Sundowning is a potential symptom of Alzheimer's disease and some other memory disorders. Family caregivers and loved ones who aren't expecting this symptom can be confused and worried by it, and even if you've been educated about sundowning by a medical provider, it can be challenging to deal with. Find out more about sundowning below and get some tips for coping with this symptom if you're supporting a loved one who is suffering from dementia.
Sundowning is the term used to describe confusion and certain behavior that some people with Alzheimer's disease and certain other disorders demonstrate at a specific time of day. It's called sundowning because the symptoms typically start in late afternoon and can extend into the evening and night hours.
People who are experiencing sundowning may be more confused than they are at other times of the day. They may also exhibit aggression, ignore feedback from others or act belligerent and have high levels of anxiety. Common physical results of this situation can be excessive pacing or wandering—including wandering around the home or even outside the home.
As with many cognitive issues, medical researchers don't have a lot of definitive information about why sundowning occurs. Some believe that the brain is changed by cognitive and memory disorders in ways that mess up someone's natural clock, which is what helps regulate energy levels as well as cycles of wakefulness and sleep. When this occurs, it's thought the person doesn't get tired normally toward the end of the day and then fall asleep to regain energy for the next day.
Some other things medical professionals think might cause or increase sundowning include pain, not being cognitively engaged or being bored, mental health issues such as depression and being hungry, thirsty or simply too tired to wind down at the end of the day normally.
Another theory is that shadows during the evening and at night can increase confusion for someone who is having cognitive challenges. This can lead to fear, frustration or agitation.
Individuals, their family and other caregivers can't always stop sundowning from happening, especially if they haven't been able to identify causes of it for that person. However, you can take some actions to help reduce the chances someone might suffer from sundowning on any given day by mitigating some of the things believed to cause it.
For example, it's believed that being overly tired in the afternoon or evening can cause or worsen sundowning symptoms. Acting to reduce exhaustion in the evening, such as encouraging a short nap in the late morning or appropriate periods of both activity and rest throughout the day, may help. You might also want to limit your loved one's intake of stimulants, such as sugar and caffeine, especially after lunch time.
Over stimulation or activity throughout the day may lead to sundowning. But since boredom might also be a cause of these symptoms, you do want to encourage some action. Work with your loved one, medical providers and others to develop plans for the right amounts of activity to provide cognitive engagement and stimulation without overdoing it.
Even if you take precautions, you might still deal with sundowning at times. Minor instances of sundowning might just include some mild agitation and pacing. Severe episodes could include aggressive, upsetting or even dangerous behavior on the part of your older loved one. If you see that sundowning is beginning to occur, here are some tips for coping with it to minimize the severity of the episode:
• Cut down on external stimuli. Have others leave the room if possible, turn off (or turn down) televisions or radios and move physical items to reduce the visible clutter of the space. It's possible that some of these stimuli may make the agitated sundowning state worse.
• Offer redirection. Play an easy and non-stimulating game, offer a snack or put on a television show that the person enjoys but isn't intense or stressful for them.
• Provide options for healthy and appropriate movement. Walk with your loved one up and down the street in the early evening if they're agitated and pacing and you can do so safely.
• Reduce the amount of shadows by adding lamps and turning on lights in rooms where your loved one tends to spend time in the evening. You can also draw curtains to keep the setting sun from casting changing shadows in rooms that face west.
Will every person and family dealing with dementia face sundowning? No, but it's a common symptom, so it's important to be prepared. And if you are looking for support for your loved one so they can continue to live as independently as possible while being safe during the entire day, you might consider memory care at Autumn View Gardens in Ellisville, MO.
Bethesda Foundaion is not associated with the Bethesda Health Group of St. Louis, MO.