Tips for coping with sundowning

Sundowning is a common symptom of Alzheimer’s disease and other forms of dementia.

Those caring for people in the mid-stage to advanced stages may find that restlessness, agitation, irritability, or confusion get worse in the late afternoon and evening.

Also known as “late-day confusion,” sundowning symptoms don’t stop at dark. Sundowning also makes it hard for people with Alzheimer’s to fall asleep and stay in bed, which can lead to dangerous wandering or fall injuries.

Possible Causes

The root cause of sundowning is still a mystery. Studies have shown that one possibility is that Alzheimer’s and dementia confuse the body’s internal clock making it more difficult to sleep. The lack of sleep then further worsens the symptoms.

However, we do know what can trigger the symptoms and how to minimize them. Possible sundowning triggers include:

• Being overly tired
• Stress
• Hunger or thirst
• Depression
• Disrupted sleep cycle
• Pain
• Boredom

The same things that would cause sleep disturbances, such as consuming caffeine or alcohol close to a scheduled bedtime, can also exacerbate sundowning.

Coping with Sundowning

Sundowning symptoms typically start in the late afternoon or early evening. Your loved one may become increasingly restless, confused and anxious. They may pace the floor or wander.

Any time a person with Alzheimer’s or dementia becomes agitated, it’s important to listen to their concerns respectfully and help them calm down. That may mean distracting them with some other conversation or activity.

The National Institute on Aging offers these tips for minimizing the symptoms of sundowning:

• Reduce noise, clutter, or the number of people in the room to reduce stimulation and stress.
• Distract the person with a favorite snack, object, or activity.
• As the end of the day nears, play soothing music, read, or go for a walk. You could also have a family member or friend call during this time as a distraction and to lift your loved one’s mood.
• Minimize shadows and changing light by closing curtains and blinds at dusk.  Turn on indoor lights to help minimize shadows.

Preventing Sundowning

Stress and exhaustion are two significant triggers of sundowning. They can contribute to agitation and prevent the natural calming cycle that leads to sleep.

Reducing stress is key to preventing sundowning. Exercise can help reduce stress and make a person physically tired versus the agitation that can accompany mental strain. Many experts now recommend getting outside during the day or using bright light indoors to help regulate a person’s internal clock.

Other strategies include:

• Sticking to a schedule. Having a routine is key to making a person with dementia feel calm and comfortable.
• Change up the eating schedule. A big meal in the evening can contribute to feelings of restlessness. Swap to bigger lunches and smaller, lighter dinner meals.
• Track sundowning symptoms: Keep a diary of activities, diet, naps, medications, etc. so you can identify patterns that contribute to sundowning. Every person may have a slightly different set of circumstances that trigger their symptoms – or a worsening of symptoms.

Seek medical help for sundowning

A medical exam can identify possible causes of sundowning behavior, from pain or illness to a prescription's side effect. Your doctor can recommend some strategies for your situation and even help reset your loved one's internal clock with a short run of prescription medication.

If you are having difficulty managing a loved one’s daily routine, diet and activities, Belvedere Home Care can help. Our caregivers can help keep senior loved ones on track throughout the day to help minimize the symptoms of sundowning. We also offer 24-hour care so caregivers can recharge while experienced home health care professionals monitor their loved ones.

Contact us today for more information about our flexible, customized care programs.  Call (518) 694-9400 Option 4 or email info@belvedereservices.com or contact us through our website.