Part 3 of 3: Tips for Daily Management, and At-home Therapies

Sundowner’s Syndrome typically affects someone with an underlying case of Dementia and/or Alzheimer’s. The loved one may experience erratic behaviors like agitation, confusion, and personality swings in the twilight to evening hours. The signs of sundowning can be challenging to spot because they may not be repetitive. Symptoms can also be attributed to pre-existing Dementia or Alzheimer’s.

This can make things very hard for the family. Not only do you have to go through the pain of watching your loved one change right before your eyes, but without prior knowledge of sundowning, its signs, and causes, you may never be aware that this is the condition that might be manifesting itself in your loved one.

In Part 1 of our sundowner series, “Sundown Syndrome and the Elderly: Part 1 – What You Need to Know – ‘What is Sundowning, What Causes It, and How is it diagnosed?’” we discussed the original origin of sundowning, how it was first spotted and how it got its namesake. We also reviewed underlying conditions that likely cause sundowning and how it’s diagnosed. If you weren’t aware of what Sundown Syndrome is before you started reading this article, Part 1 can get you up to speed.

In Part 2,Sundown Syndrome and the Elderly: Part 2 – What Are Your Next Steps? Find the Right Doctor, Track Behavior & Ask the Right Questions“, we reviewed a step-by-step diagnosis plan to get your loved ones the help they need. These steps include how to determine whether your primary care physician is best suited to address the condition, what other types of specialists might contribute to understanding or treating the diagnosis, what kinds of tests will need to be done, as well as how families can directly help their loved one by tracking behavior. Additionally, we discussed what to do with the information and how to move forward with treatment.

Next steps after diagnosis

Once the behavior has been identified and diagnosed as Sundowners Syndrome, there are myriad ways you can help at home. It is essential to note, however, that sundowner symptoms do not present as one type of behavior pattern; instead, they manifest as a collection of behaviors with no rhyme or reason other than occurring in the twilight hours.

This makes it almost impossible to find a catch-all fix for all of the symptoms. In light of the above, it is a matter of trial and error to see what works for your loved one.

As with any recommendation, you should always consult your loved one’s primary care physician before implementing sundown home care. If unsure how to start, please read the Sundown Syndrome Part 2: What Are Your Next Steps, as it will provide you with step-by-step recommendations on how to plan at-home treatment and remedies with your loved one’s physician.

Part 3: What you can do at home

What are the sources of these Sundowner recommendations?

In this Part 3 of our three part series, “What you can do at home“, we review household tips, daily management, and at-home therapies for Sundown Syndrome, we will discuss the recommended coping tips and strategies provided by:

The recommendations from these sources, though they are well-documented, should always be reviewed by your loved one’s attending physician first.

Remember that your loved one is a victim.

When dealing with living with Sundown Syndrome day-to-day, it’s important to remember that none of loved one’s actions are done on purpose. They are victims of this disease and are likely far more confused than one may think. You will notice that over time, the confusion aspect of this disease will progress and have its ups and downs.

Some days will be harder than others, and there will be no rhyme or reason to it. You have to take the good with the bad and stick to a routine that works most of the time; you have to be patient. A critical step in maintaining patience is to remember that Sundown Syndrome is not something that you or your loved one can control. Still, some of the following suggestions may help in mitigating some symptoms. As you test and evaluate these suggestions, remember to approach each suggestion from a perspective of providing comfort, support and understanding.

Are there any medications that can help?

Many times, medication is the first question a physician encounters when it comes to daily care of someone with Sundowners. However, medications can carry some risks which can potentially outweigh the possible benefits. While some medications have been proven helpful, the results are entirely dependent on the individual and their physical and mental condition.

It’s critical to note that before considering any medication as a possible treatment option, you should speak to your loved one’s physician for recommendations and/or a prescription. If you have read Part 2 of our Sundowner Series, you will learn how important it is for your loved one’s physician to take the lead in terms of prescribing and medicating, as well as implementing any of the suggested tips in this blog.

The medications listed below tend to be the most recommended for people with Sundowners. That being said, when you speak to your loved one’s physician, consult with them regarding the drugs listed below and ask them, based on their diagnosis, if any of these would help or if they have other recommendations.

• Antidepressant Medications
• Antipsychotic Medications
• Melatonin Supplement (typically helps with sleep issues)
• Anti-Anxiety Medications

If the doctor does recommend any of these drugs, make sure to carefully follow the physician’s exact recommendations and directions for use.

At-Home Treatment

If you are a family member, in-home companion, or medical caregiver who may spend time with someone suffering from Sundowners, consider some of these recommendations as possible means to help reduce symptoms. Keep in mind that none of these recommendations is a cure; this is simply a list of recommendations that have worked for others. What may work for one person may not work for another; therefore, you will need to know what works best for your situation. It is really a matter of testing each suggestion to see what works.

As with any treatment, make sure to consult with your loved one’s physician and let them know what steps you may try out and ask them for any recommendations.

Sundowning Mitigation Suggestions:

Be gentle and understanding: If you are the family member or in-home companion who has to help manage someone suffering from Sundown Syndrome, it is important to convey a calm and controlled demeanor. Pay attention to your body language, the volume, and the tone of your voice. You create what you project, so try to project a calm and peaceful tone and, most importantly, validate your loved one’s feelings. Let them know that they are not alone and that you are there to help in any way you can.

Redirect their focus: If you notice that your loved one’s behavior changes during the same time each day, plan activities just before that time to keep them busy. Look for what opportunities are at your disposal to help distract them, whether it is calm music or a relaxing activity to bring down the energy and tone of the moment. It might be a calming chore like watering indoor plants or calling family or friends for a nice, friendly chat on the phone.

