Sundowning symptoms and how they are experienced
Sundowning is a phenomenon that is associated with increased confusion resulting in a variety of behaviors that you may not see other times of the day. It can happen with any form of dementia. Up to about 50% of persons diagnosed with some form of dementia may experience sundowning. I have my own personal theories about why it happens when it does. Keep in mind that for each person, sundowning may occur at different times of the day - it's called sundowning because it happens later in the day for a lot of people.
Some of the symptoms of Sundowning
- Increased confusion
- "Exit seeking" (wanting to leave or go home-even if they are home)
The specific cause for sundowning has never been proven. Many studies have suggested that this phenomenon happens because of a disturbance in the circadian rhythm or a "built-in clock".Which means activity and behaviors are triggered by time of day, amount of daylight, change in season, full moon (and if you have never been in a memory care unit around dinner time during full moon, you don't know what you are missing!) My co-workers and I always knew when it was full moon by observing behaviors without looking out the window!). Plants, other animals and creatures have been observed to be affected by a circadian rhythm.
Here's my own personal observations, thoughts on sundowning and theory, based on my years of working with the memory impaired.
For some, especially in a facility, I don't always consider the behaviors exhibited around dinner time "sundowning" but rather a result of a day full of activities, visitors, visit with the doctor - simply over-stimulation and the need for a "time out" spending a bit of time earlier in the afternoon (before the sundowning typically starts) simply relaxing - smaller groups, soft light, soft music, maybe a hand massage with some lavendar lotion. While facilities have great intentions in providing a full activity schedule, it may be too much for some. At home it may be over-stimulation or just a need to slow down later in the afternoon - turning off the tv, asking visitors to respect a need to limit time visiting or coming earlier in the day if possible.
Before I give examples, if you have a loved one or someone in your care who sundowns, think about what they did for a living before the disease and what their routine was like. Keeping their former profession and routine in mind, think about what they would have been doing at that time of the day. For someone who has problems with short term memory, as the disease progresses, the only memories that are left are the older memories of their life and routine, going back to when they were in their 30s. 20s, or earlier.
Everyone experiences sundowning at different times of the day. Here are some examples:
A farmer typically starts their day before the sun is even up! I have observed dairy farmers experience sundowning earlier in the day than most. When I look at the biography that I had the family fill out prior to admission and saw what they did for a living and that their day typically started at 3 or 4AM, it made sense to me when they began getting a bit agitated in the early afternoon, even though all their needs were met (they had lunch, perhaps a snack, they were toileted, etc) that 3 or 4 pm was the time of day they would be winding down their day, Moving equipment back in a barn, tending to herd, and after a day in the elements - the sun, the rain, the snow, they were ready for dinner and bed! At times I'd observe my farmer walking in and out of the building, agitated. Could he possibly be thinking, "This isn't my farm!" "Where are my cows, my corn field, where is my tractor?"