In The Evening When The Sun Goes Down: Managing Sundown Syndrome

Early in the evening when the sun goes down is the time for you and your older parent to put aside the cares and chores of the day and prepare for a good night's sleep.

For many people in the later stages of Alzheimer's disease however, the end of the day and the coming of night are upsetting, confusing, even frightening. Instead of winding down and getting ready to fall asleep, these older adults are wide awake, agitated, distressed, fearful, restless and disoriented often far into the night. They pace around the house, see and hear things that aren't there. These disturbing behaviors frequently continue throughout the night and disrupt their caregiver's much-needed rest as well as their own.

IS YOUR PARENT A "SUNDOWNER"?

"Sundowning," as these behaviors are called, is common in older people with Alzheimer's disease and related memory disorders. Over time the physical and emotional stress of sleepless nights may become too much for caregivers to manage at home. They may decide that moving their spouse or relative to a nursing home will be best for both of them.

However, an understanding the sundown syndrome and what causes your parent's puzzling nighttime behaviors can help you develop strategies for coping with these behaviors so that your parent can continue to live at home – and you both will get a good night's sleep.

Common sundowning symptoms include:

• Visual hallucinations

• Disorientation, agitation

• Fear, hostility, paranoia

• Use of profanity by people who never cursed before

WHAT CAUSES SUNDOWNING

It's not clear what triggers its behaviors and why some people with memory disorders become "sundowners" while others do not.

Factors associated with end-of-the day confusion include:

• Physical and mental fatigue

• Daytime napping

• Decreased need for sleep

• Inability to separate dreams from reality

• Difficulty making the transition from daytime to nighttime

• Poor sleep quality

• Nighttime restlessness

• Lack of physical activity

According to some experts dimming of light at the end of the day may also contribute to end-of-the-day restlessness and confusion in people with Alzheimer's.

MANAGING SUNDOWNING BEHAVIORS

One of the best ways to keep your older relative relaxed and ready to sleep at night is to plan a variety of activities for him or her during the day.

Some suggestions:

• Schedule medical appointments, shopping trips and baths in the morning or early afternoon.

• Stick to a daily schedule. While your relative was working or raising a family he or she got up and went to bed at the same time every day. The body gets used to routines and still needs them even in later life.

• Avoid daytime naps.

• Take a couple of walks during the day: outside or at the mall, tidy up the house, pull weeds in the garden, mop the floors and dust. Reduce or eliminate coffee, tea, and soft drinks with caffeine to prevent sleeplessness.

• Fix an afternoon snack and plan an early dinner.

• Turn down the TV and radio at night.

• Plan visits with friends and relatives for the afternoon.

• Encourage your relative to use the bathroom just before bedtime.

• Keep rooms well-lit especially in the winter when it gets dark early.

• Insomnia is a common side effect of many prescription and non-prescription. drugs. Your relative's doctor can reduce the dose or suggest another medication that does not affect sleep.

• Turn inside lights on before it gets dark to avoid shadows that often agitate people with memory loss.

BEDTIME FOR SUNDOWNERS

Before it starts getting dark, close the curtains and put a light on in your parent's bedroom. Turn back the sheets and blankets and plump up the pillows and ask if he or she needs to use the bathroom. Help him relax by reading a poem or prayer to him or just sit together quietly until he gets drowsy.

Sundowners who refuse sleep in a regular bed may prefer to fall asleep in a comfy recliner chair. Give him or her a pillow and a blanket, turn on a small lamp and sit with him until he dozes off.

"SLEEP SWEETLY THEN…GOODNIGHT!"

No matter how young or old you are sleep is essential to good health. As a caregiver for an older adult with memory loss you can help her throughout the day to insure a good night's sleep.