Among people who suffer from Alzheimer’s disease, 20 percent of them experience something called “sundowning.” This is a common symptom that is characterized by a group of behaviors stemming the patient feeling frustrated, fearful, agitated, tense or anxious. These behaviors become apparent around dusk as the sun goes down. Many patients experience this through the entire evening, which creates great challenges for people who are taking care of them. This symptom is usually the most severe when Alzheimer’s reaches the middle stages in its progression, and tapers off as the disease continues to advance.
Medical professionals and Alzheimer’s experts do not know why patients experience sundowning. One assumption is that after a full day, the patient feels physically and mentally exhausted. The “internal clock” of the body goes through a re-wiring that affects sleep patterns. As there is less daylight, the environment becomes ridden with shadows that bring about confusion and nighttime fears. A lot of experts used to think that sundowning was caused by the reduction in daylight and shorter days. However, more research has shown that this symptom is attributed more to the exhaustion of the patient rather than how much light he is receiving.
Minimizing the effects of sundowning
People who are experts in caring for Alzheimer’s patients and the Alzheimer’s Association have advice that can help you lessen sundowning’s undesirable effects:
Fill the day with activities. When a person is inactive during the day, he has more tendency to be awake at night. Filling the day with physical activities like doing household chores, walking or doing light exercises, or just engaging in other meaningful activities can be beneficial. A good idea is to take the person to a day center for adults where he can enjoy a day of fun and interesting activities.
Try not to let the person become overly exhausted. Increasing the level activity is good, but not when there are too many things to do in one day. Bathing should be done in the morning. During the morning hours, the person has more energy mentally and physically to cope with more stimulation. Therefore, time spent with friends and family, outings and doctor appointments should be scheduled for the morning.
Look out for things that can trigger over-stimulation and watch for signs. Maintain a calm environment without surprises. Things that make a lot of noise like a vacuum cleaner and kitchen appliances, a loud TV, or people moving quickly around the house can trigger an episode of sundowning.
Monitor what the person eats. Foods with caffeine and sugar should only be provided in the morning. Keep sugar intake low during the later hours. Consider keeping a food journal to keep track of foods that cause the person to feel anxious or agitated within an hour of consuming these foods. Serve an early dinner and stick to routines. Any bedtime snacks should be light. Serve chamomile tea or warm milk for a soothing effect and as a way of telling the body that it is time to rest.
If you notice that patterns of sundowning tend to occur at around the same time each day, you can create a calming atmosphere around a half hour before the person exhibits these sundowning behaviors. Have the person relax in a favorite spot and play soft music in the background. Keep the environment calm and peaceful.
Get advice from the doctor. There may be underlying medical reasons why the person has a hard time resting or falling asleep. The doctor may prescribe medicines that can calm the individual so he can rest better at night without making him sluggish the next day. Do not just allow sundowning to take its course without exploring ways to address it.
Maintain a simple environment in the home. Remove clutter that can make the living conditions confusing and disorganized. Remove large mirrors that can make the person feel like there is another person in the room. Keep all areas of the living space properly illuminated at all times so the space will not look so dark and unfamiliar to the individual.
Help the person keep a sense of time. During the day, offer cues like reminding the person what time it is and help the person connect it with a routine activity that he just did. This helps the person maintain a mental sense of order in his mind and reduces the feeling of confusion.
During times when you see your parent getting frustrated or upset, do not just assume that it is sundowning. Approach him calmly and find out if he has an unfilled need that caused his agitation. Maybe he is hungry or is not feeling well physically. Perhaps something is causing him discomfort, like soiled clothing or a room that is too cold or hot. He may not have the ability to describe what he needs, so do your best to find out without asking him a lot of questions. Avoid disagreeing with him because that will upset him even more. He needs to feel reassured that everything is fine, so do whatever you can to calm and soothe him.