One of the most commonly asked questions by families and the caregivers of people who are experiencing dementia is how to deal with sundowners syndrome. There is a kind and effective way to alleviate the restlessness and irritability that PLWD (people living with dementia) often experience toward the end of the afternoon or in the evening, and it includes none of the side effects that accompany anti anxiety medications. But first we need to understand why sundowning occurs and what sundowners means.
What is sundowning? What can trigger sundowners syndrome?
When someone becomes more confused or irritable, or is restless and unable to settle down, we say they are sundowning or experiencing sundowners syndrome. Sundowning may occur when someone is experiencing dementia, but is not experienced only with dementia. It is a normal and common human behavior, one typical of anyone who is stressed—usually from having had too much or too little stimulation.
It’s helpful to remember that in one way our brains are like our stomachs: both need input. And, if they don’t get what they need, both make us uncomfortable until they do. When someone is hungry, their stomach constantly reminds them that they need food and they find it harder to relax or sleep. Our brains operate in much the same way: they are designed to process sensory stimulation; if they don’t get enough, we become irritable and restless and find it difficult to relax or sleep.
What can I do to decrease sundowners symptoms in PLWD?
When I was providing dementia care along with my staff who were trained in using the DAWN Method, we seldom saw our clients sundown because we filled their days with enjoyable activities and interactions. We didn’t believe that PLWD needed a low-stimulus environment: we believed they needed a managed stimulus environment—one filled with what was pleasing to them rather than what was unknown or unpleasant. Each of our clients had a very personal shortlist of sensory stimuli that made their hearts sing.
Be a beauty detective
Knowing that they could not initiate activities for themselves, we became their beauty detectives. We looked for whatever we could bring to them, or take them to, that they would find beautiful to smell, taste, see, touch or hear. Our role as their care partners was not just to keep them safe, but to do for them what they could not do for themselves: to find positive and welcome sensory stimulation each day so they could relax later in the afternoon and sleep better at night.
We discovered that one of our clients loved going to the Washington State University campus where grizzly bears were kept in an outdoor paddock. Seeing the bears never failed to bring wonder and joy to her day. Another loved classical music and ice cream. We took turns accompanying her to concerts in the evenings, and consuming bowls of the extra rich ice cream made daily at Ferdinand’s Creamery. Another had been a handyman and enjoyed trips to local hardware stores; another could spend hours in the arboretum enjoying the flowers and plants; another found her heaven in our local JoAnn Fabrics store. Another needed to go for scenic drives and savor the scenery of the Palouse region (her late husband had been a plein air artist and our drives brought back many happy memories of days spent with him in the hills surrounding her home.)
Is sundowners a disease or a symptom of dementia?
It’s helpful to understand that sundowners is not a disease or a symptom of dementia, but an expression of the restlessness and irritability we feel when our brains have had too little or too much stimulation. Small children often become irritable and cranky toward the end of the afternoon, too. Parents respond by prescribing naps. When we nap, our brains are able to process what we’ve encountered so far in the day. For children and those of us who are navigating life with fewer memory skills, rational thinking skills and attention skills (the skills we lose to dementia), it is harder to process an entire day’s experiences and we may need a nap to give our brains a chance to “catch up”—to sort and process and make sense of all we’ve encountered so far. If the problem was too much stimulation, a nap would allow them to recharge and then enjoy the rest of their afternoon and evening.
So if your loved one is exhibiting sundowning behavior, look at it as the expression of too little positive stimulation or too much negative stimulation. Put aside worries and tasks for an hour or two and find something beautiful to enjoy together. After all, the scent of the rose remains on the hand of the giver. And you both deserve to enjoy something beautiful.