Some studies indicate as many as 20 percent of persons with Alzheimer’s will experience increased confusion, anxiety, and agitation beginning late in the day.
Sundowning is a symptom of Alzheimer’s disease and other forms of dementia, most often affecting people who have mid- and late-stage dementia. Confusion and agitation worsen in the late afternoon and evening when the sun goes down, and symptoms are less pronounced earlier in the day. Sundowning is also called “late-day confusion.”
Sundowning behaviors can be verbal or physical. They can occur suddenly, with no apparent reason, or predictably result from a frustrating situation. While it can be hard to cope with, it can help when you realize that the person with Alzheimer’s or dementia is not acting aggressively on purpose.
Factors that may aggravate sundowning in seniors
- End-of-day exhaustion (both mental and physical)
- An upset in the “internal body clock,” causing a biological mix-up between day and night
- Reduced lighting and increased shadows, causing people with Alzheimer’s to misinterpret what they see, so they become confused and afraid
- Disorientation due to the inability to separate dreams from reality when sleeping
- Change in the normal routine
- Reactions to nonverbal cues of frustration from family caregivers who are exhausted from their day
Strategies for managing the symptoms of sundowning in seniors:
- Provide comfort and familiarity. For loved ones with dementia, the world can be scary. Surround them with comfortable pillows and blankets, family photographs, figurines, and other familiar objects.
- Light up the home in the evening. Adequate lighting may reduce the agitation that occurs when surroundings are dark or unfamiliar.
- Make a comfortable and safe sleep environment. Keep a comfortable room temperature. Provide nightlights and appropriate door and window locks. Door sensors and motion detectors can be used to alert family members when a person is wandering.
- Maintain a schedule. As much as possible, encourage the person with dementia to adhere to a regular daily routine of meals, waking, and going to bed.
- Avoid stimulants and large dinners. Avoid nicotine and alcohol, and restrict sweets and caffeine to the morning hours. Turn evening meals into more of a light snack.
- Plan more active days. Discourage afternoon napping and plan activities for the morning or early afternoon. Encourage daily exercise, but no later than four hours before bedtime.
- Minimize Stress. Try to stay calm in the evening hours. Stick to simple activities that aren’t challenging or fear-inducing. You might put on soft music to create a calm environment. Watching TV or reading a book may be too hard to follow ─ and frustrating for the senior.
- Try to identify triggers and write them down. Limit distractions during the evening hours such as loud music, people coming and going, etc. Keep a journal of activities, environment, and behavior to identify triggers. Then you can avoid those situations that promote agitation and confusion in your loved one.
- Be mindful of your own mental and physical exhaustion. If you are feeling stressed by late afternoon, the person may sense it and become agitated or confused. Get plenty of rest at night for more energy during the day.
Comfort Keepers® can help. Sundowning syndrome can be exhausting for seniors who suffer from Alzheimer’s and other forms of dementia, as well as their families. Comfort Keepers not only understands this challenge, we also offer respite care for family members so you can remain patient and supportive for your loved one. Call us today.
Mayo Clinic. “Sundowning: Late-day Confusion”. Web. 2013.
HealthLine.com. “What is Sundowning?” by Erica Roth. Web. 2013.
Alzheimer’s Association. Sleep Issues and Sundowning”. Web. 2013.