Sundowning | Senior Living Link

Donna Mae Scheib

Sundowning

Posted by Donna Mae Scheib on February 28, 2017

Sundowning

A symptom of Alzheimer's

One symptom of Alzheimer’s and other forms of dementia is sundowning. It seems that the varying levels of brain deterioration that stems from Alzheimer’s and dementia interact with the fading light of the day differently.

The term sundowning refers to increased confusion and agitation in the late afternoon or early evening hours compared to symptoms that the patient is showing during the day. These individuals who experience sundowning often have problems with sleeping or experience changes in their sleep schedule. And they often wake up more often and stay awake longer during the night. Brain wave studies show decreases in non-dream and dream stages as well.

However, it is not fully understand why “sundowning” occurs. Studies show that approximately 20% of people with Alzheimer’s experience sundowning. Also, individuals in the late stages of Alzheimer’s are known to spend about 40% of their time in bed at night and during the day sleeping or being “awake” which lends itself to sundowning.

What may trigger sundowning?

  • Lack of sleep
  • Mental and physical exhaustion
  • Confusion of day and night in the “internal body clock”
  • Confusion, fear, misinterpretation of what is seen
  • Disorientation from what is real or not
  • Too much time spent indoors and lack of natural light during the day’s cycle

What can be done?

  • Talk to a doctor to help determine possible causes and solutions. Sometimes physical illnesses like a urinary track infection, incontinence, restless leg syndrome, or sleep apnea play a role in sleep problems. The person might be depressed and show signs of apathy, loss of interest in activities and hobbies, social withdrawal, isolation, difficulty concentrating, and illustrate impaired thinking. Oftentimes, when the physical ailment is addressed, the sundowning decreases.
  • Use a calm manner when interacting with the individual. See if their bodily needs (food, water, going to the bathroom, etc.) are met. Don’t engage in excessive arguments or physical restraints. Help them feel reassured.
  • Gently tell them what time it is and try to have them understand if it is day or night.
  • Keep a nightlight on in the evening to help reduce unfamiliarity.
  • Keep the bedroom area temperature comfortable.
  • Ensure that the door and windows are locked.
  • Try to keep a regular, predictable schedule of routine meals, bedtime, and time to awake each day.
  • Consider having a larger meal at lunch time and a simpler meal at night.
  • Provide limited caffeine in the afternoon.
  • Encourage daily afternoon movement/exercise (no later than four hours before bedtime) and stimulating activities.
  • Use the bed for night time sleeping only; encourage the person to get up and engage in activities during the day and not to lay in bed and do them.
  • Discourage daily napping or going to bed early to avoid waking up and wandering at night. Oftentimes those who are restless and can’t sleep yell out at their caregivers and engage in other activities not compatible to getting a good night’s sleep.
  • Diminish any distractors during the evening hours (loud music, visitors, television, etc.).
  • Expose them to the sun and natural light during the day when possible.
  • Although there aren’t any FDA-specific approved medications for sundowning, there are some sleep medications that can be used to help reset the routine. Any medications should be discussed with the geriatric specialist or patient’s physician. However, these medications don’t necessarily address the root cause. Non-drug measures rather than medication are encouraged by the National Institutes of Health.

In conclusion

Sundowning can occur for any individual, but most specifically for those who have dementia and Alzheimer’s. There are many strategies that can be employed to help these individuals who experience sundowning. Awareness of the symptoms are key in knowing how to better address this situation to help the individual cope and to increase their general well-being. Many of the strategies are common sense and don’t involve a lot of effort, yet they go a long way in making a difference in the lives of loved ones.