How Sundowners Affects Caregivers: Managing Stress & Fatigue
If you care for a loved one with dementia, you may have experienced sundowning. This late day and evening hours confusion in your loved one can be very distressing. It can even be dangerous if their behaviors include violence.
Caring for someone with dementia can cause significant stress and even burnout. Sundowners often makes these effects worse. It helps to learn more about sundowners syndrome, how to manage it, and how to take care of yourself. We’ll talk about all of these important issues here to help you manage your own stress and fatigue.
Interested in learning more about dementia, its symptoms, and caregiving? Check if you have free access to Trualta’s learning library.
About Sundowners
Sundown syndrome is an increased state of confusion that many people with dementia experience in the late afternoon or early evening. It doesn’t occur only with dementia, but is strongly associated with Alzheimer’s disease and other conditions that cause dementia.
Sundowners Symptoms & Behaviors
Your loved one with dementia may experience frequent states of confusion. Sundowners is a state of increased confusion, often accompanied by:
- Agitation
- Anxiety
- Irritability
- Aggression
- Violence
- Yelling
- Sadness
- Pacing
- Wandering
Sundowner syndrome behavior can be extreme. Your loved one may lash out, resist directions, or become violent. Their agitation and confusion can cause them to wander, which can be very dangerous if the home is not secure.
Some people experiencing sundowners might even hallucinate. They can become paranoid and delusional.
What Causes Sundowners Syndrome?
No one knows exactly what causes sundowning. It’s common with dementia, but is also associated with older adults without dementia. Other risk factors include having hearing loss, having sleep issues, or taking certain medications.
More important for caregivers is determining what triggers episodes of sundowners. Sleep problems can be a major trigger for many. Some research has found that circadian rhythm is related to sundowning. This is the body’s sleep wake cycle. Sleep disturbance and low exposure to natural light during the day disrupt this cycle and may contribute to sundowning.
Some common triggers of sundowners syndrome include:
- Fatigue
- Overstimulation, especially in the afternoon or evening
- Disrupted nighttime sleep
- Disrupted daily routine
- Hunger
- Boredom
- Mood disorder episodes
- Chronic pain
- Inadequate bright light exposure
How Does Sundown Syndrome Affect Caregivers?
It’s important for caregivers of people with dementia to understand sundowners. Sundowning is distressing and sometimes harmful for your loved one. It can also be harmful to you as the caregiver.
Caregivers of patients with dementia are vulnerable to stress, depression, anxiety, and overall poor wellness. They are also more likely than non-caregivers to have poor physical health.
If your loved one has dementia and sundowners syndrome, these effects can be worse. This is because sundowning behaviors are distressing and difficult to manage, even compared to other dementia symptoms. These are some other reasons sundowning may cause you additional stress:
- Sundowning behaviors are particularly difficult to control or stop.
- Your loved one won’t follow instructions or take their medications.
- They won’t or can’t sleep at night.
- They become violent.
- Your loved one might get hurt or lost while agitated or wandering. You might feel responsible and guilty about this.
- Sundowning can make it more difficult for you to get enough quality sleep.
- You’re worried your inability to control difficult behaviors will mean a quicker transition to assisted living with memory care or a nursing home.
Tips For Preventing & Managing Sundowners Syndrome
The first approach to managing your own stress and fatigue is managing sundown syndrome. Use these tips to prevent and manage episodes:
- Establish and stick with a daily routine as much as possible.
- Keep a record of episodes and note what happened before the episode to identify your loved one’s triggers.
- Avoid or reduce their triggers as much as possible.
- Change the environment as needed to reduce overstimulation. For example, turn off the television later in the day, or ask visitors to leave.
- Distract and redirect your loved one if you see early signs of agitation. Give them an easy, repetitive task to do.
- Ask your loved one what they need when you see agitation or confusion. They may be hungry, tired, or bored, which are issues you can address immediately.
- Prioritize sleep and ensure your loved one has a calming routine that will help them maintain a healthy sleep pattern.
Talk to your loved one’s doctor if their episodes are frequent, severe, increasing, or just unmanageable. They can provide advice and suggest treatments and updates to the care management plan.
How To Stay Calm When Facing Sundowning Behavior
You cannot always prevent sundowners syndrome, but you can react in a more productive, helpful way. It’s easy to get frustrated or to express anger, resentment, or fear.
Controlling these emotions and staying calm is difficult but important. A calm reaction will help your loved one in the moment. It will also help you reduce your own stress and agitation.
Here are some tips for remaining calm while your loved one is experiencing an episode of sundowning:
- Recognize that you’re getting frustrated. Frustration is a normal reaction in this situation because you can’t control it. Learn your warning signs that frustration is rising. This might include feeling warmer, shortness of breath, eating compulsively, or getting impatient.
- Calm your frustration. Recognizing oncoming frustration allows you to take a moment to stop it and calm yourself. Take a few deep breaths and count to ten. If possible, leave the room for a moment. Focus on relaxing the tension in your body while continuing to breathe.
- Change your thoughts. You’re probably having some very negative thoughts in this moment. Recognize them and change them. You might be thinking, “I’ll never be able to handle this.” Change it to, “I can handle this situation better once I calm down and by learning new strategies.”
Self-Care For Caregivers
So much of caregiving is about your loved one. It’s important and not selfish to take time to manage your own wellness. Doing so will reduce your stress, prevent burnout, and result in better outcomes for your loved one.
Ask For Help
This is the first and most important thing you can do as a caregiver of someone with difficult sundowners syndrome symptoms and behaviors. You don’t have to care for someone with sundowners alone. If possible, get family members to step in and help.
If this isn’t an option, look into professional home care. Respite care is another option. Respite provides temporary care so you can take time off. Respite care can be for a few hours or days, or even longer.
Take Time Off
Family, professional caregivers, and respite care are all options that allow you to take much-needed time off. Many caregivers feel too guilty to step away, but shouldn’t. Time away from your loved one allows you to rest, recharge, and protect your own wellness. It will make you a better caregiver.
Build Caregiving Skills
You can learn a lot about sundowners, dementia, and caregiving from a support group, but more formal instruction is even more helpful. Look for a training program for family caregivers. It will teach you about dementia and sundowning. It will also provide practical skills to improve your caregiving. This can be very empowering, which in turn, reduces your stress.
Protect Your Physical Health
It’s easy to let healthy habits slide while trying your best to fulfill your caregiving duties. You deserve good health, and your loved one deserves to have a healthy, effective caregiver. Make sure you sleep enough each night, get regular exercise, and eat healthy meals. Avoid using junk food, alcohol, and other unhealthy habits as coping mechanisms for stress.
Join A Support Group
Support groups can be online or in person. They are groups of people supporting each other in difficult circumstances. A caregiver support group, especially one for caregivers of people with dementia, is a great resource.
In a support group, you can share experiences and difficulties with people who understand. You can listen to other people’s stories and benefit and learn from their experiences.
Try Therapy
If you’re really struggling, consider one-on-one counseling. A trained therapist can help you work through difficult feelings about anything, but especially with respect to your loved one. They provide a safe outlet and will help you develop healthy coping mechanisms to improve your own mental health and be a more effective caregiver.
Many seniors with dementia experience sundown syndrome. It’s hard for them and their caregivers. Learn more about sundowning, develop your caregiving skills, and ask for help when you need it to manage your own stress and prevent burnout.
For additional resources on related topics, check out the extensive Trualta library. This link will show you if you have free access.
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