It’s common for people with Dementia or Alzheimer’s disease to get increasingly confused, anxious, or agitated in the late afternoon or early evening. For others, the symptoms are more noticeable at night, when they experience restlessness or disrupted sleep schedules.
Because this behavior tends to happen later in the day, it’s often called “sundowning.” It affects up to 20% of people with Alzheimer’s and can even affect older people who don’t have dementia. While scientists aren’t exactly sure why sundowning happens, it’s believed to be caused by changes in the brain. Their body clock is likely affected by these brain changes, resulting in an upset in their sleep/wake cycles.
Common symptoms associated with sundowning are getting restless, suspicious, irritable, demanding, confused, disoriented, agitated, upset, or anxious. The individual might manifest these symptoms by experiencing mood swings, yelling or getting angry, pacing the room, or seeing or hearing imaginary things. These kinds of sundowning symptoms are stressful for both caregivers and older adults since they are disruptive, unpredictable, and difficult to manage. They also negatively affect the senior’s quality of life. Fortunately, there are some steps caregivers can take that can help make evenings more peaceful.
- Start by tracking behavior and looking for patterns. Determining triggers, or things that cause the senior to get agitated, can help reduce sundowning behavior. Please pay special attention to their activities a few hours before their sundowning usually starts. Within a few days, you should be able to spot clues that can assist you in pinpointing triggers. Knowing these triggers helps you avoid or minimize them.
- Meet their basic needs first. Sundowning is more likely to happen when a person has to go to the bathroom, or is hungry or thirsty, physically or mentally exhausted, in pain or discomfort, depressed or bored, too hot or cold, or having trouble sleeping. A couple of hours before their sundowning symptoms usually start, check to be sure none of these issues are pressing. Take the initiative yourself rather than waiting for them to ask, as they may not be aware of the problem or be unable to properly express their needs. Schedule snacks, toilet visits, and pain medications accordingly at set times later in the day to avoid possible problems.
- Minimize noise, distractions, and shadows. Some sundowning symptoms are triggered by fear or overstimulation. Helping your older adult feel calm and safe will go a long way toward resolving these issues. Minimize noise in the late afternoon or early evening by turning off the TV, turning down music, avoiding noisy chores like vacuuming, moving children to a different room, and not having visitors over. Don’t attempt tiring or upsetting activities like bathing at this time of day. As the daylight fades, shadows can play tricks on the person’s eyes or brain and cause anxiety. To increase feelings of safety, close curtains before the sun even starts setting and turn on plenty of lights to eliminate dark corners.
- Monitor your own stress level. It’s not easy caring for a person with dementia. By late afternoon, there’s a good chance you could be frustrated or exhausted as a caregiver. Unfortunately, those with dementia are often very sensitive to body language and tone of voice, so they may be able to sense your stress and become “sympathetically” agitated or anxious. Try reducing your own stress by taking mini-breaks during the day.
- Establish a daily routine. Letting a person with dementia know what to expect each day helps to increase their feeling of security, improves sleep, and reduces stress, all of which help minimize sundowning symptoms. If possible, set regular times for waking up, eating meals, and sleeping. Mornings are the best time to schedule visitors, baths, and appointments since the person will feel his or her best earlier in the day.
- Create a relaxing environment. Think of ways to make the person’s environment calm and soothing in the late afternoon. For example, play soft music quietly or lightly scent the room with aromatherapy.
- Improve nighttime sleep quality. Poor nighttime sleep is a top challenge for many caregivers. It can also create daytime fatigue, which leads to a vicious cycle of more intense sundowning. Additionally, living with dementia is exhausting even if the person doesn’t have much activity, so the person might want to nap a lot during the day – but that can make it more difficult to sleep through the night. It’s best to minimize afternoon naps and to encourage a little exercise in the morning. Limit or altogether avoid evening stimulants such as sugar, chocolate, alcohol, heavy meals, smoking, or caffeine. Try improving sleep hygiene by experimenting with room temperature or using a weighted blanket, aromatherapy, or a white noise machine.
While it may be difficult to eliminate all sundowning symptoms completely, following these tips can help reduce or manage some of the more challenging ones.