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Sundowning Season

The mornings are darker for a longer time now, and the sun sets a little earlier each day. Autumn is my favorite season followed by winter bringing holidays and a fresh start with a new year.

But for a caregiver of a person with Alzheimer’s, it also brings episodes of “sundowning” – an agitated response to a lack of ambient light.

The Mayo Clinic describes “sundowning” as a state of confusion at the end of the day and into the night. Factors that affect an AD patient and may lead to the exacerbation of this syndrome often include: fatigue, low lighting, increased shadows (which can be attributed to hallucinations and/or the inability to understand what one is seeing.)

During winter months the increase of storms and low barometric pressure can increase pain such as arthritis, spinal dysfunctions and headaches. Alzheimer’s patients often lack the ability to express their pain and will “act out” with pacing, wandering, agitation, anger and anxiety.

This is the time of year when preparation for sundowning is a project that should be tackled sooner than later…before the syndrome becomes more prevalent and disturbing.

Set an appointment soon with the patient’s Primary Care Practitioner. Rule out urinary tract infections now or treat one that may be discovered. If the patient suffers from chronic pain, a course of medication to control the pain should be discussed. Review all medications; both with the physician AND the pharmacist. A physician will not admit to overmedicating a patient whereas a pharmacist can bring concerns to light.

Further steps to make your home more suitable for a person who “sundowns” are:

· Stay on a daily routine as much as possible with outside activity being part of that routine (being exposed to natural sunlight helps greatly with the control of sundowning). Take walks, play with pets and garden are simple activities. Or just sitting on the porch and enjoying the day.

· Limit napping during the day as well as caffeine and sweets. A heavy meal late in the day may restrict restful sleep. Warm milk with honey and vanilla promotes drowsiness in many people; and the extra protein and calcium in whole milk is of nutritional value to those who often do not have good appetites.

· Turn on lights in the house before the sun starts to set and turn them on in the morning if it is cloudy or raining. Be sure to light hallways and dark corners to deter hallucinations or fears.

· Keep night lights on in the AD patient’s bedroom, leading to the bathroom and the bathroom itself to diminish confusion and falls.

· Loud music, scary and/or violent TV programs or a chaotic environment will ratchet up anxiety and agitation very quickly with some suffering from Alzheimer’s. A calm and pleasant atmosphere is very important to their state of mind.

· Deal with your own agitation. A person with AD easily picks up cues from those around them. Caregiving is challenging, exhausting and nerve wracking. Find ways to cope and sooth yourself and the dividends may be less sundowning episodes for the person you care for.

Caregivers learn that each Alzheimer’s patient are an individual case study; reacting differently to each and every coping mechanism used. You will need to experiment with the advised solutions and/or come up with your own. Please share what works for you with the rest of us!

Sandra Savell, Certified Massage Therapist and Author of: “Dear Clueless: A Daughter’s Journey Through Alzheimer’s Caregiving”

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