What do you give for sundowning? Strategies for Evening Agitation

According to the Alzheimer's Association, up to 20% of people with Alzheimer's disease experience sundowning, a common pattern of increased confusion and agitation in the late afternoon and evening. What do you give for sundowning? The most effective approach is often a combination of non-pharmacological interventions and, in some cases, doctor-prescribed treatments.

Quick Summary

The best ways to manage sundowning symptoms often involve environmental adjustments, behavioral techniques, and maintaining a consistent daily routine to help re-regulate the body's internal clock. Treatments can also include light therapy and, under medical supervision, supplements or specific prescription medications designed to address agitation.

Key Points

• Environmental Management: Adjusting lighting, minimizing noise, and reducing clutter can prevent sundowning triggers.

• Routine is Key: Maintaining a consistent daily routine, especially with meals and sleep, helps regulate the body clock.

• Behavioral Techniques: Use distraction, redirection, and soothing activities to manage symptoms when they occur.

• Consider Medical Options: Talk to a doctor about potential supplements like melatonin or prescription medication if non-pharmacological methods are insufficient.

• Limit Late-Day Stimulation: Avoid caffeine, long naps, and intense activities in the late afternoon and evening.

• Ensure Comfort and Safety: Check for and address potential triggers like hunger, pain, or bladder issues that might be causing distress.

Understanding the Phenomenon of Sundowning

Sundowning, also known as 'late-day confusion,' is a cluster of symptoms that occur in the late afternoon and evening, primarily affecting individuals with Alzheimer's disease and other forms of dementia. Symptoms can range from increased anxiety, agitation, and confusion to pacing, rocking, or even aggression. The exact cause isn't fully understood, but it's believed to be linked to disruptions in the body's internal clock (circadian rhythm) and the brain changes caused by dementia. A key aspect of managing this challenging behavior is recognizing that there is no single 'cure' but rather a multi-faceted approach involving environmental, behavioral, and, if necessary, medical interventions.

Environmental Strategies to Create Calm

The home environment can significantly impact a person's behavior. Small changes can make a big difference in preventing or minimizing sundowning episodes. These strategies focus on creating a sense of predictability and reducing triggers that can cause distress.

• Maintain Consistent Lighting: As daylight fades, shadows can become distorted and frightening to someone with dementia. Ensure rooms are well-lit before the sun goes down to eliminate these confusing shadows. During the day, maximize exposure to natural sunlight by keeping curtains open.
• Create a Quiet Atmosphere: Lowering noise levels can reduce overstimulation. This might mean turning off loud televisions, radio shows, or limiting the number of visitors in the evening. Playing soft, calming music or using white noise machines can be soothing.
• Reduce Clutter: A cluttered environment can be confusing and disorienting. Keeping living spaces tidy and organized can help create a sense of calm and predictability. This also reduces the risk of falls for those who pace or become restless.

Behavioral and Routine-Based Interventions

A predictable routine is the cornerstone of managing sundowning. Consistency helps reduce anxiety and confusion by giving the individual a sense of what to expect.

1. Establish a Daily Routine: Keep meals, waking, and sleeping times consistent. Schedule appointments, bathing, and other potentially stressful activities earlier in the day when the person is more alert.
2. Encourage Physical Activity: Gentle exercise during the day, such as a walk or light household chores, can help reduce restlessness and promote better sleep at night. Avoid strenuous activity close to bedtime.
3. Manage Naps: Limit or eliminate long, late-afternoon naps. If a nap is necessary, schedule it for earlier in the day, such as right after lunch, and keep it short.
4. Avoid Triggers: Pay attention to what seems to exacerbate sundowning symptoms. Fatigue, dehydration, or hunger can be triggers. Offer a light snack and a drink in the late afternoon. Avoid caffeine and alcohol, especially later in the day.

Distraction and Redirection Techniques

When an episode of sundowning begins, redirection and distraction are often more effective than trying to use logic or reason. The goal is to shift the individual's focus to a calming, positive activity.

