Sundown syndrome—also known as “sundowning”—is a term describing the onset of heavier confusion and intensified agitation in those living with dementia. Usually this begins anywhere from late afternoon to dusk. However in reality, it could happen at any time throughout the day.
Experts believe one of the contributing factors is a shift in the biological clock, caused from the change of daylight to dark. Keeping the house well-lit during these late afternoons and evening hours will help immensely. Research shows that 20%–45% of dementia patients will experience some sort of sundowning confusion. I personally believe that this percentage is higher.
Physical/mental exhaustion is another great contributor. A person who lives with dementia for an entire day experiences a time-frame which consists of coping with who’s who, “where am I,” and living in the past. This would mentally and physically drain anyone, added to the dimension of the deteriorating internal biological clock.
After caring for both parents who developed dementia (my dad with Alzheimer’s disease and my mom with vascular dementia) I have experienced sundown syndrome in many different forms and throughout different times of the day.
Out of the two, my mother’s symptoms are without a doubt, much worse than my dad’s. However, the one thing I have learnt is that fresh air and the great outdoors has helped immensely. Every afternoon, now, weather permitted, I take my mother out on the back deck, where we enjoy a cup of coffee, and some repeated conversation. Yes, we talk about the same topics and I answer the same questions over and over. But that’s okay; I’m extremely used to it. I’ve been doing this for almost the past two decades. We sit peacefully and have our quality time together for at least an hour. I like to think of it as her “Son” downers therapy.
With my father whom I have since lost to Alzheimer’s , I had a double seated swing bench in the front of my house where we would spend our late afternoons. I used to chuckle because, when I would ask him what he was doing, he’d reply, “I’m counting the cars.” I live on Highway U.S. 41 in Florida! He then would look at me and say, “Well, I’m only counting the white ones.” These are times that I dearly miss.
There are days when I swore my father’s sundowner’s would last morning ‘til night. I also recall noticing similar reactions on dispiriting rainy days. Once anxiety builds from the syndrome, it’s exceptionally difficult to turn it around. We must keep evenings as calm, routine and simple as possible. I know this is simply easier said than done at times. You can only just do the best you can.
All of this, therefore, is why we need to be proactive as caregivers when it comes to sundowning. We need to redirect those living with dementia prior to the time their confusion builds. Once they are in the sundown mode, it becomes awfully difficult to defuse it. If you know, for instance, that this takes place around 5:00 p.m. every day, about 3:30-4:00 p.m. is when you need to make sure they have something to keep their minds and hands active. Turn those lights on in the room so the evening shadows don’t start creeping in.
There can actually be various attempts to keep these folks calm around this time of day. Music is always a good choice. Or, many times I would put our cat to work around this time. With our cat placed in my dad’s lap, most of his confusion would slip away by the time he had her purring. There is truly something to be said about pet therapy: it seems to have its own type of magic. And the variation of the types of animals incorporated into this therapy is virtually endless—from goldfish, to cats and dogs. Docile, living critters are the best of the Creator’s healing salve.