Sundowning

CapeCodMermaid, RN · Jul 27, 2006

Try to keep shift change commotion and noise to a minimum. Some think an afternoon nap will help with sundowning and some people think bright lights will work. Sometimes you have to resort to PRN meds...it's so common with dementia residents. Just find what works for each resident and try to do it. (easier said than done)

hazeleyedbabygirl · Jul 27, 2006

I agree on keeping shift change commotion to a minimal. Activities may also help in the matter. Find out when this change occurs, what time of day, try to provide some type of meaningful activity just before the behavior occurs. May need to contact the family to see what activites were of interest to her in her earlier days. I also believe that PRN medications can be beneficial. Also maybe some psych counseling may help. Hope this help, and yes........... easier said than done. Oh, if this is "new" to this resident, you may want to see if she has an infection somewhere, UTI?? Has she had any new med changes?? Hope this helps. Good luck.

banditrn · Aug 5, 2006

We have one old gent who is always up all noc - talked to the earlier shift CNA, and she told me he sleeps most of the day. :madface:

I've asked them to try to keep him from doing that - with no success. One thing I've observed when we're in there at nite, is that if the bright overhead lite is turned on - he drops right to sleep!! Unfortunately, at nite, his roommate wants it dark - or I'd leave that lite on.

aznursinggal · Aug 5, 2006

I had a resident that sundown I put her to bed at 6:30 p.m and by midnight she was up again. The Nurse at the time gave her a vicodin, 2 motrin and a volume. I walked with her for four hours, Finally at 4:57 a.m she went to sleep and I stayed til 6:30 a.m to9 finish my work. It was crazy

achot chavi · Aug 6, 2006

You can research the topic by googling Alzheimers and Sundown Syndrome. It comes from the inability to quickly adjust to the difference between daytime activities and evening/nightime activities. I still have doctors who don't beleive in Sundowning Instead of dealing with the change in day to night in a matter of an hour, it is useful to break it into steps, by dimming lights slowly, change activities gradually not cold turkey. Unfortunately in a Nursing Home everything is on a schedule, so there isn't time for this, There are many useful tips. . I find our Snoozeline Room to be very helpful. I hate resorting to PRN meds because it messes up their sleep schedule. I beleive someone mentioned that.

Reorientation never works, better to leave them in their reality than upset them by reorienting them. Can the family help?

Quailfeathers · Aug 6, 2006

I've worked with several elderly individuals who experienced Sundowners. Some research suggested providing a relaxing routine before the Sundowners s/s occur ie duplicating the routine they were accustomed to when they were independent.The change in lighting; daytime to night time is difficutl for them: get lights on earlier, sometimes overactivity prior to will increase s/s, minimizing noise is helpful, having someone sit with the individual may help - family perhaps? From what I've read and experienced with clients, at best Sundowners can be minimized. And some days the interventions will work other days it will not.

weirdRN, RN · Aug 6, 2006

We have one old gent who is always up all noc - talked to the earlier shift CNA, and she told me he sleeps most of the day.
I've asked them to try to keep him from doing that - with no success. One thing I've observed when we're in there at nite, is that if the bright overhead lite is turned on - he drops right to sleep!! Unfortunately, at nite, his roommate wants it dark - or I'd leave that lite on.

I have several residents that are up all night. I also know that they were shift workers and worked mostly nights. They are also Alzhiemer's patients and are pretty well progressed. They pace, they cry, they beg for their families and people who are long dead. Reorienting helps sometimes. Others it does not. Typically what I have done is just allow them to do what ever they want until they have exhausted themselves.

When I get old, if some one tries to get me out of bed before I am ready you can bet I am going to be nasty. If they try to feed me food I don't want, you can bet I am going to be nasty then too. I doubt I will be a very compliant resident in any LTC facility.

chadash · Aug 6, 2006

I have often wondered would it be harmful to allow the patient to follow their own pattern. In a locked facility, if we have a number of sundowners, would it be appropriate to allow them their own area to walk or what not? I would be concerned that they are getting enough sleep over a 24 hour period, and meals can't be affected. Guess this is a tough concept, just wondering.

I remember a pt that one of my night shift nurses gave benedryl to, and it only disoriented her more. She was up anyway, and more prone to fall.

weirdRN, RN · Aug 6, 2006

I think to allow the individual to follow their own routine is more beneficial. Recently we had a resident that was put on a scheduled psychotic med and then given an order for a daily prn dose four hours after the last dose IF the resident was still combative and uncontrollable. We ensured that she was given her med every day on schedule, and put down for a nap after lunch and then sat beside an open window in the afternoon after she woke up. This has worked most days out of the last three months but she still occasionally sundowns.

achot chavi · Aug 7, 2006

when i get old, if some one tries to get me out of bed before i am ready you can bet i am going to be nasty. if they try to feed me food i don't want, you can bet i am going to be nasty then too. i doubt i will be a very compliant resident in any ltc facility.

here's to wishing you many years in excellant health and never needing to become a resident in (my) nursing home

the truth is i dont need a nursing home to force me to do all those things- because:

work already gets me out of bed before i am ready,

health already feeds me food i don't want (i'd eat ice cream each meal if i could)

family responsibiliies makes me be compliant....

but seriously, forcing residents to conform to the nursing home schedule is cruel while we try to be understanding (especially about meals) it cant always work in a well run institution!!

achot chavi · Aug 7, 2006

I think to allow the individual to follow their own routine is more beneficial. Recently we had a resident that was put on a scheduled psychotic med and then given an order for a daily prn dose four hours after the last dose IF the resident was still combative and uncontrollable. We ensured that she was given her med every day on schedule, and put down for a nap after lunch and then sat beside an open window in the afternoon after she woke up. This has worked most days out of the last three months but she still occasionally sundowns.

That's Great- you should also look into Behavior Modifying Techniques- if done uniformly (by everyone) they really can help!!!