Coping With Sundowners: Practical Strategies For Caregivers
Sundowners syndrome, or just sundowners, is a set of symptoms that affects many people with dementia. If you provide home care for a loved one with dementia, you may notice these troubling symptoms begin in the late afternoon or early evening.
Sundowning behaviors include confusion, aggression, wandering, and even violence. It’s difficult to see your loved one in this state, but you can manage and minimize sundowning episodes. In this article, we’ll explain:
- What sundowners is
- How to recognize signs and behaviors associated with sundowning
- Tips to help prevent sundowning symptoms
- How to respond to your loved one exhibiting sundowning behavior
- How to cope with sundown syndrome in your everyday care
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What Is Sundowners Syndrome?
Sundowners syndrome is not a medical condition. It’s a group of symptoms mostly characterized by excessive confusion that typically begins in the late afternoon or evening and may last a short time or all through the evening and night.
Sundowners is common in patients with conditions that cause dementia. If your loved one has dementia, they may be confused sometimes. If their confusion becomes heightened in the evening and is accompanied by problematic behaviors, they’re probably experiencing sundowning syndrome.
No one knows for sure what causes sundowners. It’s most common in patients with dementia, but also occurs in people without it. Risk factors include older adults, sleep disorders or disrupted nighttime sleep, later stage and more severe dementia, hearing loss, and certain medications.
What Are Sundowners Syndrome Symptoms?
The first step in coping with sundowners is recognizing its symptoms. Any increased confusion in your loved one should be cause for concern. But the confusion associated with sundowners occurs later in the day and is accompanied by certain symptoms or behaviors:
- Mood changes, including increased agitation, restlessness, anger, or sadness
- Aggressive behaviors, including resistance, yelling, and even violence
- Pacing, rocking, and other repetitive behaviors
- Restlessness and wandering away from the home
- Difficulty sleeping
- Shadowing, or following you very closely
- Hallucinations, delusions, or paranoia
As the caregiver, you know your loved one best. These and other troubling symptoms later in the day should be cause for concern. Talk to your loved one’s medical team about sundowning. They may be able to change medications or start treatments like light therapy to help.
How To Prevent Sundowning
Unfortunately, there are no proven treatments for sundown syndrome, although some can help. Prevention is also useful. Although you may not be able to prevent all episodes of sundowning in your loved one, with knowledge and practical strategies, you can prevent some episodes and reduce their severity.
Identify Triggers
Prevention begins with understanding sundowner syndrome triggers. Your loved one’s triggers will be unique. Keep track of their episodes and what happened that day to identify a pattern. Some common triggers include:
- Fatigue and overstimulation, often caused by a busy day or specifically at the end of the day
- Disruptions to regular daily routines
- Sleep problems and sleep disturbance
- Inadequate light exposure
- Mood disorders
- Chronic pain
- Hunger
- Boredom
- Certain medications
It’s worth noting sleep as a trigger in more detail. Some research has found that sundowning may be related to circadian rhythm. Circadian rhythm is the body’s natural sleep wake cycle regulated by hormones but also bright light and natural light exposure. Addressing sleep issues can be an important way to prevent sundowning behavior.
Manage Triggers
Once you see a pattern in your loved one’s episodes and triggers, you can take steps to manage them. For example, you might find the confusion and agitation begins later in the day when they’re bored and have nothing to do. Prepare simple but engaging activities for them. Repetitive tasks, like folding laundry or sorting objects can have a calming effect.
As another example, you might see that your loved one’s increased confusion is related to disruptions to their sleep pattern. Create a bedtime routine that ensures they are calm and ready for bed at the same time every night.
How To Respond To Sundowners Behavior
Prevention is a great strategy for managing sundowners syndrome, but you can’t always prevent it. As a caregiver, you need to be ready with strategies for responding to your loved one when they exhibit difficult behaviors.
Remain Calm
Sundowning is a heightened situation full of difficult emotions. It’s not easy to see your loved one in a state of confusion and being aggressive. No matter how it makes you feel, stay calm. Letting your emotions show will only make it worse. Stay calm and talk in a soothing voice.
Reassure, But Don’t Argue
Your loved one isn’t capable of reasoning with you in this moment, so it’s not worth it to try. Instead of arguing, provide reassurance. Tell them they’re safe and that you understand how they’re feeling.
Provide Space
Your loved one may be very angry, suspicious, or paranoid. Although this isn’t rational, it’s important to respect it. Step back and give them plenty of space to help them feel safer. If there are other people around, consider asking them to leave.
Distract Them
Redirecting your loved one in this difficult moment can distract them from their confusion, anxiety, or anger. Find out if they need anything immediate. For example, they might just be hungry. This can be enough of a trigger for sundowning and is easy to resolve.
The trigger may not be that simple, but distraction and redirection still help. Talk about something unrelated. Ask them to do a simple, easy task. Put on their favorite music. Anything that distracts them from an upsetting trigger can help.
Tips For Coping With Sundown Syndrome In A Loved One
Identifying and managing triggers, taking preventative steps, and responding thoughtfully in the moment are all great strategies for coping with sundowners. Here are some additional tips for living with or caring for a loved one who sometimes experiences sundowners syndrome.
Talk To Their Medical Team
Your loved one’s doctors need to know about any changes in symptoms and behaviors. Talk to them about sundowners and what you think triggers it. They can suggest additional management strategies. They may also be able to change or add treatments that can help. For example, an adjustment to a medication might make a big difference.
Establish A Daily Routine
Routine is great for anyone with dementia, with or without sundown syndrome. Confusion is a key element of sundowning, which is worsened by unexpected changes. With a daily routine, your loved one knows what to expect and is less likely to get confused.
If you do need to make a change, such as going to a doctor’s appointment, approach it carefully. Prepare your loved one in advance by talking about the appointment and when it will occur.
Change The Environment
Research suggests that the environment plays a big role in sundowning symptoms. By observing your loved one and their agitation triggers, you should be able to identify aspects of their environment that contribute to sundowning.
Overstimulation is a good example of a trigger related to the environment. Try reducing noise and the number of people around your loved one toward the end of the day. Turn off the television and consider putting on soothing, quiet music instead.
Take Care Of Yourself
Caregivers have a big effect on their loved one’s moods and overall wellness. To provide the best possible care, you need to be in good physical and mental health. This means taking time for self-care, exercise, therapy, support groups, and anything else you need to be well.
Rely on a family member to take over your caregiving duties, so you have time for yourself. If this isn’t an option, look into respite care for your loved one.
Sundowners syndrome is difficult for both the patient and the caregiver. Practical management is essential for both of you. It also helps delay transitioning your loved one to assisted living, memory care, and other types of senior living options. Use any of these tips that help, and talk to your loved one’s doctor for guidance and care management.
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