Have you ever had someone visit you from a foreign country? Until they adjust to your time zone, they will be awake and energetic when you want to sleep, and will want to sleep when you’re awake. That’s very similar to Sundowners Syndrome.
There is a big difference though.
Unlike your friend from the other country, people with Sundowners Syndrome don’t really ‘adjust to your time zone’. Sundowners Syndrome mostly affects people with Alzheimer’s or Dementia. Once they have it, they might have it for the rest of their life.
And because their family has to care for them much more than a visitor from a foreign land, Sundowners Syndrome can take a huge toll on the family. We see a lot of families bring one or both of their parents to our assisted living homes as a result of Sundowners Syndrome.
What is Sundowners Syndrome?
Sundowners Syndrome is more an affect of underlying problems than a disease or malady itself. People with Alzheimer’s, Dementia, or are just elderly become more anxious and scared. Especially when the lights start going down at night.
There doesn’t seem to be a true consensus on what causes Sundowners Syndrome. We’ve heard some theories from Doctors in our homes including:
- Hormonal imbalances that occur in the evenings
- Disruption of a person’s circadian rhythm by the Alzheimer’s or Dementia
- Not being able to distinguish easily between dreams and reality
- Inability to have a good night’s sleep causing fatigue
Whatever the reason, Sundowners Syndrome is very prevalent in people with Alzheimer’s or Dementia.
Here is an example of someone with Sundowners Syndrome:
Recognizing the Symptoms
If you are caring for a parent or family member with Alzheimer’s or Dementia in your home, you will probably be able to easily tell if they have Sundowners Syndrome.
Just think about someone who is not used to the time zone.
Then throw in some moodiness, anxiety or anger.
Here are some of the symptoms we see from some of the residents in our assisted living home. Residents with Sundowners start experiencing these symptoms late in the day or at night.:
- Ranting and yelling
- Inability to go to sleep
You get the idea. Each resident who shows signs is different. There isn’t a checklist to see if they have it or not.
And just like each resident shows different signs of having the problem, they also need different approaches to treating it.
Best Tips and Techniques To Mitigate Sundowners Syndrome
After many years of dealing with residents who show signs of Sundowners Syndrome, our caregivers have offered up their best ways to deal with it. Hopefully these tips and techniques can help you if you’re caring for someone who has the problem.
Remember that it is very difficult to tell what will work until you try different approaches. You may only have to do one of these. Or several. Or all of them. Or none of them will work. They key is to keep trying until you find something that does. For your own sake as much as your loved one.
Easier said than done when your elderly relative is yelling at you. Especially when you have been up with them the past three nights and you’re at your wits end.
The trouble is that your loved one can sense your anger and frustration. Then they feed on it. They become angry and frustrated themselves. Therefore if you stay calm, they may calm down.
Keep a Log
The State of Arizona mandates that we keep a log of all our assisted living residents. Their medications, activities, vital signs, etc. That way we can tell what is working and what is not.
You definitely should not feel like you have to keep a log as detailed as ours. But you might want to take note of what was going on when your loved one starts showing signs of Sundowners Syndrome. Lots of people find that there are certain ‘triggers’ that cause Sundowners to kick in.
- Is there a certain medication that causes it?
- Does it happen right when the sun goes down?
- Is the person taking naps during the day?
- Are they waking up very early?
- What foods are they eating?
- What are they drinking?
- What TV shows do they watch?
- Are there a lot of people in the home that are very active at night?
Being a detective can help you figure out what is initiating or increasing the Sundowners Symptoms. Once you see a pattern, try to eliminate what you think might be causing the problem. Most importantly remember that there may be a host of different factors involved.
Keep Daily Schedules Predictable
Sudden changes in daily routines can lead to anxiety. Anxiety makes it hard to sleep for anyone, let alone the elderly. Even more so with those who have Dementia.
It is much easier for our caregivers to establish a routine at our assisted living homes probably than for you to do it in your own home. That doesn’t mean you shouldn’t try. Having your loved one wake up, go to bed and have meals at the same time every day will go a long way towards making them feel more relaxed.
Avoid Caffeine and Sugar
This one is tough. We’ve found elderly people REALLY like two things:
- Coffee and
They grew up in a generation before the nutrition and health craze kicked in (remember cigarettes?). Many of them are at least mildly addicted to caffeine and sugar. Ironically the sugar may be a big contributor to their Alzheimer’s in the first place.
