What is “Sundowning”?

 

When someone you love or care for suffers from Alzheimer’s or another form of dementia, you may notice abrupt changes in their behavior late afternoon or early evening that continues throughout the night. This is called “Sundowning” or “Sundown Syndrome,” which up to 1 in 5 dementia patients experience. A disturbance in the body’s sleep-wake cycle, it results in more challenging behavior problems later in the day.

When someone is sundowning, you may notice that they are:

• Agitated (upset or anxious)
• Restless
• Irritable
• Confused
• Disoriented
• Demanding
• Suspicious

They also may:

• Yell
• Pace
• Hear or see things that aren’t there
• Have mood swings

What Causes “Sundowning”

While physicians can’t be sure, there are a number of theories as to what causes sundowning. Among them are physical or environmental “cues” that include:

• The sheer mental and physical exhaustion after a full day in an unfamiliar or confusing environment
• A change in hormone levels as the sun goes down—similar to Seasonal Affective Disorder (SAD)
• Stress or frustration in the caregiver which can be inadvertently transferred and felt by the individual with dementia
• Increased shadows in the late afternoon or early evening which causes the person with Alzheimer’s to misinterpret what they see and become more agitated
• A growing fear of being unsafe as the evening and darkness approach
• Disorientation due to the inability to separate dreams from reality when sleeping

What Can I Do To Reduce “Sundowning”?

Depending upon the behavior, there are a number of things, short of medication, that you might attempt. These include:

Stick to a Routine Schedule

• Try to stick to the same schedule every day
• Minimize activity towards the end of the day
• Ask yourself:

Did the television suddenly come on when it has been off all day?

Did a change in caregivers occur, leading to more confusion?

Does the home become more chaotic in the evening?

Are there more people in the home in the evening or at mealtime?

Ensure Plenty of Light

• As seasons change and light is reduced, increase indoor lighting
• Turn on exterior lights near windows to reduce the darkness outside
• Try brightening the lights when a loved one begins to feel confused or agitated

Monitor Eating Patterns

• Watch for nutritional triggers like caffeine, sugar, alcohol or other liquids later in the day
• Be aware that larger meals later in the day can increase agitation
• Limit evening food intake to a hearty snack or light meal

Reduce Stress

• In mid-stage or advanced dementia, watching television or reading a book may be too difficult
• Consider playing soft music to create a calm, quiet environment
• Cuddling with a beloved pet may be a calming influence

Provide Comfortable, Familiar Surroundings

• Fill your loved one’s life with things they find comforting
• Play familiar gentle music in the evening or relaxing sounds of nature
• If they’re in a care facility, ensure that their room has cherished items available

Track Patterns of Behavior

• Use a journal or smartphone to track daily activities, environments, and associated behaviors
• Once you recognize triggers, it will be easier to avoid agitating or confusing situations

Simplify Surroundings and Adjust the Sleep Environment

• Reduce napping and inactivity during the day
• Too much stimulation can cause anxiety and confusion
• Minimize physical, visual and auditory clutter
• Keep the sleeping room calm and cool

Offer Distractions

• Draw attention away from stress or anxiety with a favorite activity, another family member or pet
• Take a walk with them to reduce their restlessness

Care for Yourself

If you are stressed and impatient, the one you are caring for will pick up on it. Ensure that you:

• Eat a well-balanced diet
• Take regular breaks
• Try to get plenty of sleep
• And reach out to others for help

Summary

If a loved one has dementia, there are likely to have changes in their behavior in the later hours of the day—which is commonly referred to as “sundowning.” If you know what’s causes “sundowning” and when to most expect it, you will be better equipped to handle it when it occurs as you journey along the gray mile together.

 

@TomJonesNBTX