What is Sundowning?
And, what should I do about it?
The term “sundowning” refers to a state of confusion that often occurs in the late afternoon and may continue into the evening or night. Sundowning can cause or exaggerate some of the common behaviors associated with dementia. This could include confusion, anxiety, aggression, or ignoring directions. Your loved one might become demanding or suspicious. Sundowning can also lead to pacing or wandering.
Sundowning isn’t a disease, but a group of symptoms that occur at a specific time of the day that may affect people with dementia, such as Alzheimer’s disease.
What causes Sundowning?
The exact cause of this behavior is unknown. It might be related to light levels as the day wears on, or it might be related to fatigue if the person has been up and active for a while. They could even pick up on Caregiver fatigue!
There is speculation that the “internal clock” we all have is broken for people with dementia, so the day (and people around them) want them “awake” when their body tells them to “sleep”. Imagine how you would feel all mixed up, time-wise.
A more interesting theory to consider is that activity associated with later afternoon (shift changes, grandkids coming home from school, the dog needing a walk) may create a frustrating anxiety. The person with dementia might “remember” that they have to check on the dog, or pick up kids, or wrap up the day at work, even though this is not the current reality. Then, not being able to do it, or understand why they cannot, is frustrating and leads to behavior issues. That can include the need to “check in at home” which can lead to wandering behaviors.
Can it be prevented? How do we manage it?
The easiest approach to sundowning may be to change the stimuli of the environment. For example, keep lights brighter during the afternoon to “hold off” the shadows of evening. Close the blinds in the afternoon to avoid the changing light. The Alzheimer’s Association suggests the use of brighter lights during the evening.
You can also help the person get more or better sleep. Sometimes this might include little changes to medication or new patterns; talk to your doctor. You can arrange the bigger meal to be lunch rather than dinner/supper.
Schedule outside trips for times during the early part of the day. Go outside for a walk mid-day and limit mid-day naps, if possible. Avoid too much new activity during the time when the person with dementia seems to get agitated. Reduce noise and activity in the evening. Some people note that the TV is too distracting and suggest quiet music instead. Music can work wonders for some people with Alzheimer’s.
Care for the caregiver
Caregivers are stressed too. Take time to recover, sleep well, and relax as much as you can. Get respite help when necessary. There is no shame in asking for help and/or taking time for yourself.
For more information or help, contact a professional care manager, a home care agency, or an attorney familiar with these sorts of issues. Here is a more extensive case-study article.