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Rough caregiver nights and sundowning

by Isabel Fawcett

In gerontology and Alzheimer's studies, much has been written about "sundowning," essentially erratic behaviors and/or altered moods that may occur in dementia or Alzheimer's patients. Regardless of whether a loved one has dementia, Alzheimer's, or other chronic illnesses, end-of-day changes in behavior and cognitive abilities seem inevitable.

"Rough Caregiver Nights" and "Sundowning"

Medically labeling a mature adult's occasional or frequent end-of-day behavioral changes is non-meaningful to me. My primary end-of-day caregiving objective is to carefully observe and offer stronger support and comfort to my Mom when she experiences end-of-day shifts. Notice my avoidance of the word "sundowning" in my "end-of-day" caregiving descriptive? That is how much I dislike the label.

Sundowning: Six Bells, All's Well?

Mom gets her share of daily exercise by voluntarily washing and drying any dishes in the sink or drain, putting them away as she makes her evening rounds in the kitchen. Her involvement in mid-morning and end-of-day kitchen cleanup routines signals to me that all is well in her world.

Mom enjoys being "useful," as she says when works and hums a tune in the kitchen, or helps with garden cleanup efforts--usually as I am ready to drop from sheer exhaustion. My kitchen is usually picture perfect before Mom turns in for the night. If it is not, Mom must not be feeling well. Only when she finishes her kitchen patrol does Mom allow herself to start focusing on a new set of nighttime routines.

As Mom putters in the kitchen, I relish me-time. All's well.

Sundowning: Then What? Night Falls

Once the kitchen sparkles to Mom's self-imposed standards, we may enjoy a drive out, a visit with a neighbor, or watch television before a light snack. Our sleep cycles are seldom in sync as Mom enjoys staying awake later. Once dinner is served and the dishes are washed, I enjoy more downtime. That window of time seems to be when Mom occasionally gets to missing her parents and siblings, all of whom are now dead. It is the start of my "rough caregiving nights," some may say "sundowning."

Sundowning: We'll Make It Through This Night and Every Other Night

At the onset of the unfolding late night scenario, I intuitively resort to logic. I remind Mom that her parents and siblings all died years ago, discussed when, where, and how they died, whether she attended their funerals, and, whether some of them might still be alive, or not.

Logic also leads me occasionally to share copies of family obituaries and funeral service guest books with Mom. Shared obituaries prove helpful, healing, and also allow us both to grieve together. Sometimes the obituaries are rejected.

Logic only goes so far at sunset, apparently.

Sometimes space and quiet comfort is all that's needed. At other times, the comforting hug of a neighbor offers much needed support and balance for Mom, and me. Invariably, Mom and I always make it through the night. That is what counts when I see her smiling face in the morning, as she thanks God she is alive and asks me how I am feeling.

Sundowning: "Rough Caregiving Nights"

There are so many things which may contribute to "rough caregiving nights." I share this message hoping that it encourages my fellow caregivers who may be afraid to share, in denial, or may simply not know how to explain "rough caregiving nights," or days. You and I are not alone. You don't have to like or even use the word "sundowning" if, like me you would rather not do so. You can make it through the night and welcome the dawning of a new day.

Physical or emotional pain, fatigue, not knowing what to do next, not understanding life transitions, including something as simple as nightfall, the passage of time, and much more are likely contributing factors to the anxiety, restlessness, and other noticeable symptoms which surface at day's end for some of our loved ones.

"Sundowning" is part of a rich body of knowledge in the field of gerontology. My caregiving reality remains "rough nights," such as only a fellow caregiver would understand.

Tomorrow is another day.