For many caregivers, tempering the effects of sundowning isn’t easy.
“People told me it helped if you kept the blinds down and the lights on,” says Pauline Martin, who cared for her husband, Paul for 15 years before he moved into a nursing home. “But I didn’t find that worked.”
Even after Pauline drew her blinds, her husband would still get restless and agitated, and would wander at night.
Some people living with Alzheimer’s do benefit when they are shielded from the change in light outside. Full spectrum lights (the kind often used by gardeners to grow seedlings) also help some people.
Effective management of sundowning is always interpersonal.
“Effective management [of sundowning] is always interpersonal,” says Dr. Joel Sadavoy, Director and Founder of the CARERS program at Mount Sinai Hospital in Toronto. “That means reducing the demands on someone who is agitated. Reassuring them that you, the caregiver, are there and that everything is under control. Try to distract and redirect their attention to anything they might enjoy, music for example.” Why does that work?
“When you focus on reducing demands, what you’re doing is reducing pressure on the brain to respond to the environment,” says Dr. Sadavoy.
“For example: Not asking them to independently undertake a task, like a shower or having supper, or going for a walk,” he explains. “Sometimes those can be helpful, if they’re diverting tactics, but sometimes the usual activities that someone has been involved in don’t work at this time. So caregivers should be shielding them from that, and be prepared to step in and take over. That’s reassuring and calming to the patient.”
You should also make sure to clear out dangers in the house. “If wandering or leaving is part of the symptom package, then take steps to ensure doorways are properly secured at those times; making sure the agitated person doesn’t attempt to cook, smoke, or drink,” says Dr. Sadavoy.
Are there drugs for sundowning?
“Sometimes the caregiver can be in an impossible situation,” says Dr. Sadavoy. “For some people, it gets to be a really overwhelming time and interpersonal strategies may not be sufficient.”
There are prescriptions available, but this should be the option of last resort. “If there’s a degree of agitation that’s uncontrolled and can’t be managed, and where there’s obvious distress as a result, sometimes the only way to the help the person is with medication—not to drug people, but to give them a rest from their upset,” says Dr. Sadavoy. “But you try everything else first.”
Anti-psychotic drugs are the class most commonly prescribed for sundowning. They are effective, but they carry risks. “Medications should be used in a judicious and well-thought-out fashion in concert with a physician who knows about this,” says Dr. Sadavoy.
For Pauline, sundowning may have been the toughest part of her job as Paul’s caregiver, but she was on a mission too: “to continue the loving relationship we had,” she says. “Because this is still the person that I love, no matter what.”
About the author