Living With Hospice

Episode 25: The 7 Minute Scoop: What Is Sundown Syndrome, And How You Can Manage It.

July 21, 2020 Mitch Ware Season 1 Episode 25
Living With Hospice
Episode 25: The 7 Minute Scoop: What Is Sundown Syndrome, And How You Can Manage It.
Show Notes Transcript

Many people suffering with one of the many forms of dementia, experience a strange restlessness around mid to late afternoon. This restlessness usually carries on into the night adversely affecting sleep. This phenomenon is called Sundowning. In this short 7 minutes, Mitch Ware gives us the whole scoop on how we can manage Sundown Syndrome. 

Hello and welcome to another episode of Living With Hospice. This is one of the abbreviated versions where we squeeze everything into seven minutes, hence we call it the seven minute scoop. 

You know, I've noticed people on social media boards are asking a lot of questions about a strange behavior called sundowning. Sundowning is a group of symptoms with one of the different forms of dementia that typically start my own separate time and continue into the night. Although the exact reason why sundowning happens is really not known. Researchers believe it's a just a disruption in the circadian rhythms, in other words, a disruption to our natural body clock. 

For the most part, sundown syndrome is characterized by agitation, confusion, anxiety, and sometimes even aggressiveness. Other symptoms may be a little more subtle, like increased and regular demands. durations of anger or maybe feelings of depression, periodic anxiety, extreme agitation or frustration. Maybe there's an unknown fear. They're just cowering in a chair and scared of something. Sometimes they're delusionals. Sometimes there's hallucinations. Sometimes there's just random out of the blue emotional outbursts. There's also - what is really very common - -pacing or wandering. I had a patient at one of our facilities that would just walk the perimeter of a room for hours at a time. 

Typically, the timing of the beginning of sundowning varies from one person to another. The symptoms can interfere with sleep, create a sleep deprivation. What causes sundown syndrome, nobody really knows for sure, but we do know that there are some common triggers that have been identified. Research suggests that contributing factors may include some of the following, like sensory deprivation, or sensory overload. For example, too little or maybe too much like, maybe sounds in the room that are really really loud, or real strong aromas. unmet physical needs can also be a trigger like hunger or pain or fatigue. also limited mobility or social isolation, increase stress levels due to, like maybe too many people around unfamiliar environments can also be a trigger. Big changes in routine can also be a trigger and often are. 

So here's some ideas for managing sundowning. Once behavioral changes in your loved one have been identified as sundowner syndrome by the doctor, there are steps you can take to both prevent and manage it. First and foremost, you got to be patient, important to set aside frustration and Really take on whatever steps necessary to minimize these triggers and symptoms. 

Here are some simple tips for how to deal with sundowning: 

First of all remain calm. We're going to be patient, we're going to be calm. Avoid raising your voice. Don't make any unexpected or fast movements. The idea is to just have calm in peace in the room. 

Next, try to figure out what the trigger is at the time. You may have to ask some questions to identify any unmet needs like Are you in pain, or what seems to be bothering you or what's going on? Don't argue and don't push too much. Reduce the stimulus, turn the radio or TV off. Keep the curtains drawn to avoid any changes in light which could trigger an episode. Always make sure that the environment in the room is peaceful and calm with limited distractions, especially starting at mid afternoon. noon to late afternoon and evening. 

Keep your loved one active and busy during the day. It's kind of like when we had children and they were not going to bed on time we had keep them busy during the day, keep them active, and maybe reduce the time of their nap or take away a nap all together. 

Develop a daily routine for your loved ones stick to it as best you can. This helps them stay oriented and reduce their anxiety. 

Try to present calming activities in the afternoon and evening such as maybe watching an old movie or listening to soothing music, maybe do some bird watching out the window, or read to them from their favorite book. 

Ask the doctor about any medications that could positively impact those symptoms. 

On the other side of things, you may want to try some some light therapy, try music therapy, try some aroma therapies. Again, we're looking to calm the loved one down and not overstimulate them. 

As with all memory patients, including sundowning be sure that certain safety precautions are always taken. Make sure all doors and windows have childproof locks in case your loved one becomes agitated to the point where, while they they try to escape. Install nightlights to keep things partially lit at night and prevent further disorientation or fear. 

Keep a close eye on your loved ones diet. Make sure to restrict stimulants like caffeine and sugar intake in the afternoon. 

While it's normal for dementia patients to experience sundowning from time to time, you should never ignore any of these symptoms. Chronic sleep deprivation can worsen symptoms of dementia so talk to your loved ones hospice nurse or doctor if they're having trouble sleeping. You should also contact your hospice nurse if your loved doing symptoms become more frequent or more severe sundowning can sneak up on caregivers.   Sometimes we don't even realize it's there too. We're right in the middle of it, it can start out very, very subtly and gradually gets worse and worse and worse. 

There's no known cure. As people's disease advanced, the sundowning may diminish or disappear altogether. If you think you're at the beginning of seeing these symptoms in the loved one that you're taking care of, call your hospice agency right now get on record, let the nurse come and reevaluate and give you some good tips and reevaluate your plan of care. 

And there you have it, another Living With Hospice 7 Minute Scoop.  Drop us a note on our website, please!   Let us know how we're doing!!

You can also find us at  We really appreciate your feedback. Until next time, this is Mitch Ware!  Have a blessed day!