Rhonda cares for her mother, Betty, a 90-year-old retired nurse with Alzheimer’s disease. Betty has a quick wit, a salty tongue, and a love for music by Frank Sinatra and Nancy Wilson.
Over her past year as a caregiver, Rhonda has established routines with her mother, and things generally go smoothly. But in the early evening, Betty gets agitated when the sun goes down. She follows Rhonda around, asking questions about belongings she misplaced or hasn’t owned in years. Unsatisfied with Rhonda’s answers, she yells and accuses her of stealing. Sometimes, Betty gets upset and bursts into tears.
Frustrated, Rhonda called the doctor, who said her mother shows signs of sundowners syndrome or sundowning.
What is Sundowning?
A common symptom of Alzheimer’s and dementia is sundowning or confusion and agitation late in the day. Other behaviors linked to sundowning include anxiety, pacing, disorientation, mood swings, yelling, and delusions or hallucinations. These symptoms often begin at dusk and can continue through the night.
Sundown syndrome appears during the middle and later stages of dementia and continues until caregivers eliminate the triggers. Here are things to keep in mind regarding sundowning and seniors.
Causes of Sundowning
Researchers are not sure exactly what causes sundowning. According to the Alzheimer’s Association, contributing factors are:
- A disruption in the circadian rhythm or internal clock that tells the body to sleep at night and stay awake during the day.
- Exhaustion after a day of coping with a confusing or unfamiliar environment.
- Lower light and lengthening shadows cause the person with dementia to misinterpret what they see and become agitated.
- Nonverbal behaviors of others, particularly if they exhibit stress or frustration.
- Lack of sleep.
- Hunger, thirst, or fatigue.
Sundowning and Seniors: Ten Things You Need to Keep in Mind
While you might not eliminate sundowning symptoms completely, caregivers can manage the symptoms. Adjusting the living space and daily routine can make a difference. Here are tips to cope with sundowning.
1. Discover triggers
Pay attention to your loved one’s daily activities and look for patterns. Maybe a sleepless night leads to agitation the next evening. Once you identify potential triggers, try to avoid those situations.
2. Plan Active Days
Having trouble sleeping can increase sundowning symptoms. Encourage the person with memory loss to be active during the day to encourage a good night’s sleep. When possible, include time outdoors in the daylight.
3. Set Regular Routines
Routines set daily rhythms and help people with dementia feel safe. Establish regular times for waking, eating, and bedtime. Plan appointments and outings early in the day when your loved one is in good spirits. Avoid late afternoon naps, which disrupt sleep at night.
4. Reduce Evening Stimulation
To minimize distractions that can add to the confusion, make early evenings a quiet time. Reduce background noises from TV or loud music. Consider reading or playing calming music.
5. Let the Sunshine In
Let natural light in during the day to regulate the biological clock. A full-spectrum fluorescent light can help if your home doesn’t have enough daylight. Maintain adequate lighting in your home in the evenings to eliminate shadows that could cause confusion.
6. Create Calm and Comfort
Simplify the physical space by reducing clutter and decorating with soothing colors. Include familiar photos and cherished objects.
7. Stop the Stimulants
Limit consumption of stimulants like caffeine, alcohol, and sugar early in the day. Studies on diet and sleep quality find that noodles, sweets, and sugary drinks are associated with poor sleep. Foods that contribute to good sleep include fish, seafood, and vegetables.
8. Use Supplements
Taking a low dose of melatonin can improve sleep quality. Since sundowning can result from being overtired or staying awake at night, getting a good night’s rest can ease the symptoms.
9. See the Doctor
If sundowning persists despite these efforts, seek medical advice. A checkup could reveal causes for sundowning symptoms such as an illness, pain, or medication side effects.
10. Practice Self-Care
Being a caregiver is a demanding role. Coping with sundowning magnifies the stress you’ll experience. Do your best to get adequate rest to maintain your health. Find a caregiver’s support group online or in your area. You’ll meet others who can share their experience and learn tips to cope with sundown syndrome. The National Institute on Aging shares more information and resources.
Sundowning and Seniors
Managing sundowning behavior in a person with dementia takes trial and error and a bit of detective work. If the tips described above don’t resolve the sundowning, schedule a doctor’s appointment. Be sure to take care of yourself and join caregivers groups for support and coping strategies.