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What is Sundowning?

Sundowning, or sundowners syndrome, is a common symptom of dementia and Alzheimer’s disease. The syndrome is not a disease in itself, but rather a pattern of behavior that occurs at a specific time of day. Sundowning is also known as “late-day confusion” because of an increased state of confusion and agitation that may worsen in late afternoon and evening. In comparison, a dementia patient’s symptoms may be less pronounced earlier in the day. Additionally, symptoms of sundowning are more common in mid- to late-stage dementia. It is important to learn the symptoms and causes of sundowning to better understand and care for your loved ones. 

Signs and Symptoms

There are a variety of signs and symptoms of sundowning that range in severity. The symptoms are similar to those of dementia or Alzheimer’s but tend to begin or worsen in early to late evening. Symptoms include, but are not limited to: 

  • Anxiety
  • Restlessness
  • Increased confusion
  • Disorientation
  • Yelling
  • Pacing
  • Delusions or hallucinations
  • Sudden mood swings

These symptoms often manifest together rather than one at a time. They may occur for just a few hours in the evening, or they may last through the night. 

Causes

Unfortunately, the causes of sundowner’s syndrome are not well understood. Recent research suggests that aging affects a person’s circadian rhythm or their “internal clock.” This area of the brain signals awake and sleep cycles and may break down in those with dementia or Alzheimer’s. 

Other factors may aggravate the symptoms of sundowning; some triggers include: 

  • Pain
  • Boredom 
  • Depression
  • Increased fatigue
  • Low lighting and more shadows
  • Illness or an infection
  • Unmet needs such as hunger or thirst 

Ten Tips to Cope with Sundowning

While it is difficult to completely eliminate sundowning syndrome, caregivers can work to minimize and manage the symptoms. Managing sundowners requires attention to detail and monitoring patient’s activities throughout the day. Try the following tips to help cope with the symptoms. 

1. Look for Triggers

Triggers for sundowning are different for each individual. Record your loved one’s daily activities, environments, and behaviors. Then, look for patterns to determine what may worsen symptoms. Once you identify possible triggers, aim to avoid situations that cause increased confusion or agitation. 

2. Establish a Routine

Establish a daily routine and stick to the schedule. Routines can help dementia patients feel safe by setting daily rhythms. According to the Alzheimer’s Organization, you should set regular times for waking, eating, and sleeping. When creating a schedule, plan appointments, outings, and visits earlier in the day when symptoms are lessened. Avoid late-day naps to allow for the best sleep at night. Find a schedule that works for both you and your loved one, and make any necessary changes gradually.

3. Plan Active Days

As you create a daily schedule, be sure to plan engaging activities for your loved one. Difficulty falling and staying asleep can increase the symptoms of sundowning. To promote a good night’s sleep, encourage your loved one to stay active during the day. Try a walk outside to promote physical health, or an engaging card game to stimulate their mind.

Vineyard Henderson offers a variety of individualized activities to keep your loved ones active throughout the day and ultimately reduce the symptoms of sundowning. Our life enrichment programs are tailored to the needs of our residents individually to aid in stress reduction, which is especially beneficial for those who sundown.  

4. Relax in the Early Evening

With patients experiencing sundowners symptoms, it’s important to make early evenings a quiet time of the day. Reduce background noise in their surroundings. Consider playing soothing music or reading. It may also be best to avoid large meals late in the evening to make your loved one more comfortable and able to rest easier.

5. Let in Light

Adjust the lighting to help alleviate sundowning symptoms. Allow natural light to shine in during the day to regulate the circadian rhythm. If natural light is not an option, a full-spectrum fluorescent light can help. Consider placing the light about a meter from your loved one for a few hours each morning. Research suggests that this type of light therapy may reduce agitation and confusion in people with dementia. It is especially important to keep the home well lit in the evenings to avoid dark or unfamiliar surroundings.

6. Provide Stability and Comfort

Tips that help with overall dementia issues can also assist in lessening sundowning symptoms. For further resources, refer to this list from the Mayo Clinic. Reducing overall stress throughout the day is a good practice for those with Alzheimer’s or dementia. Reduce emotional stress by simplifying their physical environment. Remove clutter and use soothing colors in their home. Fill your loved one’s space with familiar items they cherish and find comforting. 

7. Avoid Stimulants

Caffeine, alcohol, and excess sugar can affect sleep according to recent studies. Limit the use of these stimulants to earlier in the day. Additionally, avoid long periods of television or use of other electronics in the evenings as these can also be stimulating.

8. Utilize Supplements

While consuming certain products should be avoided, some research suggests using supplements to help with sleep. A low dose of melatonin, a naturally occurring hormone that helps regulate sleep, may ease sundowning. Herbs such as Ginkgo biloba and St. John’s Wort may also alleviate symptoms of Alzheimer’s and dementia. Lastly, consider chamomile tea or lavender aromatherapy to assist with relaxation in the evenings.

9. Ask a Doctor

If the suggested tips do not improve sundowning or if symptoms develop quickly, it may be best to speak with your loved one’s doctor. Underlying conditions such as a urinary tract infection or sleep apnea may be causing pain and sleep disturbances. A doctor can further help identify causes and possible solutions for late evening agitation. Beyond prescribing medicine for sleep or anxiety, a doctor can also to approve any alternative forms of treatment such as the supplements previously mentioned.

10. Take Care of Yourself

Sundowning can be exhausting for both patients and their caregivers. As a caregiver, it is vital to take care of yourself so that you can care for your loved one. Being rested and healthy will give you the patience and support to care for those with dementia or Alzheimer’s. 

Consider joining a caregiver’s support group. This will allow you to have a support community and message board to learn more tips and share your experiences with other caregivers. Learn more about the Vineyard Support Group in our September Newsletter

Managing Sundowning Symptoms in Your Loved One

Managing sundowning can be challenging yet not impossible. Flexibility, creativity, patience, and empathy are vital to dealing with the range of symptoms. Because everyone with dementia is different, it may take trial and error to identify triggers and solutions that work for your loved one. In this process, it is essential to seek the help of experts, friends, and family to help you cope and learn how to provide the best care.

 

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