Coping with Sundowning

If you’re dealing with a parent or spouse with Alzheimer’s disease, you’ve probably heard of “sundowning.”

The term refers to a state of confusion experienced by people with Alzheimer’s disease or other forms of dementia. It’s called sundowning because of when it occurs — in late afternoon. It doesn’t stop there, though. In many cases, sundowning can stretch well into the night.

In this article, we’ll talk about what sundowning looks like, its possible causes, and how to cope when your loved one is showing signs of it.

What is sundowning?

Sundowning, also called late-day confusion, can include the following symptoms:

• Confusion and anxiety
• Aggression
• Noncooperation
• Pacing
• Wandering
• Inability to sleep

What causes sundowning?

The exact cause of this behavior is, like much of Alzheimer’s disease, unknown. However, there are factors that can exacerbate your loved one’s confusion at this time of day.

Some of these contributors are:

• Tiredness
• Dim lighting
• Not enough exposure to sunlight
• Increased shadows
• Disturbed internal clock
• An infection, such as a UTI

Some experts feel sundowning may come from past routines in the person’s life when they were used to a lot of activity in the late afternoon hours. This could be leaving work, or caring for their children. The theory is that subconsciously they have reverted to that time and place.

How to cope with sundowning

The most important thing for people with Alzheimer’s disease is to follow a predictable routine every day. Not knowing what’s coming next is extremely frightening for a person with Alzheimer’s. Keeping activities, meals, and bedtime at roughly the same time every day can help avoid late-afternoon confusion.

Here are some other tips to reduce sundowning:

• Make sure your loved one’s days are full of activities as well as adequate sun exposure. This will help limit daytime napping, as well as encourage sleepiness instead of agitation at night.
• Keep a night light lit all night to avoid a dark and frightening room.
• Try to keep the environment calm and quiet after 4:00 in the afternoon. Lower the volume on the TV, keep your voices down, and limit the amount of people in the room at once.
• If your loved one is at a skilled nursing facility like Park Crescent, the flurry of activity during the afternoon shift change might be the culprit for disturbing their equilibrium. If that’s the case, prepare for it by bringing your loved one to their room shortly before the rush starts, and putting on some soothing music.
• Playing soft music or calming nature sounds is a good idea for sundowning in general.
• Speak with your loved one’s doctor about giving a low dose of melatonin every evening. Melatonin is the hormone that makes us feel sleepy, and it may help your loved one calm down and fall asleep easily.

If the confused or irrational behavior comes on suddenly, you may be dealing with a UTI or other infection. Sometimes these infections cause psychotic behavior in seniors with dementia. Talk to your doctor if you suspect an infection is the root cause of your loved one’s sundowning.