As the hands of the clock spring forward or fall back, the biannual ritual of Daylight Savings Time affects more than just our schedules and sleep patterns. It casts a shadow on the lives of individuals grappling with dementia, especially when it comes to the phenomenon known as sundowning.
We sat down with Dr. Elaine Healy, United Hebrew’s Vice President of Medical Affairs and Medical Director, to learn more about the relationship between Daylight Savings Time and dementia and how the subtle shift in time can lead to amplified symptoms during the evening hours.
Q: What are the symptoms of sundowning?
Dr. Healy: Caring for individuals with Alzheimer’s or dementia presents a complex set of challenges, with agitation, confusion, and aggression among the most daunting behaviors to address. These behaviors can worsen in the late afternoon or evening, a syndrome known as “sundowning,” which affects 1 in 5 people with Alzheimer’s. The syndrome also manifests in heightened anxiety, verbal outbursts, restlessness, and even hallucinations. Witnessing these behaviors can be distressing, leaving caregivers feeling helpless.
Q. How does Daylight Savings Time impact sundowning? What can caregivers expect?
Dr. Healy: The shortening of the days each fall, coupled with the changing of the clocks, can cause sundowning symptoms to worsen. It may be that the body clock is not functioning as it should. It can be brought on at the end of the day by fears of lower lighting, shadows, and the dark as night approaches. Those with dementia or Alzheimer’s may not be able to articulate their anxiety, which provokes a stress response.
Q. What are the causes of sundown syndrome?
Dr. Healy: We don’t really know exactly what provokes the body’s response in this way, but we do know it has to do with the deterioration of the brain’s architecture and changes in brain chemistry resulting from Alzheimer’s and dementia. There may also be environmental factors that worsen sundowning symptoms.
Q. Can you tell us more about environmental factors? How can caregivers ease those triggers?
Dr. Healy: Sure. You want to start by addressing the fundamental hierarchy of human needs. Check in with your loved one: Are they comfortable? Too warm or cold or hungry or thirsty? Do they need to use the bathroom? Then go up the chain to other things; the person may be too stimulated or irritated by loud music or television or noise. Conversely, maybe it’s too quiet and boredom has set in. It could be a yearning for something the person can’t articulate. The hour may represent a time of day when she used to make dinner for a spouse or take the dog for a walk.
Q. So, what are some ways caregivers can cope with sundowning?
First, you want to address their physiological needs: take them to the bathroom; adjust the temperature or remove a layer or clothing; check their skin for a rash; ask them if anything hurts or if they have eaten; turn down the TV or change the music to something they prefer.
Second, some experts suggest closing curtains in the late afternoon or early evening, even if there is still a little daylight left, since semi-darkness can cause distorting shadows that can trigger fear and anxiety; switch on plenty of warm, artificial lights instead. Evening activities that are soothing and not too stimulating should be planned, such as listening to soft music or looking at tranquil pictures of nature; it is important to avoid overstimulation at this time.
Third, think about the big picture. Is there a flow to their day? Do they have structure and a schedule? Do they get exercise and fresh air? Have you built in time to rest? Our approach to memory care is to tailor activities to individual interests while providing structure to our residents’ day. If you keep to a routine, build in active periods during the day and quiet times in the evening, it can reduce the agitation associated with dementia.
Q. When should I seek outside help for sundown syndrome?
A. If you have tried everything to cope with sundowning and other challenging behaviors associated with Alzheimer’s and dementia, but you are still struggling as a caregiver, you may need to consider asking for help. That may mean turning to others in your family for help or seeking the services of a healthcare provider.
If you want to keep your loved one at home, a home care agency can provide a clinical and environmental assessment and make some recommendations. If you need to recharge your batteries, you may consider respite care, which may help you keep your life in balance. You may also consider moving your loved one to an assisted living community dedicated to caring for those with Alzheimer’s and dementia.
This post was based on an interview with Dr. Elaine Healy, United Hebrew’s medical director and vice president of medical affairs. Dr. Healy is board certified in internal, geriatric, and hospice and palliative medicine and is a clinical assistant professor of medicine at New York Medical College. Learn more about United Hebrew’s senior living campus and schedule a tour here.