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Sundowner’s Sunrises

Tomorrow is always fresh and new: compassionate Alzheimer’s caregiving 

By Mary Otte

When caring for a person with Sundowner’s Syndrome, there are a few things you must keep in mind to ease the experience for both you and the person living with Alzheimer’s or another type of dementia—not to mention Sundowner’s.

First off, if you’re living it, you know that Sundowning comes with all varieties of mood swings. From agitation and snappiness to physical aggression and outright fits. Hallways may be stomped, countertops angrily cleared to the floor and your own ears blasted with things that seem to make all too much grating sense in their nonsensical way, potentially slicing away at your heart.

Clearly both caregiver and patient are going to have a difficult time during these hours, most often between 3 and 8pm when, yep, the sun’s going down. Though it’s not clear if it’s part of an individual’s biological rhythms, the poor lighting of dusk causing confusion or pent up anxiety from the day, Sundowner’s is very real and can be very distressing. Crying, hoarding and pacing are just a few common symptoms of this heartwrenching symptom.

One of my favorite lines in movie history is from the Anne of Green Gables saga, where Anne is counseled after yet another misstep that “tomorrow is always fresh and new.” My mom even put it on a cross stitch for me. It’s right along the lines of “This too shall pass” and “Tomorrow’s another day,” but with the added delight of Anne’s visceral relief to relook at her world through this new lens.

Sundowning is a difficult condition to manage as a caregiver, all the more so when the person we care for is a family member. You’ve likely been told to try and “stay in the moment” so many times you’d like to show the next encouraging well wisher just what the moment has in store for them, but don’t lose your cool—on another living being at least. Once the person you care for has gone to sleep, feel free to punch pillows, silent scream or, if able to get away, pound it out with a good run. You’re doing your best.

Just remember, “Tomorrow’s always fresh and new,” and your loved one’s sunrises are what you live for. Enjoy times of morning lucidity, creativity, gentleness and know in your heart that what’s bound to come later doesn’t detract from the good moments, days or years that preceded.

Here are some tips on making 3-8pm more manageable when caring for someone with Sundowner’s Syndrome:

     
  • Increase morning and early afternoon exposure to the sun or light therapy lamps. This helps with setting our biological clocks.
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  • Reserve coffee and caffeinated tea for the mornings. Check the tea box if you’re not sure, some herbal teas are naturally decaffeinated and very soothing.
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  • Set up a daily routine for familiarity and to break the day up into manageable slices.
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  • Be active to their level and ability of engagement. Cognitive activities, magnetic puzzles, soft music or an early afternoon walk are all great ways to entertain and release energy.
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  • If there is a creative expression that the person you care for enjoys or has enjoyed in the past, encourage them in their art, but don’t force matters. Always keep the option open.
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  • Do not get caught up. We’ve all slipped and can only do our best, but getting agitated, yelling or having our own bursts of violence (wherever directed) will do nothing but makes things worse.
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  • Smile often; often you’ll mean it.
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  • Take notes when possible on what seem to be major triggers for extraordinary episodes. Loud noises? Children? Other people’s pets?
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  • Keep the afternoon and evening mood mellow. Soft music, minimal visitors, make sure the room’s well lit with no spooky or disconcerting shadows and turn off the news. Violence begets violence. Quiet, amusing and/or nostalgic are great criteria if TV is a must.
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  • Make sure the sleeping space is comfortable and safe. Bed wedges might soothe an ache or strain that’s been really getting to him or her. Have a nightlight near the door and bathroom.
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  • Don’t guilt trip yourself. Just don’t do it. If you must, feel the feelings then let them pass.
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  • Know that the caree is not doing any of this on purpose to make you mad or get a rise out of you. Try to listen with your ears, eyes, empathy and heart. The person may just need a drink of water, be in some kind of discomfort or want to tell you something that won’t form on the tongue. Frustrating for all, just remember…
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  • Tomorrow’s always fresh and waiting with a new sunrise to wash away the darkness and start anew.