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Wednesday, October 31, 2018

How to Overcome Effects of Sundowning

Bless the Lord, O my soul, and forget not all his benefits: Who forgiveth all thine iniquities; who healeth all thy diseases; Who redeemeth thy life from destruction; who crowneth thee with lovingkindness and tender mercies; Who satisfieth thy mouth with good things; so that thy youth is renewed like the eagle's. ~Psalm 103:2–5

What comes to mind when you hear the term sundowning? Ever heard of it? It’s horrifying actually—something Steven King would conjure up for one of his cursed characters in his latest horror novel.

When the sun sets at dusk most of us see beauty, but for dementia patients shadows can cause hallucinations. Fear and confusion come uninvited and settle in for the night. It’s petrifying for both the patient and their caregivers—it’s sundowning.

The Free Dictionary defines sundowning as the appearance of confusion, agitation, and other severely disruptive behavior coupled with inability to remain asleep, occurring solely or markedly worsening at night; sometimes seen in older patients with dementia or other mental disorders.       

Two weeks after Dad’s stroke he was transferred from the hospital to Manor Care, a rehab facility. We had to have someone there with him 24/7, which was quite the experience especially when the sun went down.

When darkness swept throughout the empty hallways of Manor Care, Dad began to speak in numbers. Attempts to crack this code failed miserably. But he was building something or trying to tell us that the world existed on four pillars. 

He existed in a world that hovered between his dreams and reality, meaning he couldn’t quite tell if he was dreaming or not. There was no way for him to know the difference. So the numbers kept coming and he became more frustrated because we didn’t understand.

Sundowning was not a term explained to us, though it was playing out right in front of us. Dad became fixated on the tubes attached to his body. To him his catheter was a weapon of four parts. In the end we realized that he was just trying to let us know it hurt and he was hungry (he had a feeding tube that hummed day and night), his throat hurt, his head hurt, his back was aching and he blamed it all on the four or five parts of these contraptions that weren’t doing their jobs correctly.

The scariest of all his behavior, however, was the hallucinations. These came every night and they seemed to materialize from the painting that hung on the wall in front of him. It was a standard painting you might find in all of the rooms at the facility—pink flowers, weeping willows, and a white Greek building in the background with sculpted  pillars.

In the beginning he was trying to decipher the painting with his number code but that changed one night when he started seeing shadows inside the painting—moving shadows. We began to pray. My niece read scriptures to him and we played worship music softly in the background.

Was this going to be our new norm? How would we deal with this? For months after Dad came home, sundowning indeed became the norm. And like I said, we had no clue. Our nurses and doctors never mentioned it. Some Christians told us that Dad’s brain had no boundaries, therefore, the old fleshly character had returned. That seemed a bit too harsh and I kept praying for a better answer than, it’s his own fault.

The Alzheimer Association lists a few contributing factors of sundowning which includes the following:

  1. Mental and physical exhaustion 
  2. An upset in the “internal body clock” causing a biological mix-up between day and night
  3. To misinterpret shadows causing confusion and fear
  4. Disorientation due to the inability to separate dreams from reality
  5. Nonverbal reactions from frustrated and exhausted caregivers (It happens)
  6. Less need for sleep


Needless to say I wish someone had directed me to this information a year ago. I prayed for God’s wisdom, and as you might suspect knowledge truly is power and learning comes from experience.

These sayings are true.
1.       Experience is the mother of wisdom. ~author unknown
2.      All experience is education for the soul. ~author unknown
3.      Learn from your mistakes. ~author unknown
4.      Nothing is a waste of time if you use the experience wisely. ~Auguste Rodin (1840-1917)
5.      Experience teaches slowly and at the cost of mistakes. ~James Anthony Froude (1818-1894)


Experience 1: Look for the obvious. In the rehab facility, when the sun went down, I simply covered the painting that seemed to be the center of his hallucinations. Closing the privacy curtain helped also. Don’t argue or try to convince that what he’s seeing is not real. Redirect and get rid of the culprit that is causing the chaos. In our case, it was the painting.

