Alzheimer's A to Z

with Dr. Jytte Fogh Lokvig


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Sundowning

Sundown Syndrome


It’s natural for all creatures, including us humans, to react to changes in the light late in the day, although for most of us it’s too subtle to notice. Some people with Alzheimer’s and another dementia are extra sensitive to the waning light and may experience this as a physical phenomenon, leading to anxiety, agitation and confusion. The condition may be aggravated by hunger and boredom. A small snack and a low-key activity, such as listening to soothing music will often help.


Sundowning vs Bodyclocks

However before we attribute this behavior to “sundown,” it’s good to consider that this may be reactions to internal body clocks.


The majority of us spend our lives in routines and most of us don’t need clocks to tell us what time it is. It’s in our bones. If we spent decades in nine-to-five jobs, we knew when to leave in the mornings and when to wrap up and call it a day in the late afternoon; if we were stay-at-home mothers and housewives our routines were around our children’s school schedules and meal preparations. These internal clocks stay with us long after we no longer need them. If we develop Alzheimer’s or dementia and lose track of where we are in time, our body clocks may return.


Marge -

Marge had been moved from her own apartment in a care facility to the secure Alzheimer’s wing. There had been no attempt to gently transition her into this restrictive environment. Although she was in the advanced stage of Alzheimer’s, she recognized right away that this was a secure unit (locked) and was understandably devastated.

The first day went pretty well, all things considered; Marge was confused and unhappy, but tried her best to fit in, but in mid-afternoon she was at the locked exit door trying in vain to work the code on the keypad. When her attempts failed she started pounding on the door and yelling for someone to open it. Several minutes later she had collapsed into a pile on the floor, sobbing.


Staff tried valiantly to coerce her back into the common room with no luck. The more they tried, the more hysterical she got. Finally two aides dragged her screaming away from the door. Once they had gotten her into the common room, it took considerable time and effort from both of them to calm her down.


Marge continued to adjust quite well during the day. She was by nature a social person and during that first week, she was quick to make friends with the other residents. However, by mid-afternoon she was back at the locked door and her agitation increased. After a few days of this scene every afternoon, we knew we had to intervene one way or another. A conversation with her daughter gave us our approach. When her children were young, Marge would pick them up from school every day in the mid-afternoon. This information explained her outbursts. We suspected that the stress of the move into an unfamiliar environment had activated her old body clock and sent her into this altered reality. In her mind, she was a young mother and her children were stranded in front of the school and this locked exit was preventing her from reaching them.


We used the same "loving lie" until one day, a couple of weeks later, when she seemed to have forgotten all about the school, the children, and the exit door. We took this as a sign that Marge finally felt safe in her new environment.


A "loving lie* (also known as therapeutic lie) is a response within a confused person’s reality at the moment.



SUN-UP SYNDROME

A few people with dementia have all the symptoms of sundown syndrome except that it happens only in the morning, not evening.


This could be so-called “dawn phenomenon,” brought on by a sharp increase in blood sugar in the early morning hours.


If this is happening to your care partner, please consider these factors:


     She may react if your morning routines are very different from what she’s used to. 


     I would suggest that you review her old habits: 


     Does everyone else get up early whereas she likes to sleep in? 


     You serve full breakfast whereas she’s used to only tea or coffee? 


     It may have to do with bathing and shower rituals? 


     

Try to involve her in your morning preparations.

She can help with breakfast, laundry, dusting, or whatever captures her fancy.


Above all, you want to avoid conflict with her. A rule of thumb for caregivers:



Never argue or admonish. It doesn’t work and it’s very much harder for people with memory-impairment to shake bad feelings, so it’s important to help her stay positive.