Sundowning, also called sundowner’s syndrome, refers to increased confusion, anxiety, agitation, pacing and disorientation that people with Alzheimer’s disease and other dementias often experience in the late afternoon and evening. It is not a disease itself but a set of behaviors likely related to disease progression and changes in the brain.
Sundowning tends to occur around dusk and continue through the night. Contributing factors may include exhaustion from daytime activities, entering an unfamiliar or confusing environment in the evening, and disruption of the internal body clock – feeling tired during the day but awake at night. Low lighting at night can also increase shadows and hallucinations. Noticing stress in caregivers may also cause agitation. Difficulty distinguishing dreams from reality during sleep can lead to disorientation upon waking.
Tips for Managing Sleep Disturbances
There are a variety of non-drug techniques that carers can try at home to combat sundowning and promote better sleep:
- Encourage ample rest throughout the day to prevent exhaustion. Allow the patient to nap as required.
- Schedule demanding activities like appointments, trips, and bathing for morning when patients are most alert.
- Maintain a regular daily routine for meals, activities and bedtime. A consistent schedule helps orient the patient.
- Spend time outside during daylight if possible to help reset circadian rhythms.
- Identify triggers of sundowning behavior and try to avoid them. Keep notes on behaviors.
- Reduce stimulation and noise in evenings – no loud TV, chores, or music.
- Offer a larger lunch and smaller, lighter dinner to avoid disrupting sleep.
- Keep home well-lit in evening to reduce confusion and shadows.
- Engage patient in calming activities at night like looking at photos, reading, or listening to soothing music.
- Take evening walks to reduce restlessness and agitation.
- Consult doctor about best times for medications to avoid disruption.
- Limit daytime naps to encourage nighttime sleep if needed.
- Avoid or limit alcohol, caffeine and nicotine, especially later in the day.
Managing Sundowning Events
If sundowning behaviors do occur, try to remain calm. Speak gently and determine if the patient needs anything urgently. Gently re-orient them to the time and place. Provide reassurance that they are safe. Allow pacing or wandering under supervision for restlessness. Try engaging them in a calming activity. Avoid arguing or restraining them.
Discuss persistent sleep issues or severe sundowning with a doctor to identify potential causes and solutions. Underlying conditions like infections, restless leg syndrome or sleep apnea may contribute. Non-drug approaches are usually recommended first, but medications may help in some cases if other options fail. Carefully weigh the risks and benefits before using medications.
With patience and consistent care strategies, caregivers can help manage sundowning and sleep issues. This can greatly improve quality of life for dementia patients and their families.