Smooth Jazz and wine.....

Round and around and around it goes....where it'll stop, nobody knows.

The sundowning is a killer for me.   What, you may ask, is "sundowing?"   Please read the following definition, courtesy of Wikipeidia:.



In medicine, sundowning, also known as sundown syndrome, is a syndrome involving the occurrence or increase of one or more abnormal behaviors in a circadian rhythm.^[1] Sundowning typically occurs during the late afternoon, evening, and night, hence the name. It occurs in persons with certain forms of dementia and psychosis, such as seen in Alzheimer's disease. Although not widely surveyed, sundowning is estimated to occur in 45% of persons diagnosed with Alzheimer's disease.^[2] A person who is sundowning may exhibit mood swings, become abnormally demanding, suspicious, upset or disoriented, and see or hear things that are not there in the late afternoon and evening. After wandering, sundowning is the second most common type of disruptive behavior in institutionalized persons with dementia.^[3] Sundowning often co-occurs with wandering, and the combination of these two syndromes is an important contributing factor to an emergency situation: elopement at night. The cause of sundowning is unknown, but may be related to disturbed circadian rhythm^[1] Contributing factors may include medications that can cause agitation or confusion,^[4] and sleep disorders.

It all seems simple and  clinical when described in the paragraph above, but if you witness it, live it, deal with it on a daily basis, you begin to realize that those horrible nursing homes just may be onto something.
Sundowning is the only thing, so far, that has me agreeing with the mass sedation of dementia patients that I am convinced, goes on in long term care institutions.   When I toured them, (and I toured a lot of them) the one thing that struck me was the state of most of the patients in the Alzheimer's ward.  They all seemed to be highly sedated and sleepy.  Some residents were slumped over, strapped into chairs.  Other's were just asleep in their rooms or in front of the television in the common room.   This played a large role in my decision to care for Marjorie at home.   I didn't want her drugged and left to live her life out in a semi-conscious state, in a strange place.  Locked in and sedated.   That's what I called it.

Tonight was a one of many, but one of the  more "intense" periods of sundowning.   It's like Marjorie cannot manage the change from day to nite.   She might experience the same in the morning, but she's sleeping through the change from nite to day, so it doesn't affect her.  Like clockwork, close to 4pm, she begins to become restless.  She is not longer happy to sit with a cup of tea, a cookie, watching her favourite show or folding laundry.  Suddenly, she needs to be roaming, on the move and touching almost everything in her path.  Questioning every little specimen she comes across.   Car keys, chapstiks, blackberry's, anything that she can lay her hands on.  Blinds must be drawn, lights turned on, lights turned off, blinds pulled up again.  She circles the living room, kitchen, and dining room, without fail, for up to two hours. 
I find that music helps.  Music and a big glass of wine.  (ok, it's not real wine, but Mum loves to drink her wine, so we've switched it off for non-alcoholic).  But as her dementia progress', these great savers are proving less effective.  I can remember a few yrs ago, some smooth jazz, a glass of wine, and a small task like peeling potatoes, or making a salad would settle her into a happy, adjusted mood.   I was adamant that I didn't need to place Mum on any sedatives.  That I could manage the agitation with environmental adjustments.   It used to be like that.  But now, I realize that maybe the nursing homes may actually know what they are doing.  

.25 mg of respirodone is now what Marjorie takes, twice daily.  But even that doesn't seem to be calming this latest surge of sundowning.   I am attributing it to the change of seasons (fall-winter) combined with the change from day to nite.   I think it's just too much for her to absorb in such a short period.
Ok.  Ok.  Ok.  I have just re-read this entry, and yes, it's dry.  Dry and boring.  But I may have lost you on the description, but I hope that I left you with some wisdom, or insight or something new for you to try in your situation, whatever that may be.   Smooth Jazz and some wine.  Sometimes that can't even cure it all.  Maybe I owe those nursing homes an apology for all those terrible things I spouted about them.   :)