By Colleen Kienbaum, RN-BSN
It’s that time of year again — the time when households all over America set their clocks forward and lose an extra hour of precious sleep during the night. For people living with or providing care to someone with Alzheimer’s disease or dementia, the time change can also be the beginning of a change in routine. Some changes that come with Daylight Saving Time can be beneficial, while others can cause upset and increased anxiety.
Sleep disturbances and sundowning
Sleep disturbances are a common problem faced by many at some point following an Alzheimer’s diagnosis. Cognitive changes in the brain tend to exacerbate these disturbances in individuals with moderate to advanced Alzheimer’s disease. These cognitive changes and sleep disturbances frequently accompany a phenomenon known as sundowning where symptoms such as confusion, anxiety, agitation, pacing and disorientation begin during the mid-to-late afternoon and continue into the night.
These behavioral changes can be difficult for caregivers and people with Alzheimer’s to navigate as the triggers are not always clear-cut. Changes in routine and light exposure can have an influence and are worth considering while marking the calendar for the upcoming time change. Some tips to help manage sundowning during the time change include:
- Keep the home well lit in the evening and close the curtains or blinds at dusk to minimize shadows and reduce the confusion it might cause.
- Schedule activities and outings in the morning hours as much as possible.
- Take a morning walk if weather permits, and as the weather starts to warm, avoid going outside during high-heat periods of the day.
- Discuss concerns of increased agitation or sundowning with a doctor and ask if medication changes may be needed.
- Limit environmental factors in the evenings, like TV, loud music or visitors, as these can increase restlessness.
Effect on circadian rhythm
Seasonal changes, particularly when combined with the time change, are known to impact internal circadian clocks. These innate biological clocks comprise circadian rhythm: a recurring pattern in behavior and physiology that repeats approximately every 24 hours.
Circadian rhythm patterns are already altered in people living with Alzheimer’s disease and agitation is a common symptom of sundowning. According to an article published by Johns Hopkins University, people who experience agitation in Alzheimer’s disease are more sensitive to changes in their circadian rhythms. These changes were noted to increase sleep disturbances and levels of agitation in the afternoon and evening hours, which could exacerbate symptoms of someone already experiencing sundowning.
The best way to mitigate the sleep disturbances is to maintain normalcy in routine and take advantage of the extended daylight hours as darkness and shadows in the evenings can be one of the triggers for sundowning. While changes in circadian rhythm may be unavoidable, changes in routine can be easily minimized to help provide a smoother transition during the upcoming seasonal change.
Effect of temperature changes
While it is true that many living with Alzheimer’s will experience sleep issues and sundowning, the effects of seasonal changes remains an emerging science.
Researchers have increasingly begun to look at ties between the seasons and those diagnosed with Alzheimer’s disease. Besides alterations in circadian rhythms, there is also a link to changes in temperature. According to a nine-year longitudinal study conducted in England, hospitalizations of people with a primary diagnosis of dementia peaked in the early summer and winter months.
In this same study, the temperature seemed to play a role in summer hospitalizations, with an estimated 10% increase in admissions for every rise in temperature of 5 degrees Celsius (9 degrees Fahrenheit). Adverse effects were noted in dementia patients when external temperatures consistently exceeded 15 degrees Celsius (59 degrees Fahrenheit).
The results of this study suggest that people living with Alzheimer’s or dementia can be sensitive to even small changes in their environment. As temperatures warm in the spring and summer months, it may be beneficial to schedule outings at times when you can avoid the high-heat periods of the day.
Reach out for help if you need it
Research is beginning to provide more insight into environmental changes that will help caregivers and health providers improve care for people living with dementia. Knowledge is power and the more we understand about sundowning, the better we can help our loved ones cope with the discomfort it can cause them. If you notice changes in your loved one and need guidance or support, the Alzheimer’s Association 24/7 Helpline is available to help any time, day or night, at 1.800.272.3900.
Colleen Kienbaum, RN-BSN, is passionate about writing on various health care topics from a nurse’s perspective. She has worked in several nursing specialties including emergency medicine, cardiac care and perioperative services for the past eight years. Currently, she holds CPAN and CAPA certifications and enjoys the dynamic role nurses play in today’s health care. Colleen is also a military spouse and mother who enjoys traveling and exploring new places with her family.