If you care for someone who has dementia or Alzheimer’s disease, you may notice a significant shift in their behavior during the late afternoon into evening. It’s not unexplained behavior. It’s sundown syndrome.
Sundown syndrome, or “sundowning,” refers to the late-day confusion that begins in the afternoon and continues into the evening. It is not a disease, but rather a group of behavioral symptoms including confusion, aggression, anxiety, hyperactivity, ignoring directions, pacing or wandering. Sundowning is prevalent among those with dementia, including Alzheimer’s disease, because dementia disrupts the body’s internal clock or sense of time.
Those with dementia tire easily and can become restless and challenging to manage when tired. A person experiencing sundowning may be hungry, uncomfortable or need to use the bathroom, but only be able to express it through restlessness.
Sundowning tends to worsen during winter months, when shorter days mean less exposure to natural sunlight, further agitating sundowning symptoms. This has led researchers to believe that sundowning syndrome may be related to Seasonal Affective Disorder, a type of depression more common during winter, caused by insufficient exposure to natural sunlight.
What Triggers Sundowning?
Sundowning occurs as the result of changes in the brain caused by dementia, but those exact changes are unknown. There are understood causes of sundowning, however, including:
- Fatigue. Those with dementia generally tire more easily and thus become more restless, agitated and difficult to care for. General exhaustion from the day and the sudden lack of activity that occurs after an evening meal can also trigger symptoms.
- Low lighting. As the sun sets, which is even earlier during Daylight Savings, there is less light available, causing shadows and affecting vision.
- Disruptions to the internal clock. Dementia disrupts the body’s internal clock, or sense of time, which is essentially regulated by memories. You know what day of the week it is because you’re able to remember what happened yesterday. For those with dementia, that sense of time is lost. They are unable to remember what happened a few hours ago or what will happen a few hours from now. Without the internal clock's ability to regulate the time of day and the typical behaviors and activities that go with it, sundowning can occur.
How to Manage Symptoms
The treatment of sundowning, just like its cause, is not well understood. There is no single, one-size-fits-all approach to treatment. However, there are ways to manage sundowning symptoms:
- Maintain a routine. Because sense of time is controlled by memory, it’s important to stick to a daily routine that establishes a sense of familiarity and predictability for your love one. Keep times for going to bed, waking up, meals and activities consistent. Without a structured schedule, your loved one is more likely to feel confused and stressed.
- Limit stimulation. As the day goes on, it may help to reduce the amount of stimulation your loved one is exposed to. Lower the volume on the TV or stereo beginning in the late afternoon into evening. If you’re expecting visitors, schedule the visit earlier in the day when your loved one isn’t showing sundowning symptoms.
- Keep the home well-lit. Ensure that rooms are well-lit as the sun sets. Light therapy boxes can help reduce the effects of sundowning, as they keep areas brightly lit, minimizing shadows and loss of color. Nightlights can also help your loved one feel more comfortable in dark, unfamiliar settings. When your loved one can actually see their surroundings and move around easily, they’ll have a stronger sense of familiarity.
- Prepare for bedtime. Comforting, peaceful activities, such as listening to soft, familiar music, drinking warm tea, cuddling with a pet, or getting a back rub will help calm your loved one down and go to bed more easily. Don’t schedule any activities that may agitate your loved one right before bed, like bathing. Such activities are better suited for daytime when symptoms are less prevalent.
- Schedule rest. Fatigue can worsen sundowning symptoms. If that’s the case, an afternoon rest could help. Schedule activity during the morning and encourage a rest after lunch, whether that’s a short nap or a period of quiet time.
When to Talk to a Doctor
If you have concerns about your loved one’s change in behavior, talk to your doctor. They’ll be able to identify an underlying illness or condition, such as a urinary tract infection or sleep apnea, that may be to blame. They’ll also be able to assess whatever medications your loved one is currently taking, as side effects may be to blame. Changing the dosage or the time medication is administered can help relieve symptoms.
Additionally, your doctor may recommend medication or supplements to better manage symptoms. Research suggests that a low dose of melatonin, the hormone that causes sleepiness and regulates the sleep/wake cycle, may help reduce sundowning symptoms.
A dementia or Alzheimer’s diagnosis can be really scary for the family. At Bluebird Homecare, we understand that this phase of life can be overwhelming because we’ve been there. That’s why we offer a team of specially-trained and certified staff dedicated to caring for clients with dementia and Alzheimer’s.
Contact Bluebird today to learn more about our services and how we can help with dementia and Alzheimer’s care.