Experience 2: If the darkness is the cause of confusion, bring the light. I kept the door ajar—enough to let him see the dimmed and soothing light of the hallway. Bring in the Light of the World; Read scripture to calm fears and return a measure of peace and joy.

Jesus said “I am the light of the world:  he that followeth me shall not walk in darkness, but shall have the light of life.” ~John 8:12

Dad recognized scripture and still knew some passages by heart and recited them which helped him fall asleep. I guess it was fitting that Psalm 23 was his go-to passage.

Experience 3: I’m right sometimes … maybe more than sometimes. I don’t have scientific research to back up my findings, nor do I have a medical degree, but I do have on-the-job experiences.

Experience 4: God is for us, not against us. God is our refuge and strength, a very present  help in trouble.  Therefore will not we fear, though the earth be removed, and though the mountains be carried into the midst of the sea; Though the waters thereof roar and be troubled, though the mountains shake with the swelling thereof. Selah. ~Psalm 46:1–3

God whispers. I love his whispers. In my experience, he never hits you over the head with information and then says, “Duh!” Instead, he gently gives you drops of wisdom when you need it and says, “Well done.”

“Keep the house subtly lit. A night light can subside fears and lessen those horrid night hallucinations. You’re creative, my child, string some Christmas lights to the banister.” Then I really got creative and added solar lights to the garden. Mom likes it, too.

Experience 5: Most doctors don’t like essential oils. But using essential oils like lavender in a diffuser are lifesavers. It’s calming and soothing. Melatonin can help with staying asleep, and scented candles are candy for the brain. Oh, how we love our pumpkin spice candles.

For the caregiver there is much to learn. And learn we must in order to keep our sanity, and obtain a better understanding of what dementia patients are going through.

Things have turned around a little. Dad’s not afraid of the night anymore. He even gets up by himself to visit the bathroom. Keeping the light on is a sweet comfort, a welcome sight.

Experience 6: Sundowning hallucinations have not all been bad. That might have something to do with prayer, and Dad’s anchor in Jesus. Turns out he also had visions of heaven. He just didn’t know how to explain what he saw. From what I remember he said that the earth was filled with light and angels (or the disciples) roaming the four corners of our planet. He didn’t feel worthy but they were calling out, saying not to worry because they were with him. And Jesus has walked with him a few times.

There have also been moments where the fog lifts and he receives those moments when  life makes sense again. What’s the first thing he does? He praises the Lord for giving him life; he thanks Jesus for dying on the cross in his place; and he cries because God his Father never leaves or forsakes. God will turn their sundowning into dancing and praise.

Remember there is help for the caregiver. Information is out there—free classes, online articles, support groups, and your first resort … look up; God’s got your back and whether you believe it or not, He’s the one with all the answers. 

Call unto me, and I will answer thee, and show thee great and mighty things, which thou knowest not. ~Jeremiah 33:3

A Caregiver's Prayer

Lord, thank you for wisdom, your wisdom. Give me sympathy, patience, and unconditional love. When I am overwhelmed lead me to your rest. Thank you for never leaving or forsaking me. 


Beloved Caregiver

Stay strong
Be fearless
He’ll find his way
Find courage
Seek wisdom
And always pray

You are guardian
Defender
Giver
And nurse
You are mine
A blessing, never a curse

Stay joyful
Be kind
She knows the way
Find peace
Seek mercy
And always pray

(Copyright by Deborah L. Alten, 2018)



2 comments:

  1. Thank you for this. It was wonderfully inspiring. Thankfully, Mom has never sundowned, and I hope she never does. But I always find comfort in hearing others' experiences.

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  2. Yes, that is something to be very thankful about. It's amazing how our experiences can help others. Greatful you are blogging about your journey. Will bookmark your blog. Thanks for the encouragement.

    ReplyDelete