People with mid-stage and advanced dementia often follow a pattern: As the day goes on, they get more and more confused and agitated. That’s because new routines, new places and things, can cause stress and anger in people who are biologically very set in their ways.
Technically, this is known as “late-day confusion,” but most folks just call it “sundowning.” And thought there’s no known way to reverse it, there are seven ways to reduce it:
Stick to routine. Following the same exact routine day after day after day can keep elders with dementia in their comfort zones. So once you’ve established a routine that works for both of you, don’t change it unless you really have to. And then, ease in the adjustments and incrementally and gradually as possible.
Let there be light. A Psychiatric Investigation research review suggests that light plays a big role in sundowning. Bright light therapy and melatonin have both been helpful treatments. So keeping the light bright indoors hours before it starts getting dark outdoors could reduce the severity of sundowning or delay its onset.
Pay attention to sleep cycles. The timing and amount of light at home can affect circadian rhythms – our sleep-wake cycles. It can be a vicious cycle: Too little light and too much dozing in day time can lead to too little sleep at nighttime, which can produce fatigue which leads to too much daytime dozing, and so on. Turning on a full-spectrum fluorescent light or a light therapy lamp about three feet from your family member for a few hours each morning could help break the cycle – or, at the least, keep it from worsening.
Activity is healthy. Staying active during the day helps promote a good night’s sleep. So go for a walk in the park together, or plan some other gentle physical activity. It’s good for sleep quality (see above) and physical health.
Make lunch the big meal of the day. A big evening dinner, particularly with caffeine or alcohol, can keep sundowners up at night. So make lunch the big meal and limit suppers to hearty snacks or light meals. They’ll sleep better at night (and so will you).
Minimize evening stress. For someone with mid-stage or advanced dementia, even watching television or reading a book can be challenging and frustrating enough to bring on more confusion and irritability. So keep evenings calm and quiet – maybe with soft, calming music, maybe with snuggling with a pet.
Familiarity breeds comfort. Help fill your family member’s home with things they’ll find comforting. If they have to move to a nursing home or assisted living facility, make sure they take their favorite blanket, their family photos, and other mementos that matter to them. The comfort and familiarity can help ease the transition – and alleviate some of the stresses than can lead to more sundowning.
Track their triggers. Different people have different triggers for sundowning. So use a journal or smartphone app to record daily activities, environments, and behaviors. Then look for patterns to learn which situations seem to make them more agitated or confused. Knowing what their triggers are will help you avoid situations that pull them.
Don’t take it all on yourself. You’re only one person – with your own life, your own family, and probably your own job and career. You need well-balanced meals, regular exercise, and enough sleep. And you need some time off, to replenish your supply of patience and support. That’s where we can help, working with you to develop a coordinated care plan, integrating your needs as determined by our thorough three-part assessment; your responsibilities, and your schedule with the needs and comfort of your loved one. To learn more about the difference that can make, please contact us for a consultation.
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