A Primer All About Sundowning

Hi, everybody, welcome to another brand new episode of the Truth Lies, and Alzheimer's show. I'm Lisa Skinner, your host, and I am bringing you today a new episode that I really think it's time to kind of dive deep into and elaborate on because I know talking to people every day about Alzheimer's disease and dementia, there's a lot, a lot, a lot of confusion surrounding the topic of sundowning. So I'm going to give you a really in depth, description and overview of what it is and what it isn't. Hopefully, this will be helpful because I know it's a very confusing topic. So sundowning is a phenomenon that commonly occurs in people with dementia, particularly with Alzheimer's disease, and does involve increased agitation, increased confusion, and restlessness in the late afternoon and evening. That's how it got its name. But that's not entirely the truth. I'm going to elaborate on that part. In terms of it has only happens in late afternoon and evening that is not true. While the exact cause of sundowning is not fully understood, several factors have been suggested to contribute to this phenomenon. So number one, there could be a disruption of their internal body clock this we know this happens people with dementia may experience disruptions in their circadian rhythms, which regulate the sleep wake cycle. As a result, they may become more confused and agitated as the day progresses and the evening approaches. And the disruption of their circadian rhythm also, is contributes to why a lot of people with dementia want to sleep during the day and they're awake all hours of the night. This is a true this is a true fact. And the reason why is because of the disruption to their circadian rhythm, fatigue and exhaustion throughout the day, people with dementia may become tired and fatigued, leading to increased confusion and agitation as their cognitive abilities decline, reduced lighting and shadows as natural light decreases in the evening. The presence of shadows and changes in lighting conditions can be disorienting for individuals with dementia, leading to increased confusion and agitation. Some people experience hormonal imbalances and we know that changes in hormone levels such as increased levels of the stress hormone cortisol, in the evening may contribute to sundowning behaviors. Then there's environmental factors, factors such as increased noise levels, caregiver shift changes, and disruptions in routine can also contribute to sundowning episodes. Well, those things can happen any time of the day. They're not limited to the afternoon or the evening. This one to sensory overload. over stimulation from loud noises, bright lights or crowded environments can overwhelm individuals with dementia and contribute to increased agitation and confusion. Especially in the evening when fatigue levels are higher, but not limited to the evening it can happen anytime of the day. And met needs can trigger the sundowning episode, which includes hunger, thirst, pain, or discomfort can escalate in the evening when routines may change or caregivers may be less attentive. Addressing these basic needs promptly can help reduce the likelihood of sundowning episodes. They can be having A medication side effect. Certain medications, their timing or changes in dosages can potentially trigger or worsen sundowning symptoms. It's essential to monitor medication effects, and discuss any concerns with your loved ones health care providers, they could have an infection or an illness. The presence of infections such as the urinary tract infection, or respiratory infection, or other illnesses can exacerbate symptoms of dementia and sundowning. Prompt identification and treatment of underlying health issues are crucial. exhaustion and over exertion can trigger these behaviors. physical or mental exhaustion from too much activity or exertion during the day can lead to increase confusion and agitation in the evening, but not limited to the evening. Emotional stress, anxiety or changes in the environment such as moving to a new location, or changes in their routine can trigger sundowning episodes, a lack of stimulation. Conversely, lack of mental or physical stimulation during the day can lead to restlessness and agitation in the evening. But, of course, it can happen any time of the day. Engaging in calming activities or routines throughout the day may help reduce sundowning symptoms. Contrary to its name, this is where we're getting into this. Contrary to its name sundowning does not always occur precisely at sundown. While sundowning often refers to the increase in confusion, agitation and restlessness that commonly occurs in the late afternoon and evening. The timing and duration of sundowning episodes vary among individuals with dementia. It can begin in the late afternoon around sunset, or later in the evening, depending on various factors such as an individual's internal body clock, their level of fatigue, the environmental stimuli, and their overall health. Some individuals may experience sundowning symptoms consistently at a particular time each day, while others may have more unpredictable patterns of onset. It's important to note that sundowning is a complex and multifaceted phenomenon influenced by so many different factors, and the timing of symptoms do vary from person to person. care givers and healthcare providers should observe and track the patterns of the son downing of the sundowning episodes in individuals with dementia to better understand and manage these behaviors effectively. Establishing consistent daily routine, creating a calming environment, and addressing potential triggers can help reduce the frequency and the severity of sundowning episodes, regardless of the exact time they occur. So we know that person centered care, which is a holistic approach that focuses on the individual's unique needs, preferences and abilities, help manage sundowning and individuals with dementia. Person Centered Care Solutions aim to address the specific characteristics and triggers of each person to provide personalized care and support. And here are some of the things that you can offer that will be considered person centered care. You want to establish a consistent routine, creating a daily routine that aligns with the individual's preferences and habits. For example, when they were in the prime of their life or they used to taking a shower in the morning, or maybe when they got home from work, they would take their shower in the evening. So whatever they were accustomed to, you should follow that same pattern and not try to change it. Consistency in daily activities in their mealtimes and bedtime routines. can help promote a sense of security and reduce their anxiety. To reduce confusion, you might try dimming the lighting you soft bulbs. Because this can help create a relaxing environment and may reduce agitation. encourage physical activity, engage the individual in light physical activities during the day to reduce restlessness and promote better sleep at night. Outdoor activities and exposure to natural light can also help regulate the sleep wake cycle provide meaningful engagement. And you can do this by offering activities that the individual enjoys and finds meaningful such as reminiscence therapy, art therapy, and sensory stimulation. meaningful engagement can help reduce feelings of isolation and boredom, which may contribute to them having sundowning episodes.

