How to Manage "Sundowning"

When you are with someone who has Alzheimer's disease, you may notice big changes in how they act in the late afternoon or early evening. Doctors call it sundowning, or sundown syndrome.

Fading light seems to be the trigger. The symptoms can get worse as the night goes on and usually get better by morning.

Although you may not be able to stop it completely, you can take steps to help manage this challenging time of day so you both sleep better and are less tired during the day. Let your loved one’s doctor know what changes you have seen, too.

Symptoms

When someone is sundowning, they may be:

  • Agitated (upset or anxious)
  • Restless
  • Irritable
  • Confused
  • Disoriented
  • Demanding
  • Suspicious

They also may:

  • Yell
  • Pace
  • Hear or see things that aren’t there
  • Have mood swings

 Up to 1 out of 5 people with Alzheimer’s get sundown syndrome. But it can also happen to older people who don’t have dementia.

Causes

Doctors aren’t sure why sundowning happens.

Some scientists think that changes in the brain of someone with dementia might affect their inner “body clock.” The area of the brain that signals when you’re awake or asleep breaks down in people with Alzheimer’s. That could cause sundowning.

It may be more likely if your loved one is:

  • Too tired
  • Hungry or thirsty
  • Depressed
  • In pain
  • Bored
  • Having sleep problems

What happens around someone can also set off sundowning symptoms. Some triggers are:

  • Less light and more shadows in the house. This can cause confusion and fear.
  • Trouble separating dreams from reality. This can be disorienting.

If you feel tired or frustrated at the end of a day of caregiving, your loved one may notice, even without you saying anything. This can upset them, too. It’s normal for you, as a caregiver, to have feelings like that. Try to be aware of how you manage those emotions if you think that might make a difference.

How to Help Someone Who Is Sundowning

Look for patterns. Note the things that seem to trigger it, and then do your best to avoid or limit those triggers.

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Keep a daily routine. Set regular times for waking up, meals, and going to sleep. Try to schedule their appointments, outings, visits, and bath time in the earlier part of the day, when they are likely to feel their best.

Limit or avoid things that affect sleep.

  • Don’t let your loved one smoke or drink alcohol.
  • Make sure if they have sweets and caffeine that they just do it in the morning.
  • Make a big lunch, and keep their evening meal smaller and simple.

Avoid letting your loved one nap or exercise later than 4 hours before bedtime. If they absolutely need to nap, try to keep it brief and early in the day.

Keep things calm in the evening.

  • Close curtains and blinds and turn on lights. Darkness and shadows can make them more upset.
  • Fix the room temperature so they're comfortable.
  • Tell other family members or visitors not to make too much noise.
  • Put on relaxing music, read, play cards, or go for a walk to wind down.

How to React

  • Stay calm.
  • Ask your loved one if they need something.
  • Remind them what time it is.
  • Don’t argue with them.
  • Reassure them. Tell them everything is OK.
  • If they need to get up and move around or pace, don’t try to hold them back. Just stay close by to keep an eye on them.
  • Keep them safe with night-lights and locks on doors or windows. Use a gate to block the stairs, and put away anything dangerous, like kitchen tools.

Also, consider getting a baby monitor, motion detectors, or door sensors. They can let you know if your loved one is walking around.

When You Need a Doctor’s Help

If the above tips don't work, tell his doctor, who can check to make sure that your loved one’s medicines that help him relax and sleep don’t cause more confusion the next day.

Take Care of Yourself

Sundowning can make it hard for you to get restful sleep. And you need to take care of yourself in order to be there for your loved one.

You can:

  • Ask a friend or relative to fill in for you at night.
  • Try to get a daytime nap.
  • Take breaks whenever you can during the day.
  • Hire a home health care service for backup.

Other ways to take care of yourself are to exercise, eat healthy, spend time with friends, and try to find time -- even if it’s not a lot -- for your own hobbies and interests. Consider joining a caregiver’s support group, too.

WebMD Medical Reference Reviewed by Neil Lava, MD on December 17, 2015

Sources

SOURCES:

National Institute on Aging: “Sundowning.”

Alzheimer’s Association: “Sundowning.”

Khachiyants, N. Psychiatry Investigation, December 2011.

Alzheimer’s Foundation of America: “Behavioral Challenges: Coping With … Sundowning.”

Schwartz, J. Current Neuropharmacology, December 2008.

Alzheimer’s Association: “Sleep Issues and Sundowning.”

Family Caregiver Alliance: “Caregiver’s Guide to Understanding Dementia Behaviors.”

National Institute on Aging: “Caring for a Person with Alzheimer’s Disease.”

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