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Memory Care Facility

What Is Sundown Syndrome and How Caregivers Can Cope with It

John Trevey on Sep 25, 2023
What Happens During Dementia - Barton House, Sugar Land, Texas
Table of Contents
  1. Symptoms of Sundown Syndrome
  2. What causes Sundown Syndrome?
  3. Tips for Coping with Sundown Syndrome
  4. Sundown Syndrome vs. Delirium

If you’re a parent, you likely experienced the “witching hour” when your child was an infant—the evening hours when your baby is especially fussy or cranky. It’s not a time parents look forward to. Both you and your baby are exhausted, but you know your greatest task is still at hand: getting your baby to sleep.

For people who are living with dementia, their “witching hour” is known as “sundown syndrome.” Sundown syndrome is irritation, agitation or confusion that occurs in the late afternoon and evening hours. Similar to young parents, this time of day can be exhausting for caregivers who know that their loved one needs a good night’s rest, but sundown syndrome may get in the way.

Caregivers can find solace in the fact that sundown syndrome is very common among those who are living with dementia and Alzheimer’s. As many as 66% of those with moderate to severe cognitive decline experience it. Sundowning is typically seen in those who are still living at home, but happens in memory care facilities as well. The location doesn’t matter.

Understanding more about sundown syndrome, its causes and its symptoms can help you and your loved one cope with it.

Sundown syndrome is irritation, agitation or confusion that occurs in the late afternoon and evening hours.

Symptoms of Sundown Syndrome

Common symptoms of sundown syndrome include:

  • Restlessness
  • Irritability
  • Confusion
  • Disorientation
  • Wandering
  • Hallucinations
  • Mood swings

Sundown syndrome can begin as early as 3 or 4 p.m. and continue into the night hours. A change in the light outside is typically what triggers symptoms.

What causes Sundown Syndrome?

There are no agreed-upon causes of sundown syndrome, but experts have a few theories.

1. Brain fatigue

The brain of someone with cognitive decline has to work extra hard throughout the day to understand what is going on around him. Some experts think by mid-afternoon through the end of the day, the brain is fatigued and starting to wear down, which can lead to a meltdown of sorts, causing agitation during this time of day.

2. Triggering of old memories

Sundown syndrome can begin between 3 and 4 p.m.—this is typically a busy time of day for people who work or pick up kids from school. As this expert explains, although the person with dementia is likely no longer working or picking up kids from school, it’s possible her brain and body remember this as a busy time of day, triggering her to become more active. When she doesn’t have anything to do or anywhere to go, she may become agitated or irritable, especially if her caregiver is encouraging her to calm down or be still.

3. Caregiver exhaustion

Caregivers are often tired by the end of the day. They may be agitated with their loved ones or tired of taking care of them, needing time for themselves. This article suggests the loved one can sense this from his caregiver and may respond with sundown symptoms, unable to express how he’s feeling and unable to ask his caregiver how she is feeling.

Other possible causes of sundown syndrome include fatigue, depression, boredom, and poor sleep.

Tips for Coping with Sundown Syndrome

Sundown syndrome may feel overwhelming for caregivers, but you are not helpless at this time of day. There are behavioral and environmental changes you can make that may help reduce your loved one’s symptoms.

Dr. Natali Edmonds, a geropsychologist and the founder of Careblazers—a community and resource hub for caregivers — suggests adopting the following strategies to help manage your loved one’s sundown syndrome.

1. Set and stick to a routine.

Set up a predictable route for your loved one. Eat meals at the same time of day, have activities during certain times and establish a nighttime routine. These will help keep your loved one regulated and calm throughout the day.

2. Prioritize sleep.

Make sure your loved one is getting the right amount of sleep at night—not too much and not too little.

Avoid stimulants like caffeine and alcohol in the evening as these can keep your loved one awake.

3. Prioritize your own self-care.

Make sure you are taking time for yourself each day. Caretaking is exhausting. You need breaks. You need time to recharge. This will give you the energy required should sundown symptoms arise.

4. Schedule activities strategically.

Most people with dementia have the most clarity and energy earlier in the day. Schedule doctor’s appointments and other tasks during this time when your loved one is most alert and schedule enjoyable activities throughout the day that don’t include sitting around or watching T.V.

5. Keep your home well-lit in the evenings.

When lighting is dim, it can be hard for your loved one to see properly. She may mistake objects or feel startled by shadows. Keep lighting bright enough to prevent this confusion and disorientation.

6. Practice relaxation.

Include relaxation techniques throughout your day, such as aromatherapy and calming music. If your loved one likes to watch T.V. in the evening, keep the volume low and make sure he’s not watching anything that would disturb him.

7. Keep a journal.

Keep track of your loved one’s sundown symptoms, when she exhibits them and possible triggers. Look for patterns. This will help you know how to manage symptoms and avoid triggers in the future.

8. Ask your doctor about medication.

Dr. Natalie Edmonds suggests medication as a last resort. If these behavioral and environmental changes don’t help, there may be a prescription or over-the-counter medication that could. Talk to your doctor to discuss your options.

Sundown Syndrome vs. Delirium

It’s also important to know the difference between sundown syndrome and delirium, a more serious condition in those who are living with dementia.

Delirium tends to come on suddenly and can happen at any time of day and throughout the day. Delirium causes a drastic difference in your loved one’s behavior. Symptoms can be similar to sundown syndrome but more severe and sudden. Talk to your doctor immediately if you think your loved one may be experiencing delirium as this is typically indicative of another medical condition such as infection.