Light therapy: Previous evidence has indicated that exposure to light for one to two hours in the morning can help reduce symptoms later in the evening. A percentage of those people who also suffer from depression have experienced better-than-average results. Weather and mobility permitting, you can take your loved one for a short walk in the sunshine.

Proper lighting in the home: The lengthening of shadows and the shadows themselves are indicators of waning daylight, which can act as a trigger for some people’s behavior. Pay attention to the indoor lighting and see if you can adjust it in such a way that it fills any areas that may be in shadow later on during the day.

Avoid ingesting stimulants: Caffeine, alcohol, and nicotine disrupts the body’s natural daily rhythm and sleep cycles. Avoid any caffeinated products such as coffee or soda and refrain from smoking or consuming alcohol.

Keep evening meals light: The Alzheimer’s Association has reported that it is important to modify your loved one’s diet and eating patterns if they suffer from dementia, the underlying cause of sundowners. A large meal in the evening can increase stress levels, so try to make the afternoon meal the larger one of the day and have a lighter meal in the evening. This will help their comfort level, making it easier for them to rest in the twilight and evening hours.

Keep a fixed schedule: Many healthy people dislike routing , but for a Sundowner routine can be a game changer. Not only will they have something to look forward to, they will likely feel much safer and more secure when they know what to expect from each day’s routine.

Try to limit disruptions in routine: You should plan for deliveries and social visitors in the morning. Your friends and family should be made aware of your loved one’s schedule and routine so that they don’t accidentally create a disruption. Stress to them that you are trying to create a place of calm where your loved one can feel relaxed and safe.

Get some exercise: Exercise can help your loved one relax in the evening hours, and the more active you are, the more the body will seek a restful sleep. Exercise can simply be a small walk around the block or down the street and back, some simple stretching, or something fun like chair yoga. Make sure to take your loved one’s age into account and consult with their doctor for recommendations regarding their mobility and activity levels; then, if possible, plan it so that you’re doing them in sunlight for added benefit.

Fresh air therapy: Some evidence indicates that a probable trigger of Sundown Syndrome occurs due to a problem with the internal body clock disrupting their circadian rhythm. Taking a walk outside in the fresh air and sunlight during the daylight hours can help reset their internal body clock, with the added benefit of exercising helping them get a better night’s sleep.

A good sleep does wonders: There is no doubt that fatigue and lack of adequate sleep can create stress, which will worsen symptoms. Pay attention to your loved one’s sleep schedule and ask their doctor just how many hours of sleep they need per day. Plan your days to have alternating periods of activity and rest to help ensure your loved one gets a good night’s rest.

Don’t neglect your own health during this process.

Do not neglect yourself. Caring for anyone who has dementia or Alzheimer’s, who may or may not be exhibiting sundowning symptoms, can be exhausting. You cannot provide calm, soothing help to your loved one if you are stressed out. Therefore, pay attention to your diet and make sure you get restorative sleep.

Additionally, do not be afraid to ask for help. Enlist other family members, if at all possible, or hire an in-home companion to watch over them and provide you with a respite break.

Our shared goal

Families who take care of a loved one with Sundowners share the same goals as Maxim at Home: We both want your loved one to age in place for as long as possible. Companions can help with this mission by providing that much-needed social interaction that people crave, and by doing so, can give family members time to take care of themselves.

The Maxim at Home team is here to help

Our mission is to redefine independence by providing you with compassionate support you can trust. For more information on how MAH can assist you and your family, explore MAH’s In-Home Companion Services near you, or call to speak to one of our caring Advisors: 1-844-624-5646

SUNDOWNER BLOG SERIES:
Part 1 of 3 – What you need to know • What is Sundowning, What Causes It, and How is it diagnosed?

Part 2 of 3:  What Are Your Next Steps? • Find the Right Doctor, Track Behavior & Ask the Right Questions

Part 3 of 3: What You Can Do at Home • Household tips, Daily management, and At-home therapies

References:

Sundown Syndrome in Elderly Persons with Dementia
www.ncbi.nlm.nih.gov/pmc/articles/PMC3246134/

Light and Older Adults
www.lrc.rpi.edu/programs/lighthealth/lightolderadults.asp

Exercise and Sleep Wellness
www.hopkinsmedicine.org/health/wellness-and-prevention/exercising-for-better-sleep

Daylight Exposure, Exercise and Sleep Quality
www.health.clevelandclinic.org/how-exercise-affects-your-sleep/

Importance of Fresh Air
www.onlinelibrary.wiley.com/doi/full/10.1111/ina.12254

Alzheimers and Sundowning
www.mayoclinic.org/diseases-conditions/alzheimers-disease/expert-answers/sundowning/faq-20058511

Additional Resources

Area Agencies on Aging
(AAA)—A network of over 620 organizations across America that provides information and assistance with programs including nutrition and meal programs (counseling and home-delivered or group meals), caregiver support, and more. The website can help you find your local AAA, which may provide classes in Tai Chi and diabetes self-management.

National Council on Aging
—Works with nonprofit organizations, governments, and businesses to provide community programs and services. This is the place to find what senior programs are available to assist with healthy aging and financial security, including the Aging Mastery Program® that is shown to increase social connectedness and healthy eating habits.

National Institute on Aging (NIA)
– Provides materials on social isolation and loneliness for older adults, caregivers, and health care providers. Materials include health information, a print publication available to view or order no-cost paper copies, a health care provider flyer, and social media graphics and posts.