Ideally, we would recommend that people with Sundowners Syndrome cut out both caffeine AND sugar until their symptoms are greatly reduced or eliminated. We know that it may be really tough to do (if you’ve figured out how to eliminate it, please let us know!).
Anything you can do to cut down on either sugar or caffeine will definitely help. At the very least, see if the person can have their daily dose in the morning only.
Keep Rooms Well Lit, Even After the Sun Goes Down
This seems like the wrong thing to do at first. Lots of advice you see on sleep these days says to decrease the amount of light exposure as bed time approaches.
That works well for people in good health. With Alzheimer’s and Dementia it’s different. Older people become a lot more nervous and anxious, particularly when the lights do down. You have to think of it more as dealing with a small child. Although the elderly person is not worried about the monster under their bed, they are concerned.
Try to keep rooms well-lit before they go to bed. Then when they are in bed, consider having a night light. Sundowners may just be afraid of the dark. Having some light may calm their fears.
Here is a video with some wild ideas for night lights:
Also don’t forget to make a lit path for them to get up and walk around, if they are able. It would be terrible to take care of the lighting in their room only to have them fall during a bathroom trip.
There are certain vitamins and supplements that can help an elderly person sleep at night. Some of them are similar to what anyone could use with a sleeping problem:
Let me just say that we DO NOT give our residents any vitamins, supplements or medications without a Doctor’s order. Besides it being illegal for us to do so, we would want to work with our Doctor.
Elderly people typically are on a lot of different medications. Mixing their prescription medications with other vitamins or supplements may cause a severe reaction. We HIGHLY recommend you work with your Doctor or pharmacist to determine the best set of medications for Sundowners Syndrome.
The body has a remarkable ability to heal itself. Granted this ability is less in the senior population. It is still there. You just have to help your loved one’s body have the fuel it needs to improve.
We already talked about removing sugar and caffeine. Think of other whole foods you can provide. Lots of fruits and vegetables will help. Lots of processed foods probably won’t. The more you can improve the diet of your parent or relative, the less anxiety they will have.
We’ve had some remarkable success by changing the diets of our residents. Our residents become stronger, happier and more self-confident. It lowers their stress levels and therefore their Sundowners Syndrome.
Reduce their Stress
This theme has been running through most of the other techniques. It’s still worth mentioning on its own. When you see someone with Sundowners Syndrome, they will be agitated and restless.
Same as any younger person who might be very stressed out.
Try to figure out what is stressing them out. Talk to them and reassure them. Because when you’re dealing with someone who has Alzheimer’s, they may be living in a different reality. Don’t try to bring them back to your reality. Don’t contradict them or argue. Play along with them. Make them feel like they know what is going on.
Once you have figured out what you think is causing the problem, you can try to distract them from it. Our caregivers will often gradually change the subject to something nice and peaceful. We talk to residents about their pets, grandchildren or the weather. Find something to take their mind off whatever is stressing them out.
Take Care of YOU, the Caregiver
If you’re stressed out, your loved one will be stressed out. That’s when Sundowners Syndrome kicks in. It will then make you more stressed out and make your loved one more stressed out. It’s a vicious circle.
Therefore we make sure our caregivers have plenty of rest before they show up for their next shift. If they have a lot of problems outside of work, we find a substitute caregiver. It’s very important for you to do the same thing.
Try to find time to relax. Practice meditation. Or do whatever you need to do to get your life back. You can hire a caregiver from one of the home health agencies to give you a break. Or have another family member step in for a while.
It’s very easy to burn out when caring for an elderly family member. Many people feel like they have to be a martyr in order to take care of their family. Don’t be that person. Your family loves you just as much as you love them. They want you to take care of yourself.
Talk to everyone else in your family. Map out a strategy that will help you maintain balance in your life while still making sure your elderly relative receives the care they need.
Can We Help?
I hope this article helps you with your Sundowners Syndrome issues. If we can be of further help or assistance, please don’t hesitate to reach out and contact us. You can reach us on Facebook (@aparadiseforparentsassistedliving), through the form on the home page of our website, by email – Cam@aparadiseforparents.com or call us at 623-295-9890.