Managing Caregiver Anxiety Triggered by Dementia-Related "Sundowning" or Aggression

Managing Caregiver Anxiety Triggered by Dementia-Related “Sundowning” or Aggression

By Beth Rush, Founder and Managing Editor, Body+Mind Magazine

If you’re a caregiver or have a loved one with dementia, Alzheimer’s disease or other dementias, you’ll occasionally feel stressed or anxious. These feelings are common, especially during the period beginning at dusk and continuing through the night. During this period, “sundowning” often occurs in those with dementia-related conditions. Calming your personal anxious feelings is essential in effectively knowing how to calm anxiety in dementia patients during this time and others.

What Is Sundowning?

Sundowner’s syndrome — or sundowning — collectively describes the behaviors or symptoms Alzheimer’s and dementia patients experience from sundown and into the night. These may include anxiety, disorientation, agitation, aggression, and hallucinations, which may cause pacing and problematic sleep. Why sundowning occurs is still a relative mystery among medical specialists, but it may happen because of the disease’s progression, which can cause changes in the patient’s brain.

National Anxiety and Depression Awareness Week is coming up during Mental Health Awareness Month this May, so it’s an apt time to examine factors that may contribute to sundowning. Knowing them could assist you in better understanding why the syndrome occurs, managing sundowning behavior, and dealing with the resulting anxiety in your patient or loved one while also contributing to relieving your own.

How to Manage Sundowning: Dealing With Its Factors

Although there’s no exact science explaining sundowning, knowledge of dementia-related conditions suggests some common factors that could contribute. You may recognize some of these factors as you read, so heed any proposed suggestions on better coping with a dementia patient’s stress points and your anxiety.

1. External Stress and Frustrations

When a dementia patient is around others who display aggression, frustration, or other stress-inducing behavior, it can also cause them to become unsettled and stressed. Whether it happens in the morning or near bedtime, it can cause the patient’s brain to carry the stress until another occurrence shifts it.

After such an event, identify an activity that soothes the person. Listening to their favorite music, watching a loved movie, or going through family photographs can relieve their stress and direct their thinking to more pleasant activities.

Lori La Bey — the founder and editor of Alzheimer’s Speaks, which is an organization providing hope and support for people living with Alzheimer’s and family members — features “The Purple Angel Project” among her website’s list of free educational resources. Norman McNamara — who has dementia — and Jane Moore — a care partner — devised the project to assist and support those with all types of dementia and their caregivers. Accessing The Purple Heart Project or Lori’s website will give you some valuable alternatives and help you understand and relieve your stress.

2. Body Clock Changes

Dementia creates confusion and may involve the patient’s internal body clock, depending on how the condition affects their brain. It’s not uncommon for somebody with Alzheimer’s or other dementias to believe it’s 10 am instead of midnight, for example. At the time, if a care partner encourages the patient to go to sleep, this belief could cause a frustrated or even aggressive reaction to their words.

In this instance, a way to handle your loved one’s or patient’s frustration or aggression is to take an outdoor walk or drive to show them that the sun is shining brightly and that it is morning. If they can’t walk, consider acquiring a portable wheelchair that you can slip into the trunk of your car.

That way, you can push them around the property or take them on a drive for a change of scenery. Remember, though — unfamiliar surroundings can be detrimental for those with dementia conditions, so assess the situation carefully. When learning how to manage sundowning, the trick is to take outside excursions regularly.

The fresh, outside air will benefit your anxiety levels, and outdoor environments help to readjust your patient’s internal clock. Should you still feel anxious about this latest development, you could also visit a Memory Cafe near you. They assist caring friends, family members, professional care partners, and those with cognitive concerns in locating programs to help them while offering understanding and advice through friendship.

3. Confusing Dreams

Should people with Alzheimer’s or other dementias fall asleep and experience vivid dreams, they could awake disoriented and confused. When this happens, these symptoms may cause anxiety for them and you. Your anxious feelings may stem from your inability to calm them and relieve their stress.

The best you can do is offer calm reassurance that everything is fine and they have experienced a bad dream. Explain their environment and that their anxious feelings are only temporary. Allow them to pace under supervision and avoid arguing or raising your voice.

Breathe deeply or count to 10 to calm yourself if necessary, and occasionally remind patients of the time and encourage them to return to bed. Touch and caress them gently to calm them further, and perhaps provide water or a cool water-based cordial to help them relax.

Another of Lori La Bey’s projects is her “Dementia Quick Tips: Advice for Caregivers and Patients” page, which offers a summarized insight into everyday care, safety, lifestyle, and future planning for dementia caregivers. The article also provides ideas for your self-care so you can support and do your best for your loved one or patient.

4. A New Environment

Perhaps you’ve recently moved a parent with Alzheimer’s or other dementia into your home or admitted a new patient into your care facility. Remember that the transition will likely be difficult for you and them, and constantly remind yourself of this fact.

There will be times you feel frustrated and anxious — your loved one also will. Knowing a few guidelines could smooth the transition and relieve your collective anxiety:

Create a calm and serene living space.
Implement a routine for bathing, meals, walks, TV times, doctor’s appointments, and rest.
Keep your home well-lit in the evenings to reduce the confusion, hallucinations, and shadows may cause.
Provide larger lunches and smaller dinners.
Identify enjoyable activities like calming music and display family photographs in your patient’s room and around your home.
Make notes of the difficult moments and what happened before them to identify the triggers.
Take regular outdoor walks.
Keep objects like car keys, sharp objects, and weapons in safe, inaccessible places.
Maintain your composure in your loved one’s presence.

Managing Your Stress Will Calm Your Patient

Your ability to minimize your anxiety will calm your loved one’s or patient’s aggression or sundowning periods, but likely won’t eliminate them altogether. Use the available resources and follow the provided guidance to assist in controlling your stress levels during difficult times.