact cause(s) for Sundowners syndrome. Findings from researchers show that a person’s brain works differently throughout the day. If you’ve ever found that you have more energy to tackle a project in the morning, you’re not wrong to do so! The brain will typically work best in the morning (following a good night’s sleep). However, it slows down and becomes more tired later.

A tired brain doesn’t always help a person with sundowners fall asleep. As the light dims, people with sundowners syndrome may display more symptoms (e.g. confusion, restlessness, and/or showing repetitive behaviors).

sunset

What Triggers Sundowners or Makes Sundowning Worse?

Several causes have been identified for Sundowners syndrome. Take steps to correct the following:

  • Heightened end-of-the-day activity. What does the early to late evening look like for your loved one? Is he or she still busily occupied or relaxing? Relaxing gives the senior a better chance to wind down. With this said, caregivers will want to encourage some activity since doing nothing after dinner will lead to increased fatigue. Maybe a short walk around the block or a simple game of cards for physical and mental stimulation?
  • Unfamiliar environment. As a rule of thumb, I typically will not sleep very well in a hotel room for the first several nights of a holiday. This is because I’m not comfortable in a strange new room or the bed. Seniors need familiarity as well. Begin by supplying the senior with their regular pajamas or nightgown, and a favorite blanket for the bed.
  • Limited light. As the sun sets each day, the amount of natural light is reduced and shadows appear. If a senior has limited eyesight, these shadows and darkened areas can be more difficult to manage and navigate through. This can increase the stress and agitation levels your loved one exhibits.
  • The colder season comes with shorter, cloudier days. Shorter days with more clouds to block out the sun can confuse a senior’s internal time clock. While chillier winter temperatures can lead to hibernation and restrict outside activity, people need sunlight as it is rich in Vitamin D. A lack of sunlight can lead to Seasonal Affective Disorder (SAD), which may be linked to Sundowners syndrome.
how-to-get-rest-with-sundowners

How to Get Rest When Sundowning is Keeping You Awake

If a senior is up at night due to Sundowners syndrome, family caregivers will tend to the senior’s needs and may not even get a break. However, this becomes a “Catch 22” since family caregivers need their own sleep, space, and time to do something just for themselves. Proper sleep is crucial. Without it, caregivers can continue to be physically and mentally exhausted. A tired body lacks the ability to fight off diseases and infections. A tired mind cannot concentrate or make decisions. Therefore, sleepless caregivers are at a higher health risk. To get more sleep, try these sleep tips:

  • Napping earlier in the day
  • Registering your loved one in a respite program so that you can have some down time
  • Hiring a home care service for backup
  • Asking a reliable friend or relative to fill in for you at night, even for one night a week

We hope these tips for reducing sundowning help.

Learn more about how having a professional caregiver can manage the symptoms of Alzheimer’s and dementia care here: https://homecareassistance.com/alzheimers-dementia-care

Resources

Scientists Pinpoint Dosage of melatonin for insomnia

10 Ways to Manage Sundown Syndrome

Sundowning in Dementia: Clinical Relevance, Pathophysiological Determinants and Therapeutic Approaches

What’s to Know About Sundowners Syndrome?

Side Effects of Melatonin: What Are the Risks?

Dementia and Sundowning: Tips to Help You Manage (video)

Other Chapters in Dementia Care Guide: Strategies for Providing Compassionate, Effective Dementia Care:

  • Chapter 1

    How Vision Changes with Dementia

    View
  • Chapter 2

    Can Dementia Come And Go?

    View
  • Chapter 3

    Communication in the Early Stages of Dementia

    View
  • Chapter 4

    Communication in the Middle Stages of the Dementia Journey

    View
  • Chapter 5

    Effective Communication in Late Stage Dementia

    View
  • Chapter 6

    Strategies for Dealing with Sundowners Syndrome (aka Sundowning) in Seniors

    View
  • Chapter 7

    Try This Instead of Antipsychotic Drugs for Paranoia in Dementia

    View

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