What is sundowning?
Sundowning is a condition characterized by cycles of increased confusion, disorientation and agitation in the late afternoon or early evening hours in people who are in the middle to late stages of Alzheimer’s or other forms of dementia. Unfortunately, this is not a rare occurrence, as some studies indicate that up to 66% of those with memory loss may experience the effects of sundowning. Some of the more severe cases of sundowning may include extreme anger and aggression along with anxiety, pacing and depression. More often than not, these symptoms fade overnight and during the daytime hours until the cycle begins again at sundown. As a caregiver of someone with dementia, you may feel confused and anxious about your loved one’s seemingly random mood swings and behavior. The good news is there are ways you can help.
Causes
As with changes in memory and behavior, sleep changes somehow result from the brain changes, but the good news is that this sleeplessness does not last forever. As the disease progresses, these symptoms tend to improve. Although doctors and dementia experts are not quite sure exactly what causes sundowning, here are some of possible factors that can contribute to sundowning and sleep disturbances:
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Disruption in the circadian rhythm – the body’s internal clock that regulates our sleep-wake cycle
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End of day mental and physical exhaustion
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Reduced lighting with increased shadows that cause dementia persons to misinterpret what they see and become confused and afraid
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Disorientation resulting from increased difficulty separating dreams from reality
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Less need for sleep, which is common for older adults
Coping strategies
There is no cure for sundowning, but there are some things you can do to help reduce the effects and discomfort on your loved one. Consider utilizing some of the following to minimize sleep issues and sundowning.
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Adjust your home lighting during the day. Use of full-spectrum fluorescent lighting can help simulate daylight and mimic sun’s rays.
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Dimming the interior lights in the evening can help trigger the release of melatonin, a hormone which tells the body that it’s time to go to sleep.
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Maintain a schedule including wake time, meal times and bed time in order to improve sleep quality.
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Plan more active and challenging days to keep your loved one physically engaged and discourage afternoon napping.
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Reduce stimulants such as alcohol, caffeine, nicotine and late night TV watching, which are all stimulants that can affect one’s ability to sleep.
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Try alternative approaches to facilitate calming in the evening such as music therapy, melatonin supplements, CBD oils, massage or aromatherapy to lessen or mitigate sundowning symptoms.
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If all else fails, talk to their doctor. Although non-drug measure are often encouraged, your loved one may require medication in order to help identify the causes of the sleep disturbances and possible solutions
As a caregiver, it is very important to be mindful of your own well-being and make sure you get plenty of rest so you will have more energy during the day. It may be helpful to keep a journal of the events and times of the day when things seem to be better or worse in order to assist with helping your loved one establish their routines. Talking with others, whether it’s their doctor, their therapist or another caregiver (perhaps in your support group), can help provide you with strategies you may not have thought of and keep you from feeling overwhelmed. And remember, this stage isn’t permanent, so just keep trying. You’ve got this.
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