Sundowning

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ASK DR. MINDY

MINDY KIM-MILLER, MD, PhD
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Question:

My mother has bouts of “sundowning.” She is on Dilantin and carbadopa for her Parkinsons. During her bouts, she clicks her teeth and makes other animated movements. She has not verbalized for years. Her countenance also changes–sometimes she is as pretty as a picture, and other times she looks like a munchkin. She is comfortable in her surroundings here at home, but has even displayed these tendencies during an infrequent hospital instay. In fact once when she was hospitalized, the whole floor of elderly patients seemed to “howl.” Is there a cure for sundowning?

–AJ, Pennsylvania

Answer:

Sundowning is a common occurrence among people with dementia. Although there is no “cure” for it, there are some medications that may decrease its occurrence and some medications that may actually increase it. In your mother’s case, her dilantin and carbadopa may be increasing her sundowning. You should speak with your mother’s physician about her medications if you feel that her sundowning is a significant problem or is harmful to herself or others. In addition to medications, there are some non-drug strategies that can help prevent sundowning.

Sundowning can be worsened by confusion and loss of orienting cues in the environment. For example, a dimly lit room without a clock and familiar objects to the person can exacerbate sundowning. So try to keep your mother’s room well-lit and comfortable with familiar objects and people around her. Look for things in the environment that might be triggers for her sundowning and address them. For example, mirrors and shadows can sometimes worsen sun downing.
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Try to maintain a regular schedule, especially in the evenings. This will help regulate her biological clock. Being overly tired at the end of the day can worsen sundowning. So try to make the late afternoon and evening hours calming and relaxing without stressful activities.

Regular daily exercise, such as walking, can help improve people’s energy and prevent sundowning. Sometimes sundowning can be triggered by restlessness, so give her simple activities to do and spend time with her during the times of the day when sundowning usually occurs. Avoid stimulating foods in the evenings, such as foods containing caffeine or lots of simple sugars.

Lastly, pain can worsen sundowning, so if she has pain issues, try to treat them as much as possible. Again, this something that you should discuss with her physician if you haven’t already done so.

I hope some of these strategies can help your mother. Good luck.

Dr. Mindy Kim-Miller is a trained medical physician who provides useful, but general answers to questions provided by online visitors. While Dr. Mindy can not provide specific medical advice or services, we hope you find her responses useful in your personal education. All information is provided for informational and educational purposes only and is not meant to be a substitute for professional medical advice, diagnosis or treatment. If you suspect you have an illness or disease, or a health related condition of any kind, seek professional medical care with an appropriate health care professional immediately. Do not postpone or delay seeking treatment or disregard professional advice based upon the general answers provided by Dr. Mindy. Dr. Mindy’s advice is not intended to substitute for a visit to your personal physician or other qualified health provider. Any specific medical concerns or questions you may have should be directed to your personal physician or other qualified health provider.

 

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