Sundowning and How To Manage It
Sundowning is a state of increased confusion that may be accompianied by agitation, activity and negative behaviors that happen late in the day through the evening hours. When sundowning, the person may become demanding, suspicious, upset, disoriented, see or hear things that are not there, and believe things that are not true. They may pace or wander around the house while others are sleeping.
Sundowning Factors:
Experts are unsure why this behavior occurs, but they suspect that the problem of late afternoon confusion, or "sundowning," may be due to these factors:
Alzheimer’s disease and related disorders (ADRD) can lead to a disturbance in the "biological clock" making it difficult to distinguish whether it is day or night.
For some with ADRD, vision is impacted so they cannot see well in dim light and may become confused or unable to identify commonplace objects that may appear changed.
Fatigue, both physical and cognitive, seems to be involved. When a loved one is tired, as often happens later in the day, they are less able to cope with stress.
For some people with ADRD being involved in activities all day long is helpful and they grow restless without a clear schedule for the later afternoon or evening.
Reducing Sundowning:
If your loved one is experiencing sundowning, here are some tips for potentially reducing its occurrence and softening its effects when it does happen.
Be observant to possible causes: Many times, there are triggers to agitation leading to sundowning. Examples of possible triggers include children coming home from school, a television show playing, loud noises, mirrors, and many others potential disturbances. Each person is unique so pay close attention to your loved one’s possible triggers. Caregivers should watch to see what is going on, what events are happening, and who is present prior to sundowning, as this can help reveal some possible causes and potential solutions.
Make sure that your loved one is well-rested: Encourage them to take a nap during the afternoon or about one hour before they usually start having trouble. Turning off the TV and playing soft music may help.
Focus outings and activities to the morning hours: Plan your trips to the grocery store, involvement with kids, visits to adult daycare, and so forth during the earlier part of the day. This should be followed with a time of decreased stimulus and quiet time to allow your loved one to wind down and relax.
Decrease the length and amount of stimulus: Take steps to eliminate over-stimulation such as television, children, any noise-making items, quick movements, and many things going on at the same time. Sometimes excessive stimulation cannot be avoided. When that happens, allow your loved one to have a quiet area to retreat to.
Identify and minimize physical discomfort: Other types of physical discomfort can also play a part in sundowning. Hunger, being wet or soiled, feeling cold/hot, and other sources of discomfort can increase agitation.
Contact the doctor to identify and treat medical ailments: Many ailments can contribute to sundowning and agitation. Arthritis can be one of the most common causes. Urinary Tract Infections (UTI), flu/colds, asthma, allergies, and other conditions are all medical ailments that can contribute to sundowning. Take your loved one to the doctor to discuss any medical conditions that may exist.
Provide a private space for your loved one: Designate an area for your loved one to have their own space, therefore giving you some space as well.
Clear the house: There are times when it seems that nothing you do will ease the most aggressive sundowning episodes. Send others out of the house if you can, turn off the TV/radios, and either go to a quiet corner or go sit outside for a moment. However, don’t leave your loved one; stay close by.
Keep things simple: Keep the surroundings as simple as possible. Be sure your loved one’s walking paths are clear from clutter and obstacles. Mirrors and pictures can often become unfriendly visitors that the individual with ADRD cannot understand. Complicated, noisy appliances are also frustrating to them. Avoid changing things once you have things simplified. Changes of any kind can be extremely frustrating for your loved one.
Control your loved one’s diet: Reduce food and beverages that contain caffeine (such as chocolate, coffee, tea and soda), or restrict these foods to the morning hours to reduce agitation and sleeplessness. An early dinner or late afternoon snack may also help.
Follow your loved one’s cues: Take a walk in the sunlight if your loved one tends to be restless/pacing. If your loved one wants to “pack and go home,” let them pack a small bag and then take them for a drive. By the time you get to the ice cream parlor for a treat, they likely will have forgotten they were “wanting to go home” in the first place. For the non-pacers who still have anxiety, have available some soothing items for them to hold, such as a soft blanket, doll, stuffed animal, or some fidget items. Or you could bring out their favorite photo album or snack to give them a distraction.
Watch your own mood (easier said than done): If a family caregiver communicates fatigue or stress to the loved one with ADRD, they may be more likely to respond with anxiety or agitation.
Sometimes no matter what we do, sundowning will happen. But if we cannot prevent it, we can at least help lessen the symptoms and make it less unpleasant for our loved ones and those around them. If sundowning is particularly troublesome, check with your doctor; you may need some extra help from a change in your loved one’s prescription medications, or a new medication.
Please talk with your own/loved one’s healthcare provider before using any of this information.