Curing Sundowning with Music?

Hey Caregivers, “Sundowning” is one of the most recognized terms in the dementia care industry and one of the least understood dementia behaviors. What is it? What are the symptoms? Why does it occur? And what can you do about it? Watch to the end of this video where I share an interesting research-based tip that’s worth trying for your loved one with sundowning issues.

Sundowning is a term used to describe the increased confusion and agitation that some people with dementia experience in the late afternoon and evening as the sun goes down. Studies have found that up to 80 percent of people with dementia experience sundowning at some point, but it’s not a disease; it’s a set of symptoms that can be caused by a variety of factors.
These include changes in the brain because, as the disease progresses, the brain changes in ways that lead to changes in your loved one’s sleep-wake cycles, mood and behaviors. Also, environmental factors and changes in the environment, such as moving to a new home or being in a nursing facility, can trigger sundowning. Sundowning can also be caused by physical factors such as pain, hunger, or thirst that your loved one might be experiencing.

So, what are the symptoms of sundowning? Well, they vary from person to person, but they may include agitation, confusion, disorientation, hallucinations—which means that they see and hear things that simply are not there—pacing, wandering, and sleep problems.

Is there a cure for sundowning? Despite numerous studies on the sundowning phenomena, there is no cure for it. The good news, however, is that there are things you can do to help manage the symptoms. A lot of these are behavioral, which means they are safe to try and have little or no side effects:

Establish a regular routine. This can help to regulate your loved one’s sleep-wake cycle and reduce their confusion. Get them up at the same time each day. Stick with a consistent routine that includes the time they eat breakfast, lunch, and dinner, the time they bathe, the time they take a walk, play with the family pet, and so on. If they have a favorite TV program, make sure you respect that schedule. Generally speaking, people with dementia do not respond well to changes in their routine; it can lead to concern, fear, and suspicion. It might seem boring for you to do the same thing day after day, but that’s the way it is.

Provide a calm and familiar environment. This can help reduce stress and anxiety. This is pretty obvious when you think about it: you don’t need to have dementia to become annoyed and unsettled with loud, jarring noises or any type of disruption.

Avoid changes in the environment. If possible, avoid making changes to your loved one’s environment like the daily routine. New things can lead to suspicion, misunderstanding, or frustration. If you do have to make a change, such as going to a medical appointment, try to do this earlier in the day before sundowning sets in. Make sure that your loved one understands what is going on as much as possible. Make the change as smooth as possible by explaining, for example, why they are going to the appointment, that you’ll be with them the whole time, and that you’ll be there to answer questions or hold their hand for reassurance.

Make sure that physical needs are met. This includes making sure they’re getting enough to eat and drink, and getting enough sleep. Adequate food and rest are critical in the management of challenging dementia behaviors.

Provide activities. This can help keep your loved one’s mind active and reduce their boredom. While we want to keep the same daily routine, empty hours can be an opportunity for people to become bored and distracted. Playing cards, checkers, looking at photos, doing puzzles, or any physical activities like walking outdoors can all help.

Manage pain. Pain is another common element that can lead to challenging behaviors, and it’s not always easy to recognize. Your loved one may have had pain for so long that they don’t complain about it, or they may be unable to express it because of their dementia. Pay attention to things that might be bothering them: Is a garment fitting the wrong way? Is there an itching tag? Do their shoes fit poorly? Do they seem to favor an arm or a leg? Figuring out pain can take a little bit of detective work, but it’s worth the effort.

Talk to your loved one’s doctor. If these strategies are unsuccessful, there might be medications that can help. In my opinion, pharmacological solutions should always be the last plan of attack, but there are indeed medicines that can successfully help manage behaviors. Your loved one’s physician can also help rule out any underlying medical conditions and help develop a plan to manage symptoms.
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I always like to cite research studies when they’re available, and a remarkable number of studies have been done in the area of sundowning. What is equally remarkable is how inconclusive many of the studies are. They agree that many people with dementia experience sundowning, and they further confirm that there is no certain cause and no certain remedies.

I think one of the most noteworthy pieces of research examined the impact of sundowning not on the person with dementia, but on their caregiver. The authors found that sundowning can have a significant negative impact. Caregivers of people with sundowning were more likely to experience physical health problems like fatigue, sleep disturbance, and headaches, as well as mental health problems such as anxiety, depression, and stress. Sundowning can also lead to social and economic problems, such as needing to take time off work or limiting social activities, which leads to isolation.

Like a lot of things related to dementia caregiving, you need to take care of yourself as well as your loved one:
Get support. Join a support group, talk to friends regularly, or get out with folks for a cup of coffee to talk about the issues you’re wrestling with.

Develop coping strategies. These can help you deal with the stress of caregiving and include relaxation techniques like deep breathing, taking a yoga class, or hiring care help so you can step away for a few hours every day.
Get professional help. If you’re really struggling, don’t tough it out alone. Don’t rule out counseling or the benefits of medication for yourself.

As a final thought, I would like to share one research study which experimented with video and music for people going through sundowning. The study explored the benefit of a nature-based slideshow accompanied by classical music. The findings show that exposure to six-minute videos that incorporate calming nature images like waterfalls, trees, and lakes, combined with classical music, had a statistically significant impact on people with sundowning. The piece of music they used was Mozart’s Serenade Number 10 for Winds.

There are a lot of studies that support the use of music to help manage challenging dementia behaviors, and the best part is that so much of it is available for free on the Internet with no known negative side effects. If you’ve tried everything else and it’s been unsuccessful, give something like this a try. What have you got to lose?

I hope you find this information helpful. Caregiving can be one of the most challenging things you will ever do, and your loved one doesn’t come with an instruction manual. If you are interested in other non-pharmacological approaches to managing challenging behaviors, please see my video here. Thank you for watching and God bless you in your caregiving journey.