What is Sundowning?
Sundowning is a common symptom of dementia and Alzheimer’s disease where patients experience increased confusion, anxiety, agitation, pacing, wandering, and even aggression in the late afternoon and early evening. It is thought to be caused by disruptions to the body’s circadian rhythms or biological clock.
Sundowning behaviors usually start around dinnertime and can last into the night, making it very difficult for patients to fall asleep. This leads to extended periods of restlessness and disorientation. Sundowning can be extremely distressing and exhausting for both dementia patients and their caregivers.
When Sundowning Typically Occurs
Sundowning symptoms often begin appearing in the late afternoon as natural light starts to fade and shadows set in. The term “sundowning” refers to this timing, as behaviors tend to worsen through the sunset period into the night.
Patients may experience a spike in confusion, anxiety, pacing, wandering, and repetitive motions. Sundowning can also cause hallucinations. Patients may see or hear things that are not there. Sundowning behaviors disrupt normal sleep cycles, frequently leading to late night awakening and nighttime wandering.
Causes of Sundowning
While the exact causes are not fully understood, some factors believed to contribute to sundowning include:
- Fatigue and lack of rest during the day
- Disruption of the body’s internal circadian rhythms and sleep-wake cycles
- Diminished lighting and increased shadows in the evening
- Reduced cognitive stimulation and sensory input later in the day
- Hunger, pain, thirst or other unmet physical needs
- Effects of dementia on the brain’s ability to regulate sleep and behavior
- Disorientation and confusion from transitioning between brighter daytime light to dimmer evenings
Tips for Managing Sundowning at Home
If your loved one with dementia experiences sundowning, here are some tips to help minimize behaviors and create a calmer evening routine:
Modify the Environment
- Increase lighting in the evening to help reset circadian rhythms. Open blinds and use lamps.
- Reduce noise and distractions. Turn off TV and radio.
- Keep rooms tidy and free of clutter to minimize confusion.
- Use night lights in hallways and bathrooms to reduce hazards if wandering at night.
Provide Engagement
- Play soothing music or let loved one watch a favorite show earlier in the day.
- Offer activities like folding laundry or looking at photo albums.
- Schedule walks or other exercise earlier to avoid restlessness.
- Keep evenings focused on relaxation with limited stimulation.
Tend to Needs
- Make sure your loved one isn’t hungry, thirsty, or in pain. Provide a snack.
- Eliminate caffeinated beverages in the afternoon and evening.
- Ensure the person has had physical activity, social interaction, and time outdoors earlier in the day.
Establish a Routine
- Keep a consistent evening schedule for dinner, bathing, winding down, and bedtime.
- Limit daytime napping and keep naps short to promote nighttime sleep.
- Try to have the same caregiver assist with the evening/bedtime routine. Familiarity is comforting.
Address Agitation
- Speak in a calm, reassuring voice when the person becomes agitated or aggressive.
- Try gentle touch and distraction rather than arguing or forceful redirection.
- Validate their feelings while redirecting to activities.
When to Seek Medical Advice
If sundowning behaviors persist and significantly disrupt sleep for your loved one and yourself, consult a doctor. There may be underlying medical factors or medication side effects at play. Ask about adjusting medications so highest doses are given before late afternoon. In some cases, medications may be prescribed short-term to help calm sundowning behaviors and insomnia. Carefully monitor side effects if new medications are introduced.
Support for Caregivers
Coping with sundowning is extremely difficult for caregivers. Make sure to take care of your own rest and ask family or friends for help with respite care. Seek support from local Alzheimer’s resources and support groups. With patience, creativity, and the right support, it is possible to make evenings more peaceful for those with dementia.