What is Sundowning?
Persons with acute or chronic confusion become more confused, restless, and insecure late in the day and especially after dark. This happens whether they are living at home or in a facility, but most often, it is worse after a move or change in the patient’s routines. They may become more demanding, restless, upset, suspicious, disoriented and even see, hear or believe things that aren’t real, especially at night.
What Causes Sundowning?
No one is sure what causes Sundowning, although it seems to result from brain diseases - whether acute(treatable) or chronic (irreversible). Alzheimer’s patients tire more easily, even from minimal demands on their thinking ability, and they become more restless and hard to manage when tired. It’s as if their ability to cope with a confusing environment has been used up. All stimuli, because the patient can’t sort out sounds or activities, has an add-on stressful effect.
Sundowning may relate to lack of sensory stimulation after dark. At night they are fewer cues in the environment, with the dim light and absence of noises from routine daytime activity. Those routine noises are a major source of security for AD patients, many of whom sleep well only during the day and in chairs close to nursing stations. A Sundowning, restless patient also may be hungry, uncomfortable (too tight clothes?), in pain or needing to urinate, all of which can only be expressed through restlessness. AD patients may regress to childlike behaviors and thinking patterns as the disease progresses. As they understands less about what’s happening to them, they become more frightened of things like the dark or being left alone. They becomes more frantic in trying to restore their sense of familiarity or security. Many families caring for AD patients say the patients become more anxious late in the day about "going home, finding my mother" (all those things indicating a need for security and protection).
Helping Strategies
* Keep the patient active in the morning and encourage her to rest after lunch. If fatigues is making the Sundowning worse, an early afternoon nap might restore their composure.
* Don’t physically restrain them. That tends to make AD patients worse- they may scream, squirm , or become even angrier and more resistant.
Instead, let them pace back and forth where they can be observed. If one can, fall in step with them and offer a brief moment of companionship and distraction from their mumblings. Taking them outdoors for a walk would also help-fresh air seems to clear the minds and reduce restlessness in AD patients. When you pass them, reach out and smile, pat their or say, "It’s good to see you."
* Don’t argue or condemn them for "wanting to die." It’s probably a phrase that got stuck in their mind and they can’t help repeating it. They’re looking for attention. Reassurance is the best response. "We love you and we’ll help you."
* Give them something to fiddle with in their hands to distract them from pulling on or tearing their clothes. Perhaps he could be asked to hold something "for you" which keeps his hands too busy to fiddle with anything else. If she pulls her skirt up regularly in public, get her some pull on slacks, or even a jumpsuit.
* Some patients are comforted by stuffed animals, real animals, hearing familiar tunes, or an opportunity to do a favorite pastime, i.e. window shopping at the mall looking at cars on used car lots or whatever.
* Don’t ask them to make decisions, or ask what’s wrong. If you make the decisions, they'll be relieved of that taxing responsibility.
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