• Offer a Favorite Snack or Drink: A familiar, comforting treat can be a simple but effective distraction.
• Engage in a Soothing Activity: Simple tasks, like folding laundry, looking through a photo album, or listening to a favorite album, can provide comfort.
• Use Gentle Touch and Reassurance: Holding a hand or offering a light shoulder rub, along with calm, reassuring words, can help de-escalate anxiety.
• Create a Safe, Contained Space: For individuals who become a flight risk, ensuring the home is safe and they are contained within a secure area is crucial. This helps both the caregiver and the individual feel more secure.

Medical and Complementary Therapies

Consulting a healthcare provider is essential before starting any medical treatment or supplement. A doctor can rule out other potential causes for the behavior, such as a urinary tract infection (UTI), pain, or medication side effects.

Comparison of Treatment Options for Sundowning

Method	How It Works	Benefits	Considerations
Melatonin Supplement	A naturally occurring hormone that helps regulate the body's sleep-wake cycle (circadian rhythm).	Can aid in establishing a more regular sleep pattern, reducing nocturnal restlessness.	Requires medical approval and can be ineffective for some.
Light Therapy	Exposes the individual to bright light in the morning to help reset the body's internal clock.	Can improve sleep quality and reduce the severity of sundowning symptoms over time.	Requires a special light box and consistent use. Not suitable for everyone.
Antipsychotic Medication	Prescribed by a doctor to treat severe agitation, aggression, or hallucinations associated with dementia.	Can be very effective for severe symptoms not managed by other methods.	Used as a last resort due to potential side effects, including increased mortality risk in elderly with dementia.
Anti-anxiety Medication	Can be prescribed for individuals experiencing significant anxiety related to sundowning.	May help reduce overall anxiety and calm agitated states.	Must be used cautiously; some medications can increase confusion in older adults.

Authoritative Guidance and Seeking Help

Navigating the challenges of sundowning requires patience and support. Relying on accurate, authoritative information and seeking help from professionals is vital. Organizations like the Alzheimer's Association offer valuable resources, support groups, and advice for caregivers.

For more detailed information on coping strategies, refer to the Alzheimer's Association guide on sleep issues and sundowning.

Conclusion: A Holistic Approach

There is no single item you can 'give' for sundowning that will solve the problem instantly. Instead, a comprehensive, compassionate, and patient-centered approach is required. This involves creating a structured and calming environment, using behavioral interventions to prevent and manage episodes, and exploring medical and complementary therapies in consultation with a doctor. By combining these strategies, caregivers can help reduce the frequency and severity of sundowning, leading to greater comfort and well-being for both the individual and their support system.

Frequently Asked Questions

What is the best way to handle sundowning without medication?

Effective non-medication strategies involve establishing a predictable daily routine, maximizing sunlight exposure during the day, ensuring a calm and well-lit evening environment, and using distraction techniques like engaging in a favorite quiet activity or offering a soothing snack.

Can melatonin be given for sundowning?

Melatonin is a naturally occurring hormone that regulates sleep, and it can be a useful supplement for some people experiencing sundowning. It should only be given under a doctor's guidance, as results can vary.

What kind of environment is best for someone experiencing sundowning?

A calming, predictable, and well-lit environment is best. This means keeping noise and clutter to a minimum, closing curtains at dusk to prevent confusing shadows, and playing soft, soothing music. Consistency in the physical space is comforting.

Should I try to reason with someone who is sundowning?

No, reasoning with someone in a sundowning state is generally not effective and can increase their agitation. They are experiencing confusion and a logical conversation is difficult. Instead, use gentle reassurance, redirect their attention, or use a comforting touch to help them feel safe.

What triggers sundowning episodes?

Common triggers for sundowning include fatigue, hunger, dehydration, overstimulation, changes in routine, pain, and a disruption of the body's internal clock due to reduced light. Noting patterns can help caregivers proactively prevent episodes.

How can I prevent sundowning from happening?

Prevention strategies include maintaining a consistent daily schedule, ensuring adequate light exposure during the day, limiting daytime naps, avoiding caffeine and heavy meals in the evening, and engaging in calming activities during the late afternoon transition.

Are there any medications that can make sundowning worse?

Yes, some medications can worsen confusion and agitation in individuals with dementia. It's crucial to consult a doctor about all current medications, including over-the-counter sleep aids or antihistamines, as they can sometimes have an opposite effect.