Insights to Care Post 06
Sundowner syndrome commonly occurs in dementia patients. It can be distressing and harmful both to your loved one and you as the caregiver. It’s important to learn more about sundowning behavior, what causes it, and how to manage it.
In this article, we’ll talk specifically about the effect of the environment on sundowner and dementia symptoms. We’ll explain the connection and suggest some ways you can change your loved one’s environment to ease challenging behavioral symptoms.
Interested in learning more about dementia, its symptoms, and caregiving? Check if you have free access to Trualta’s learning library.
About Sundowner Syndrome
Sundowning, or sundowner syndrome, is a state of increased confusion that occurs at the end of the day. It’s not really a syndrome by itself. It’s a group of symptoms and behaviors. It’s common in patients with dementia or Alzheimer’s disease but sometimes occurs in older adults without these diagnoses.
Sundowning causes difficult emotions, including confusion, anger, sadness, irritability, and paranoia. Your loved one experiencing sundowners dementia may exhibit some of these symptoms and behaviors:
- Agitation, aggression, and violence
- Pacing, rocking, and other repetitive behaviors
- Shadowing, following you closely
- Wandering
- Crying
- Difficulty sleeping
- Hallucinations or delusions
Sundowning behaviors can be challenging, but they can also be dangerous. Your loved one may become violent and can hurt themselves or others. Wandering behaviors are also very dangerous. If their home isn’t secure, they can wander and get lost.
Managing sundowning is essential for keeping them and you safe. It also helps delay the transition to senior living facilities, like assisted living, memory care, or other types of residential senior care.
How Does The Environment Affect Sundowner Syndrome?
There is no known cause of sundowners syndrome. Although every dementia patient is different, common factors often trigger or worsen sundown syndrome. Many of these are related to your loved one’s home care environment:
- Fatigue and overstimulation, especially at the end of the day
- A busy day with disruptions to the usual routine
- Inadequate lighting or light exposure during the day
- Sleep issues or sleep disturbance
- Hunger
- Boredom
- Chronic pain
- Mental health conditions, like depression
Too many people in the home and loud noises can be overstimulating. Too few activities or things to do can lead to boredom. Poor light exposure and other environmental factors can affect sleep. While the environment isn’t everything in sundowning, it does play a big role in triggering episodes or making them worse.
Tips For Changing The Environment To Manage Sundowning Symptoms
The most important thing you can do to help your loved one with dementia and sundown syndrome is to work with their medical team. There is no cure for dementia or sundowning, but treatments help. Report all changes in behaviors and talk to your loved one’s doctor for guidance on managing sundown syndrome.
Treatment and dementia care are important, but how you manage your loved one’s environment also matters. Here are some ideas to help you create a safe, stable environment that minimizes sundown syndrome.
Create Space & Comfort
A good home environment for someone susceptible to sundown syndrome includes plenty of space but also comforting elements. Someone who is sundowning may be agitated and even paranoid. They may be afraid of you and need space to move away and pace. Make sure the home has room for this and that they can move around safely.
Your loved one going through sundown syndrome is confused and scared. Keep comforting items in the home to soothe them. These will vary by individual but often include items they’ve had for a long time. Soothing music or a familiar TV show played at low volume can also create comfort.
Reduce Late Day Stimulation
Patients with sundowners syndrome seem to get more agitated late in the day when overstimulated. Take steps to create a calming and soothing late-day environment in the home:
- Reduce the number of visitors or caregivers if possible
- Turn off the television and any loud music
- Lower the shades and put on soft lighting
- Play soothing music or a program that calms your loved one
- Create a cozy, comfortable area for your loved one to relax and engage in a simple activity
Change The Environment To Prioritize Sleep
Sleep seems to play a big role in sundown syndrome. Some research indicates that disruptions to circadian rhythm, the body’s sleep wake cycle, could trigger sundowner behaviors. This has led to treatments, like light therapy and melatonin supplementation, that could help.
Your loved one’s doctor can recommend these treatments. You can help minimize this trigger by helping them get more sleep and better quality sleep. While melatonin and other treatments can help, the environment is most important for minimizing sleep problems.
Change your loved one’s bedroom to make it conducive to sleep. Lower the temperature a little. Use light-blocking curtains if outside light is an issue. Use dim, warm nightlights if they need some nighttime light. Make the bed soft and comfortable. Make sure the house is quiet, not just at bedtime, but also in the hours leading up to it.
Get More Light Exposure Early In The Day
The body’s circadian rhythm depends on darkness at night but also on light during the day. This is why light therapy can help. You don’t need a prescription to help your loved one get more day time light exposure.
Keep window shades and blinds open, and encourage your loved one to sit near windows during the day. If possible, get them out of the house. Natural light in the outside environment, along with fresh air and early-day activity, can help them sleep better at night.
Set Up The Home For Routine
Because sundown syndrome is so closely related to confusion, routine can help. Create a daily routine, so your loved one knows what to expect every day. Set up their home environment to support it. Keep items they need to use daily in the same spots. For example, if they begin each day by turning on the television, keep the remote control in its usual spot so they know where to find it.
Some disruptions to the routine are inevitable. If you need to take your loved one to a doctor’s appointment, bring comforting, familiar items. This can help you create a more soothing environment no matter where you go.
Have Simple, Soothing Activities On Hand
A good home environment for dementia and sundown syndrome includes activities and things to do. Boredom is a common trigger for difficult behaviors and symptoms. Keep your loved one’s home stocked with activities, easy tasks, and familiar games.
Easy, repetitive tasks can be very soothing for someone with dementia. Prepare these tasks in advance, so you have something ready if they begin to get agitated at the end of the day. You may not always have a chore they can do, but a soothing activity doesn’t have to be a useful task. It could be a set of shapes that you ask them to sort or a pile of clothing to fold.
If You’re Struggling As A Family Caregiver
Being a caregiver for a family member is a big responsibility. It can be time-consuming and stressful. The burden is higher with dementia patients and sundowning syndrome. It’s important to ask for help if you feel overwhelmed.
If possible, rely on other family caregivers to take over some of your duties. Or, hire a professional home care worker. You can also benefit from respite care to take a break from caregiving responsibilities.
Your own self-care is important. Take time to relax, get exercise, eat healthy meals, and do things you enjoy. When you take care of yourself, you can take better care of your loved one.
Changing the environment for your loved one with dementia is one important tool in preventing and managing sundowning. Remember to talk to your loved one’s doctor about sundowners, especially if it gets worse or if you cannot manage it well.
Use this link to find out if you have free access to Trualta’s library of resources on caregiving. It includes more articles on dementia, sundown syndrome, and other caregiving issues.
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