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What is Sundowning?
Jan L. Warner & Jan Collins

Question: Since my husband was diagnosed with dementia nearly three years ago, I have seen a slow, but steady decline in his memory and personal habits. Because our home was a split-level with the bedrooms upstairs, I decided to move into a one level home early last year for safety reasons. Because I wanted to keep my husband at home with me for as long as possible, I installed appropriate hold bars throughout the house, a specially designed bathroom, etc.

But since we moved, my husband seems to have deteriorated more rapidly. He has become more confused, especially in the late afternoons and evenings to the extent that he often becomes frantic, not even realizing that he is home. More often than not, he paces incessantly, especially in the evenings, and is keeping me up all hours of the night. Is this normal for his stage of the illness?

Answer: It appears that your husband is being affected by what is commonly called “sundowning” or Sundowners Syndrome – that is, the time of the day – generally in the late afternoon -- when folks diagnosed with dementia tend to become more agitated, upset, suspicious, and difficult to manage. While no one knows what actually causes sundowning, most experts seem to think that sundowning becomes worse after a move or schedule disruption. Some people even see or hear – and believe -- things that aren't real, sometimes causing violent behavior.

No matter the cause, dealing with the problem is essential. The first order of business is a thorough medical examination and review of your husband’s medications with his physician. In some instances, modification of medication dosage may help relieve the symptoms.

It is important to keep your husband active and to suggest a period of rest after the midday meal because being overtired can increase the severity of sundowning. Instead of restraining your husband or keeping him inside to watch television, which may add to his confusion and restlessness, take him for walks outside where he does not get “sensory overload.” If he is calmed by pets, stuffed animals, or even hearing familiar music, be sure to cater to his desires. One reader told us that her husband enjoyed listening to the 1940’s music played continuously on XM Radio (www.xmradio.com) for six to eight hours each day.

Besides rest and a structured daily routine, you might consider minimizing new challenges or information that can be upsetting. And if there are to be special occasions or changes in routine, make sure to explain them weeks ahead of time and repetitively so they won’t come as a complete surprise. Try and condition him to the upcoming changes by making incremental changes to his routine.

Taking the NextStep: In addition to sundowning and memory loss, dementia can bring with it such other challenges as wandering; driving an automobile in an unsafe manner; difficulty with dressing; incontinence; refusal to eat; personal hygiene; and sleeplessness.
While different persons have different tolerance levels when it comes to dealing with dementia and its many permutations, all caregivers need respite and relaxation away from the incapacitated family member. In fact, stress and exhaustion from the daily intense supervision may result in punishment or abuse of the person with dementia. For that reason, both doctors and other professionals should carefully monitor caregivers. And should the use of prescriptions be necessary to maintain your household safety, the need should be reassessed monthly by a physician.

Besides regular communication with his doctors, you may want to contact a qualified geriatric care manager (www.caremanager.org) to see if there are other avenues to help you. Certainly contacting your local Alzheimer Association may give you insights into other ways of helping your husband through sundowning.



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Planning Your Future with 20-20 Vision™


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