Do We All Experience Sundowning?

It’s Sunday night two weeks after daylight savings time has ended. I’ve performed my usual weekend routines—taking a long walk, folding laundry, paying bills, and cooking a meal of chicken cacciatore. Drying the dishes, my hands begin to tremble. I set down a ceramic platter for fear of breaking it.

Looking out the window, the dim shadows take me back to caring for my mother, who experienced dementia and lived in a care home setting.

As the clock’s hands moved around the hours, darkness would drape the furniture in her care home. Most residents settled in for the evening. Some, like my mother, did not—or could not. Instead, they experienced sundowning, a period of “increased confusion, anxiety, agitation, pacing and disorientation beginning at dusk and continuing throughout the night, disrupting the body's sleep-wake cycle.” (Alzheimer’s Association)

Residents might be physically or mentally exhausted because of participating in a full day of activities or visitors. Or their confusion was caused by reduced light exposure, uncertainty of their surroundings, or the anxious behavior of those who surround them.

Visiting my mother in the evenings was often a difficult journey for me. I was frightened by the prospect that her life shut down by 6 p.m. while I went on, active as ever, writing, traveling, and spending time with our children. Due to her wandering, we couldn’t share peach ice cream and watch reruns of M*A*S*H together. Because of her agitation, we didn’t kiss each other goodnight.

The Effects of the Pandemic

Fall and winter are seasons when we pride ourselves in staying busy. There are fundraisers and school outings to attend. Meetings and presentations to be held. Families gather. People begin celebrating, first with Halloween followed by Thanksgiving, then observing the holidays in December.

We move through our days and evenings, checking items off our lists, dropping kids off somewhere, and picking them up. Working longer hours. Volunteering at church or non-profit organizations. Decorating with twinkling bulbs. These commitments distract us from the gloominess which occurs as we lose hours of light.

We’re now in the middle stages of the pandemic and not only have the hours in our days slowed, but our nighttime ones have too. Despite access to cooking shows, sports and Netflix, isolation bears down on us.

There is virtual work and school. From home. Virtual cocktail hour and writing workshops. From home. By five p.m. I’ve shut down most of my activities, including my laptop. The news is filled with consternation over the next steps toward a vaccine. And the silhouettes outside my window darken before dinner.

Our lives outside of the home have begun to resemble those lived inside, which leads me to wonder, am I too, feeling something akin to sundowning in the evenings?

Overcoming Sundowning

To help those who experience sundowning or similar effects, the National Institutes of Health suggests we keep to a schedule, reduce noise and clutter, minimize the shadows in the room, and lessen our distractions.

After putting the dishes away, my husband and I proceed with our nightly routine and stroll around the city’s Washington Park. We listen to a pop-up concert in the bandstand on a rare warm night, a reminder that some activities still occur outside the home. After adding timer switches to the lamps, we reenter a home that is flooded with incandescence.

Next up on our schedule is a cribbage match before settling into other rituals. The games started off rocky as we relearned the rules, but, like the rest of the world, we have plenty of time to recoup this knowledge.

An hour before bed, my breathing has slowed. My hands rest on the covers of a book.

Learning to feel what my mother felt in her days of darkness, eight years after I began caring for her, and incorporating strategies to move through the empty hours, is a small victory in the end.

Annette Januzzi Wick is a writer, speaker and author of I’ll Have Some of Yours: What my mother taught me about dementia, cookies, music, the outside, and her life inside a care home (Three Arch Press), available through online retailers and distributors, and is a recipient of a 2020 National Society of Newspaper Columnists award. Visit annettejwick.com to engage her services or learn more.