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Sundowning – Not the beautiful sunset you might imagine!
by Reece Jobe
“Sundowning” a term that only a few know about unless you work in dementia care of course! Well, I am about to help change that. I can remember being appointed to my first care position which was a Health Care Assistant for a domiciliary agency and thinking “Great! I have studied A levels in Health and social care this shouldn’t be so hard.” Joke was on me, because how very wrong I was! Welcome to a mind field of abbreviations, terminology and working with people directly.
I have worked in the Health and Social care sector for just shy of 10 years now working in different roles and used techniques that really support people with dementia experiencing the affects of Sundowning.
What is Sundowning?
Sundowning is an American term used to describe changes in behaviour that occur in the evening, around dusk, this is normally associated with dementia. It is often understood that people who are affected by Sundowning experience increased levels of anxiety, confusion, aggression and generally being more agitated. This is not to say that other changes in behaviours will not happen. Everyone is different. In my personal experience Sundowning is always exacerbated in the winter months due to the lack of natural day time light.
Why does Sundowning happen?
There is no straight answer but, hopefully I can give you an insight to help you understand. Firstly, it is important to understand that Sundowning is thought to be a part of our natural body clock, we all have one hence why some of us love to get up super early and get on with the day but if you’re like me mornings are a no go! Body clocks are caused by the chemicals in our brain which tell us when we should be thinking about going to bed or getting up in the morning.
So, it is simple really if you are not getting enough sleep then this can trigger the Sundowning effect.
Secondly, hunger can be a trigger of Sundowning, so afternoon snacks are welcomed. I would suggest having something healthy but who does not enjoy a little cake in the afternoon?! This leads me on to ensuring that we all drink enough water, you have heard it 1000 times, but it is true! I am not going to bore you with facts of why it is imperative to drink water just do it your body will thank you.
Thirdly, another trigger might be physical needs. It is easy to forget sometimes, but we all have basic needs. Think about it, when you need the toilet and cannot go for whatever reason it is painful and makes us feel uncomfortable and irritated. If someone living with dementia is un-able to communicate verbally that they need to use the bathroom its highly likely that they are going to become unsettled and possibly show signs of Sundowning.
This is the same for pain, my advice is to rule out these immediate issues. Ask the individual are they: In any pain? Do you need the use the bathroom? Or would you like a drink and a bite to eat?
This time of the day does not need to be perceived as negative, if you can get into the habit of spending some quality time with someone during the later afternoons/ evenings then great.
If you are still experiencing Sundowning then consider the environment. It is very easy not to really be aware of your environment, especially if its somewhere very familiar to the person who is experiencing Sundowning. Stop! think about what going on, is the Television on in the living room, and the radio playing the kitchen? Or is there lots of people around talking and making lots of noise. Maybe the room has become quite dark as the evening is drawing in?
Try and eliminate environmental factors that could be increasing to the individual’s anxiety.
Symptoms of Sundowning
Learning to see the symptoms of Sundowning is not something that you can pick up overnight, and again I want to stress that everyone is different and will display signs in different ways. However, I am going to keep it short.
In addition, the individual who is experiencing Sundowning may become agitated, distressed, or even become aggressive towards others.
Help is at Hand
I completely understand that this can be a distressful for everyone who is involved in the situation. I use many of the tips that I am about to suggest helping defuse situations. I find they really help the person living with dementia to become calmer and more relaxed.
Do not get angry!
Yep it is a stressful situation and you are also tired from your day but please trust me when I say it. If you become angry and frustrated, you are only adding fuel to a fire you do not want.
Try and use distraction techniques, it is important to think about what the person finds enjoyable, maybe go for a walk, or sit and share a drink together in a relaxing atmosphere. Remember the individual might be trying to communicate something to you, like needing the toilet or and they are in pain!
Validation techniques are also helpful when people are asking for loved ones, ask about that person! “tell me more about that them, what did they do, what did you love doing with that person”
Understand why that individual is asking for a certain person like their mother or farther. It is understood that when a person asks after their mother, they are likely to want to feel loved and cared for! If they are asking after their father then the person is wanting to feel safe and secure.
Natural light is so important to us, we are much a like a humble house plant we need constant light and water. Try and get plenty of natural light during the day and shut the curtains and turn on the lights just before dusk. Its super simple but can be effective.
Sundowning will not affect everyone who is living with dementia. Sometimes it comes, sometimes it goes. However, what is known that it does not need to ruin your evenings especially on those dark winter days. If you can change your mindset and think about that time as being some precious one-to-one time, then you are making great steps forward. I acknowledge that it is easier said than done but have faith in your newfound skills and you can start to make a change.