For people who are aged and suffering from health issues sundowning is a maor issue . Sundowners syndrome is behavioral problem that begins generally at dusk and last into the night. Sleep disturbance, restlessness, irritability, confusion, agitation will begin as daylight fades. Symptoms will become worse if the person suffers from dementia or Alzheimer’s disease.

Sundowning makes it hard for the care givers to take rest and sleep. This will cause trouble to caregivers and functioning during day becomes tough for them.

Causes of sundowning syndrome:

Sundowning causes are not well understood. One of the reason could be, according to experts is, changes in brain function and loss of memory. This will affect biological clock resulting in confusion, disturbance in sleep cycle. Other factors that may contribute for sundowning and sleep disturbances could be:

1. Mental and physical exhaustion
2. Biological mix up between day and night – disturbance in internal body clock
3. Loud noises and reduced lighting, increased shadows
4. Inability to distinguish between dreams and reality
5. Hunger, thirst, boredom, pain, depression
6. Reactions to nonverbal frustration from caregivers who are exhausted by taking care

Symptoms of sundowning:

Fear, Paranoia, Wandering, Insomnia, yelling, screaming, rocking, stubbornness, depression, hallucination, shadowing, not eating, not talking etc.

How to cope up with sundowners syndrome?

1. Make comfortable sleep environment: Let the temperature in the room be comfortable. Turn on nightlights, make person feel safe by providing window locks and closed door. Draw curtains to create dusk and night.
2. Maintain schedule : As much as possible bring routine to meals, going to bed and waking up. Encourage person to go to sleep at night.
3. Avoid stimulants: Do not give caffeinated drink, nicotine, alcohol, regular tea at evening. Restrict sweets. Monitor their diet. Discourage watching TV at night. Bright screen keeps person stimulated and causes confusion.
4. Plan activity: Discourage person to take nap in the afternoon. Encourage to step out, to sit in Sun and light exercise four to five hours before going to bed. Turn on TV and let the person watch a familiar show.
5. Reduce: Loud voice, music, audio, number of people in room, clutter that bothers the person and keeps awake.  
6. Exposure to light: Make person sit near window to show bright sun light – this could helps to set the biological clock
7. Melatonin: This natural hormone helps to regulate sleep-wake cycles. Talk to doctor about its interference with current medications.

Approach of care givers:

1.If the person is agitated, approach in calm manner. Find what is causing agitation.

2.Find out what the person wants

3.Minimize the stress and frustration, especially late evenings

4.Do not show anger and avoid arguing

5.Assure the person, that everything alright – nothing to be scared or afraid of.

6.If the person is cranky, use loving and calm words

7.Massaging the feet and leg will help them to calm down. Apply essential oils or massage oils.

8.Provide comfort and familiarity. Use same bedsheets, pillow, chair, plates, cup etc that the person is familiar with.

When to see doctor?

If the problem continues, and person does not sleep then talk to doctor. Doctor might prescribe medications that help to sleep. Understand the side effect of medicines as long term use of these medicines could cause more confusion, fall, dizziness and further complicate memory.

References:

https://www.healthline.com/

https://www.nia.nih.gov/

https://www.alz.org/

https://www.agingcare.com/

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