Does your beloved adult get restless in the evening? Let's talk about Sundowning!

Does your elderly mother, father, grandmother or grandfather seem to be doing well during the day, but suddenly start to get anxious, restless, and confused in the evening, as the sun sets? You may have experienced this. This can be a really difficult experience for you and for them to take care of. In medical terms, we call this condition "Sundowning". Let's talk about it simply and kindly today.

Simply put, sundowning is a collection of symptoms that many people with dementia , especially Alzheimer 's disease, experience in the afternoon and evening. These include confusion, insomnia , anxiety, wandering , and hallucinations. In fact, about two-thirds of people with Alzheimer's experience this condition. These symptoms begin to appear as the sun sets and darkness falls. They increase as the evening approaches and usually subside in the morning.

What are the symptoms of sundowning?

A person can exhibit a variety of symptoms during a sundowning episode. Let's take a look at some of the most common ones.

Why does this happen? What are the causes of sundowning?

Doctors still don't fully understand the exact cause of sundowning, but there are a few things they think may contribute to it.

• Body Clock Problems: Our bodies have an internal clock that tells us when to wake up and when to go to sleep. Alzheimer's patients have damage to the part of the brain that controls these signals. Scientists believe that this rhythm in the body can be disrupted, leading to sundowning.
• Certain medications: Some medications for conditions like depression and Parkinson's disease can cause confusion and restlessness as a side effect or as their effects wear off.
• Other causes: If your loved one has these things, they are more likely to experience sundowning.
• Feeling extremely tired throughout the day.
• Hunger or thirst .
• Depression.
• Having some pain in the body.
• Being lazy and doing nothing.
• Having sleep problems.

What are the triggers that make this situation worse?

Sundowning symptoms can also be exacerbated by certain things happening around the patient. We call these 'triggers'.

• Low light and shadows: As the light inside the house decreases in the evening and shadows fall, the patient may feel afraid and anxious because things cannot be seen clearly.
• Confusing reality with dreams: Sometimes they can confuse the real world with their dreams. This increases confusion.
• Unfamiliar environment: This condition can be exacerbated when you are in an unfamiliar place, for example, in a hospital or another person's home.
• The caregiver's mental state: This is also very important. It's normal to feel tired and frustrated by the end of the day after caring for your loved one. But how you handle those feelings in front of them can affect them. They can sense your anxiety even if you don't say it.

How to manage sundowning?

While we can't stop this completely, there are many things we can do to manage these challenging times.

Look for patterns

Pay attention to what times of the day your loved one is most anxious and what is happening at that time. It could be because the TV is too loud. If so, turn down the volume at that time. Identify these triggers and try to avoid them.

Keep a daily routine

A consistent routine is very comforting for dementia patients. Because they know what's coming next. So, get into the habit of waking them up, feeding them, and putting them to bed at the same time every day. Encourage them to do activities like taking them for walks early in the day, when they're feeling better. Try to schedule doctor's appointments, visits to relatives, and bathing early in the day.

Limit things that disrupt sleep

• Stop smoking and alcohol completely.
• Only give sweet foods and caffeine (tea, coffee) in the morning.
• Dinner should be light and simple. Serve a good meal at noon.
• Avoid exercising within 4 hours of bedtime and taking naps during the day. If you must take a nap, it should be a short nap and early in the day.

Keep the evening calm.

• In the evening, close the curtains and turn on the lights before it gets dark. The darkness and shadows can make them more anxious.
• Keep the room at a comfortable temperature.
• Ask other people in the house or guests to be quiet during that time.
• Put on some light, calming music.
• Engage in a light activity, like reading a book or playing cards.
• Turn down the volume of loud things like the TV and telephone, or turn them off.

How you should respond

• Stay calm: If you panic, the situation may get worse.
• Ask him: Ask him kindly what he wants, what his problem is.
• Don't argue: Never argue with them. Instead, reassure them by saying, "It's okay, I'm here." Holding their hand or patting their back can help them calm down.
• Distract: Talk about another topic. Do a simple task together, like folding some laundry. Put on a TV show he likes.
• Let him walk if he wants to: If he wants to get up and walk, don't try to stop him. Instead, stay close to him for safety.

When should you seek medical advice?

If you've tried all of these things and still can't get your sundowning under control, talk to your doctor . Also, if you suspect that it's caused by a urinary tract infection (UTI), sleep apnea, or another medical condition, be sure to see a doctor. It's also important to talk to your doctor about whether the medication you're taking to help you sleep is causing you to feel more confused the next day.

As a caregiver, you also need to think about yourself.

Caring for someone with sundowning can be mentally and physically draining, so it's essential that you stay healthy and well-rested to be there for your loved one.

Sundowning, dementia, Alzheimer's, elder care, mental health, memory loss, confusion