Creating a common environment is so essential. And you can accomplish this by minimizing noise, minimizing distractions, and minimizing clutter in the environment to create a peaceful and soothing atmosphere. This is very true clutter does trigger people's sundowning episodes. Use familiar objects and cues to provide a sense of familiarity and security. And then you always always, always want to communicate effectively. Well, what does that mean? I'm going to tell you use clear simple language, use nonverbal cues to communicate with the individual. offer reassurance offer validation and offer emotional support. All of these things can help reduce anxiety and confusion. So by incorporating Person Centered solutions, tailored to the individual's preferences, abilities, and triggers, caregivers and health care providers can effectively manage sundowning behaviors and improve the overall well being of individuals with dementia. You can collaborate with the individual with their family members, and a multidisciplinary care team who can help develop a comprehensive and individualized approach to address sundowning symptoms effectively. One of the things that I recommend is you try to limit sugary foods that because they are known to affect sleep patterns. And also you want to promote restful sleep. You can do this by establishing a calming bedtime routine that includes activities like a warm bath, a gentle massage, like a hand massage, or reading to promote relaxation and prepare the individual for sleep. Ensure the sleeping environment is comfortable, quiet and conducive to restful sleep. Now, keep this one in mind, limit stimulating activities in the hours leading up to bedtime, avoid activities that may be overstimulating, such as watching intense television programs, or engaging in mentally taxing tests. Instead, opt for the calming and relaxing activities to help wine down. Offer emotional support. Again, that includes validation and reassurance to individuals experiencing sundowning symptoms. And one of the ways you can do this is acknowledge their feelings and offer comfort to help reduce their anxiety and distress. consider incorporating therapeutic interventions such as music therapy is a great one, but not really loud. Music that'll kind of get them to want to be dancing. Later later in in the afternoon in the evening. It should be calming and soft music in the latter part of the day. Pet Therapy is great for relaxation, aromatherapy, which promotes relaxation and emotional well being. All these interventions can have a calming effect and help reduce agitation. So I'm going to give us a few specific examples of person centered and practical strategies to help manage sundowning and individuals with dementia. You can create a customized activity kit for them. You create personalized activity kits tailored to the individual's interests and hobbies. For example, if the person enjoys gardening, assemble a kit with small garden tools, seeds and plant pots for them to engage in a calming and familiar activity in the evening. sensory stimulation. I mentioned that before, but I'll give you examples of what that means. You can offer them items like textured blankets, scented lotions, or again soothing music that the person finds comforting. This can definitely help reduce agitation and create a relaxing environment. There are memory boxes that you can create. You fill them with meaningful objects or photographs from the individuals past. And this encourages reminiscence and also storytelling, which can provide a sense of continuity and connection, potentially easing sundowning symptoms therapeutic touch that would be gentle touch such as hand massages or shoulder rubs. This can promote relaxation and emotional well being. Incorporating Therapeutic Touch into the evening routine can help the individual unwind and feel comforted. You can go for a structured evening walk which is taking the structured evening walk in a familiar surroundings to provide gentle exercise, gentle exercise, and exposure to natural light. This can help regulate the sleep wake cycle and reduce restlessness in the evening. We talked about this already. But aromatherapy can be hugely beneficial. You use essential oils like lavender chamomile in a diffuser, or as a massage oil to create a calming and soothing atmosphere. Aromatherapy. If you didn't know this can help promote relaxation and improve the individual's overall well being. Also, you can help by using visual cues such as clocks or calendars to help orient the individual to the time of day. Play soft calming music, or nature sounds those work in the evenings. Allow them to have creative expression times encourage this through art activities like painting, drawing or coloring. engaging in creative pursuits can be therapeutic and provide a positive outlet for emotional expression. Tailor your communication strategies to the individuals preferences and abilities. And you can accomplish this by using familiar phrases, gestures, or visual cues to facilitate their understanding of what it is you're trying to communicate, which will reduce frustration during interactions. Encourage the individual to spend time outdoors during the day to receive natural light exposure. We know this can help regulate the sleep wake cycle and improve mood and cognition. Make sure they stay hydrated. Ensure the individual stay hydrated throughout the day by offering water and other fluids regularly. Dehydration can exacerbate confusion and restlessness. So it is essential to monitor fluid intake. I mentioned this on another one of my shows that people with dementia don't always even realize that they're thirsty. So if you regularly offer them fluids, they might be more inclined to accept it and drink it than trying to just make that decision on their own. Especially if they don't know that they're thirsty and then promote physical exercise. You can encourage light physical activities during the day such as stretching, walking or gentle exercises, physical exercise can help reduce anxiety, improve sleep quality, and enhance their overall well being. So hopefully that helps you have a little bit better understanding of what sundowning is. A lot of these symptoms that I discussed, that actually were part of the sundowning explanation are very common behaviors that we see with Alzheimer's disease. So a lot of times they are sundowning without you even realizing it, but they are part of the disease. And I think it's important for people to really wrap their heads around that concept, instead of maybe mistakingly thinking that they're just trying to be difficult and make your life miserable. No,

that's that's not the case in most situations. So I hope this has been helpful for you today to maybe separate the confusion from the reality of sundowning. I appreciate you being here with me today. I will be bringing you another new episode of the Truth Lies and Alzheimer's show next week. I'll be back. I'm Lisa Skinner, your host and I look forward to having you here with me next week, and as many times is you can in the future. So have a great rest of your week and I will see you here next time. Bye bye for now.