Holistic Care for Sundown Syndrome

Rachel looks at her watch. It’s six o’clock, and Grandma Donna is sitting in her chair by the window, knitting a blanket. “Grandma Donna seems calm today,” Rachel thought, but knows that at any minute, she could sit up straight, and demand to go out. Grandma Donna’s normally sweet personality could change in a flash, and she could become angry and confused, demanding her granddaughter not question her.

For the past few years, Rachel has been her family’s main caregiver for her grandmother, who was diagnosed with Alzheimer’s disease. The experience has been incredibly challenging for Rachel, and in recent months, her grandmother has become more and more volatile in the evening.

Sundown syndrome impacts many seniors with dementia

What Grandma Donna is experiencing is a phenomenon known as “sundowning.” According to the Alzhiemer’s Society of Canada, sundowning is when a senior “becomes confused, anxious, aggressive, agitated, or restless consistently later in the day.” This behavior is thought to impact over 60% of people with dementia or Alzhiemer’s. It happens to most people in the middle stage of Alzhiemer’s or dementia. Sundowning occurs at dusk and can continue throughout the night.

Many of Qualicare’s in-home health care and senior care franchise caregivers work with individuals experiencing sundowning. Some typical symptoms of sundowning are:

• Problems sleeping 
• Impulsive actions & requests
• Demanding to leave home immediately 
• Hallucinations or delusions
• Struggling to do tasks they can do during other parts of the day
• Demanding, aggressive, and sometimes violent behavior 
• Wandering around or pacing 
• Sadness and mood swings

Why does sundowning occur? 

As the sun goes down, seniors with dementia become more tired, and they have less energy to deal with the stresses of the day. Physical discomfort like hunger, or pain, are harder to manage, and can trigger these unpleasant symptoms. It is thought that less activity and structure at night, as compared to the rest of the day, can make seniors feel restless. 
Typical triggers of sundowning, according to AARP, are related to the change in the light as well. Low light can create confusion as shadows make the world look different. Sundowning is also thought to occur because seniors in general need less sleep, and also because some people with dementia can struggle with discerning the difference between dreams and reality. Some people who suffer from sundowning are triggered by feelings of fear related to darkness, or the feeling that they need to “go home.”

Tips for decreasing potential sundowning episodes

The Alzheimer Association offers several tips for helping seniors avoid potential sundown episodes.  

• Set and keep the same daily schedule. 
• Take walks or go outside every day to get natural light. This helps to maintain a healthy circadian rhythm for good sleep, and walking eases physical pain. 
• Schedule activities that require some work, like doctor’s appointments or bathing in the hours of the day the person with dementia is most alert — like the morning or mid-day. 
• Light the home well-lit at night. 
• Try to keep stimulation at a minimum in the evening, such as loud television or animated conversations, which can lead to more stress. 
• Limit daytime naps, if the person is struggling with sleep.
• Avoid or reduce alcohol, caffeine, and nicotine, which impact sleep. 
• Take note of what causes sundowning spells and identify the triggers to avoid.

Managing sundown symptoms 

It can be really difficult, and sometimes even frightening to be with an individual who is sundowning. It’s important for caregivers to know ways to de-escalate the symptoms and help the individual suffering from dementia calm down. Here are a few tips: 

• If the individual is feeling restless or is pacing, join them on a walk.
• Don’t restrain a person physically if they are agitated, as it can make things worse. Rather, tell the person their feelings are valid and try to distract them into a calming activity. 
• Have a list of calming activities for the person ready, such as music, a favorite movie, or looking at photographs.
• Use scents to help calm a person who is experiencing sundowning. Essential oils with a calming scent like frankincense rose, and lavender can be soothing. Using a diffuser can be a great way to establish an aromatherapy environment for a senior with dementia. Test scents and see which ones are best for your loved one.

Helping the body recover from sundown symptoms

Our bodies are so in tune with the brain and memory, that creating a calming physical environment can really help seniors transition into the nighttime hours. Physical touch, such as massage therapy, a foot rub, a hot soak in a bath, a loving hug, holding hands, a nice head scratch, etc. can have a big impact on sundowning symptoms. Restorative spa-like treatments are an especially great way to relax the body and soaking in Epsom salts and essential oils can help relieve pain, anxiety and calm the nervous system. Some people who have dementia also benefit from eastern medical practices like acupuncture, Chinese medicinal herbs, and other treatments. 

Rachel walks over to Grandma Donna and puts her hand on her shoulder. 

“How about a nice soak before dinner?” Rachel asks. 

Grandma Donna’s nightly foot treatment has become a part of her routine. Rachel puts on music Grandma Donna loves – Frank Sinatra – and she brings the special foot bath to Grandma Donna’s chair. Filling the tub of hot water with Epsom salts, and lavender oil, Rachel gently massages her feet and sees Grandma Donna smile. Caring for the matriarch of her family in her twilight years has not been easy, but Rachel knows during moments like these, she is really providing relief to her grandmother. Rachel also enjoys the calming environment and has noticed that she too is sleeping better. The lavender scent fills the home, and this night, Grandma Donna eased peacefully into the evening.