Hey! So I was wondering about your thoughts on sundowning — like, what IS it really. Some say its a real phenomenon while others say it's just another word for disruptive behavior at night? What are some interventions that have worked for you? And what about PRN medication used to treat sundowning/disruptive behavior at night? Where is the line between therapeutic medication and chemical restraints? Thanks!

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Hi! Good question. Most of us, dementia or no, get tired later in the day. For people with dementia, that exhaustion can manifest itself as anxiety, panic, and aggression. People with dementia just don’t always have the ability to say, “I’m tired/hungry/feeling cranky/confused, leave me alone,” like the rest of us do. Instead, you see the anxiety and anger.

Calming music, scents, and activities can combat these behaviors. If a person is engaged (holding a baby doll, folding laundry, enjoying a TV show, or something else that is fun but calming) he or she won’t be panicking about leaving, getting hostile, or picking fights. Most people begin to sundown around 3 PM, so that’s when they need to be engaged in something pleasant.

I always recommend avoiding “chemical restraints” like antipsychotics. What does work for some people who experience a ton of anxiety, though, are anti-anxiety medications that a physician can prescribe.

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Rachael Wonderlin is an internationally-recognized dementia care expert and consultant. She has a Master’s in Gerontology and is the author of three published books with Johns Hopkins University Press. Rachael owns Dementia By Day, a dementia care consulting and education company.

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