What is sundowning?
Sundowning is a symptom that can show up in people who have Alzheimer's disease or other dementias. When someone becomes confused, anxious, aggressive, agitated, or restless consistently later in the day (usually late afternoon or early evening), this is called sundowning.
It is thought that sundowning can be a problem for as many as 66% of people with Alzheimer’s disease or other dementias. It can occur at any stage of the disease but it tends to peak in the middle stages of dementia and lessens as the disease progresses.
Sundowning often affects the person’s quality of life and it can be exhausting for the caregiver.
Behaviours associated with sundowning
Some behaviours are typical with sundowning. They include:
- Becoming demanding or aggressive
- Experiencing delusions and hallucinations. Learn more about delusions and hallucinations.
- Pacing or wandering
- Doing impulsive things
- Attempting to leave home
- Having difficulty understanding others
- Having difficulty doing tasks that were done without difficulty earlier in the day
What causes sundowning?
A variety of events or issues can trigger sundowning. These include:
- Being tired at the end of day (can lead to an inability to cope with stress)
- Low lighting and more shadows (can create confusion and hallucinations, especially with common objects that look different when it is darker)
- Disruption of the Circadian cycle (sleep/wake pattern) because of the dementia (the person cannot distinguish day from night)
- Not as much or no activity in the afternoon compared to the morning (can lead to restlessness later in the day)
Responding to sundowning
Finding a way to respond to sundowning may take some trial and error. Every person is different and may react differently. Some ways to try to head off a sundowning episode or to lessen it once it has started are:
- See if the behaviour is being caused by discomfort (hunger, need to use the toilet, pain).
- Allow for rest and naps between activities.
- Avoid making appointments, bathing, or other potentially stressful activities in the late afternoon or evening.
- Prevent over-stimulation from the television or radio, which can lead to increased confusion.
- Provide adequate lighting to lessen shadows when it begins to get dark.
- A rocking chair can provide stimulation while having a calming effect.
- Brisk walks or other forms of physical activity throughout the day may reduce restlessness or the need to wander later.
- Keep him active and distracted when sundowning may occur (for example, preparing dinner, setting the table).
- Allow quiet time if this helps
- decrease agitation.
- Restrict the amount of caffeine and sugar he has in the morning.
- Maintain a regular eating and sleep schedule as much as possible.
- It may be helpful to keep a daily journal to pinpoint the causes of sundowning symptoms and see which strategies help.
- Familiar routines may help him feel more secure. They can include readying the home for evening (closing curtains, turning on lights) or bedtime routines that include warm milk and soft music.
- Change sleeping arrangements, for example, adding a comfortable chair to the room, a night light, or leaving a door open.
- Doctors may recommend certain medications to ease the symptoms, for example, antipsychotics, sedatives, or sleep-regulating hormones such as melatonin. These can help some people, but because many have serious side effects such as dizziness, sedation (causing sleepiness), or dependence, it is recommended that other options be tried before relying on drugs. Talk this over with the doctor.