Sleep Issues and Sundowning

Hello Volunteers,

For July we will focus on the topic of sleep disturbances and sundowning.  Sundowning is an increase in behavioral problems that begin at dusk and last into the night.  At Seasons we often see these concerns which greatly affect the participant and their caregiver.  Hope this information is helpful.  As always we so appreciate you and your efforts at Seasons, we couldn’t do it with out you! 

What causes Sundowning?

Scientists don't completely understand why sleep disturbances occur with Alzheimer's disease and dementia. As with changes in memory and behavior, sleep changes somehow result from the impact of Alzheimer's on the brain.

Some studies indicate as many as 20 percent of persons with Alzheimer's will experience increased confusion, anxiety and agitation beginning late in the day. Others may experience changes in their sleep schedule and restlessness during the night. This disruption in the body's sleep-wake cycle can lead to more behavioral problems.

Factors that may contribute to sundowning and sleep disturbances include:

·       End-of-day exhaustion (both mental and physical)

·       An upset in the "internal body clock," causing a biological mix-up between day and night

·       Reduced lighting and increased shadows causing people with Alzheimer's to misinterpret what they see, and become confused and afraid

·       Reactions to nonverbal cues of frustration from caregivers who are exhausted from their day

·       Disorientation due to the inability to separate dreams from reality when sleeping

·       Less need for sleep, which is common among older adults

How to Help?

·        Approach him or her in a calm manner.

·        Find out if there is something he or she needs.

·        Gently remind him or her of the time.

·        Avoid arguing

·        Offer reassurance that everything is all right.

·        Don't use physical restraint. If the person needs to pace, allow this to continue under your supervision.

·        Keep the home well lit in the evening.
Adequate lighting may reduce the agitation that occurs when surroundings are dark or unfamiliar.

·        Maintain a schedule.
As much as possible, encourage the person with dementia to adhere to a regular routine of meals, waking up and going to bed. This will allow for more restful sleep at night.

·        Avoid stimulants and big dinners.

·        Plan more active days.
A person who rests most of the day is likely to be awake at night. Discourage afternoon napping and plan more challenging activities such as doctor appointments, trips and bathing in the morning or early afternoon. Encourage regular daily exercise, but no later than four hours before bedtime

·        Try to identify triggers.

·        Be mindful of your own mental and physical exhaustion.
If you are feeling stressed by the late afternoon, the person may pick up on it and become agitated or confused.

Renee Pope, CTRS

Activity Coordinator

Seasons Adult Day Health Services

(989) 633-3734