As exhausting as sundown syndrome is for caregivers, remember it is common. You’re not alone. Try the strategies we listed above. Talk to your doctor and your fellow caregivers. With the right behavioral and environmental changes, this time of day can get easier.

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Covid Information

Continuing an Environment of Caring in Times of COVID-19


Safety of Residents and Staff

As the coronavirus (COVID-19) pandemic continues to evolve, our communities are focused on keeping our Residents and staff safe while also maintaining Resident engagement and daily fulfillment. We are taking a cautious approach, balancing the highest level of safety within the least restrictive environment.

We will continue to follow and augment State and C.D.C. safety recommendations:

Screening: We screen every employee every day. We require our staff to complete a questionnaire (inquiring about possible symptoms, recent travel and exposure), have their temperature and oxygen level checked before entering the building. Staff are also required to clean their cell phones, keys and wash their hands while being observed. We monitor our Residents’ health closely with temperature and oxygen level checks at least twice a day. We help our Residents wash their hands throughout the day and encourage them to wear a mask or face covering.

Cleaning: We have enhanced our cleaning products with regard for their effectiveness in killing COVID-19 particles and proper sanitization and disinfection, using the EPA’s specific list of disinfectants for use against the coronavirus. We are using this list and training staff on how long cleaning solutions must be kept on a surface before wiping it off to ensure its effectiveness. We prioritize cleaning high-touch areas and horizontal surfaces, cleaning them several times a day.

Physical Distancing: We encourage 6 foot distancing between Residents and with staff unless they are providing direct care to a Resident.

Testing: We test all Residents and staff for COVID-19 every three weeks, and more as needed. Our nurses utilize a PCR test, which we send to a private lab to expedite results.

Physical Changes: We have installed ultraviolet lights in our air conditioners that supply air to the common areas of the houses. This method is believed to be helpful in killing bacteria that is cycled through the systems and pushed back into the house. We’ve also enhanced our HVAC filters to near HEPA levels, trying to add additional layers of protection to keep COVID-19 out of the building. Most importantly, air purifiers have been added to common areas and each resident room.

PPE: Staff members wear masks at all times and we encourage Residents to wear masks when outside their rooms. We also encourage physical distancing between our Residents. Staff wears additional protective equipment when deemed necessary while caring for our Residents. Staff are continually trained on when and how to use personal protective equipment (PPE).

Individual Needs Stay Paramount

The uncertainty surrounding COVID-19 affects us all. At our communities, we are not letting it stop us from safely offering a life well-lived. Above all, we are providing the utmost attention to the safety and well-being of our Residents. Our Program has always revolved around the individualized needs of each Resident and this has not changed during COVID-19. Residents are still able to connect with each other and staff while maintaining a safe physical distance. Weather permitting, we enjoy the patio and large backyard. We continue to keep our Residents engaged through cognitive, physical, recreational experiences. We offer enjoyment and connection throughout the day even during these unprecedented times.

Visitors

Since early March we have restricted facility access to prevent the spread of COVID-19.

Essential Visitors: Healthcare providers including physicians, home health, private duty services, physical therapy and hospice staff have not been allowed in the communities unless there is an acute, essential need for our Residents. These services continue as needed through FaceTime, tele-med and phone conversations. If physical access is absolutely necessary, the individual will complete our questionnaire and screening for temperature and oxygen stats. No one is allowed in the community if they fail to meet our screening criteria.

Families: We are happy to help schedule window visits, FaceTime, Zoom and phone calls with your loved ones based on what is allowed and prudent. To ensure the proper support from our staff, our visits are scheduled ahead of time.

Tours and Move-Ins

Tours: We recognize that regardless of the changes with COVID-19, your need for senior living hasn’t changed. For the safety of you, our Residents and staff, we are currently offering virtual tours where you can see our community, as well as meet our staff. Please contact our Community Relations Director to set up a virtual tour.

Move-Ins: We are accepting a limited number of move-ins (unless otherwise instructed by public health department). New Residents must be tested for COVID-19 prior to move-in. Upon admission, we will place a new resident in their room to quarantine as an additional precaution.

We will share community-specific information with residents and families as our quarantine measures continue to evolve with new information of COVID-19.

We are honored to care for your family member and loved one.

 

Comments we’ve received from our families during COVID-19.

“We appreciate all of your efforts. Your team clearly is a leader in the response to COVID. Thank you for keeping our loved ones safe.”

Joseph

“Thank you, thank you, thank you for ALL you have done and are doing to keep the residents and staff in a safe environment! The continuous learning and improvements empower caregivers and families to do better at home and in our communities.”

Tommy

“I appreciate you taking the time to update us and share them with my family living in AL, GA, VA, MD, FL…we are extremely grateful and comforted by your proactive and decisive measures! We’ll continue to keep you in prayer for health, safety and more.”

Rebecca

“In keeping with the parade theme you had, the employees there are super heroes. They are plowing forward in the midst of this horrible virus and taking care of their patients selflessly. I just wanted to acknowledge their bravery and dedication and thank them from the bottom of my heart for the goodness in their hearts and their dedication to their patients and jobs.”

Abigail

“Thank you! You locked down early & your diligence has paid well.

The Bader support group continues meeting once a month by Zoom. We all appreciate you so much. Everyone comments on how grateful we are that our parents are at Barton House!

We appreciate everything: sending us pictures, calls, alerts to bring supplies/clothes as needed, staying in virtual contact with hospice.
Blessings to each of you.”

Marsha

“Thank you for all y’all and all the staff are doing for my mom and the other residents. We truly appreciate your hard work.”

Carol

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