Sundowning and the witching hour

As the light fades, they become agitated. Freaked out, confused, angry. And it’s your job to absorb all those feelings and manage the consequences of those feelings, somehow without becoming agitated yourself.

In people with Alzheimer’s disease, we call it “sundowning”. In babies, we call it “the witching hour”. As far as I can see, it’s exactly the same thing: agitation in the late afternoon and the early evening, usually presenting in people who have an early bedtime and wake up early in the morning. An adult with Alzheimer’s might pace around or shout at their caregiver; a baby will just keep screaming.

The advice for dealing with both sundowning and the witching hour is eerily similar. Adjust mealtimes. Use soft music/white noise. Set the heating to a comfortable temperature. Speak in a reassuring tone of voice. Identify triggers for the behaviour so you can avoid them…wait a minute, is the internet really telling you that the daily setting of the sun is a trigger you can avoid? Well, no. But the “avoid triggers” advice, just like the “look after yourself and take breaks” advice, is a way of clueing you in that there’s nothing you can actually do to stop the behaviour, only stuff you can do to make yourself feel like you’re doing something, so you don’t go crazy.

In my post about the politics of sleep I wrote that it’s initially hard to understand why one person would try to control another person’s sleep patterns – until you realise that the person whose sleep is being controlled is work for the first person. Attempting to control someone else’s sleep patterns probably means that their very existence constitutes work for you. And vice-versa: if there is someone who can’t be awake without being work for you, of course you’re going to obsess about when they sleep.

And so the advice for dealing with sundowning old people and wailing witching-hour babies also includes stuff on not “letting them nap” for X hours before bedtime. Congratulations! You are now in charge of another human being’s circadian rhythms. It is your job to repeatedly wake them when their body and brain are telling them to sleep, because their body and brain are telling them to sleep at the “wrong” time. Oh, but it’s also your job to worry when they won’t sleep at the “right” time, because if they’re not well-rested they will supposedly kick off even more. (If you’re currently dealing with a old person wandering around the house turning all the taps on, or a screaming witching-hour baby, you might wonder exactly how it could get any worse.)

My hunch is that sundowning is linked to advanced sleep phase disorder (ASPD) and that advanced sleep phase disorder is itself an extreme manifestation of the tendency to become more of an early-bird as you get older. I don’t know where the cut-off point is between “natural lark” and “person with ASPD”; it seems kind of arbitrary to me. Human circadian cycles vary, but we’ve defined a specific range as “normal”, which means everybody whose body-clock is outside that range must be suffering from a disorder. (A bit like what happened with the BMI.)

The President of Starbucks is a successful go-getter because she sets her alarm for 4:30am, while an elderly person who wakes up between 3am and 4am is suffering from advanced sleep phase disorder. Is the difference between “person with a disorder” and “successful go-getter” really about the actual times they wake up, or is it about the context?

Maybe the real difference is that Michelle Gaas and Howard Schultz wake up early so they can do more work, while many of the elderly people with advanced sleep phase disorder become work as soon as they open their eyes.

When we obsess about a person’s sleep, we forget about the real problem: the work we have to do every moment this person is awake. We forget that sundowning and the witching hour are both emotionally draining ordeals. We say “He won’t settle” when we mean is: “Someone I love is screaming at an ear-splitting volume for hours on end, and there’s nothing I can do to console him.” We say “She won’t sleep and I need a break” when what we mean is: “My mother yells abuse at me all evening, using foul language I never thought she even knew.”

I don’t know what hell is like. But imagine being in a room where a fire alarm is going off at ear-splitting volume. Your body is saying: “Emergency! Run!” but you know you can’t leave because it’s your job to be in this room. And the alarm isn’t a normal bell sound. It’s been fine-tuned to a frequency that will upset you more than anybody else who hears it. Oh, and the message the alarm is sending is that you’re a shitty failure because you can’t stop the alarm. Well…that’s basically what we call “sundowning” or “the witching hour”.

(With sundowning, there’s also the possibility of being physically attacked or having a fire or flood in your home. The advice about adjusting mealtimes and getting fresh air is almost comically inadequate when you understand that context.)

The obsession with sleep is driven by the desire for a break from what would be called abuse or torture if it was inflicted by people who have full agency. What if we stopped talking about naps and mealtimes and lighting and started asking why we expect parents and carers to just take that daily abuse and bear all the emotional costs of it?

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