What is Sundowning?

Sundowners wordleFor most people, sunset can be a beautiful time of day. The sky is filled with the last rays of sunshine as day turns into night. Sunset signals the end of another day and a time of rest and relaxation.

For caregivers, particularly those caring for patients who have dementia or are in the middle stages of Alzheimer’s disease, sunset signals something else entirely. For many caregivers, sunset signals the beginning of a sundowning episode. These episodes occur among people experiencing sundown syndrome.

As many as 20 percent of Alzheimer’s patients experience sundowning symptoms and they largely correlate to the late afternoon and early evening hours.

What are the Symptoms of Sundowning?

Part of what makes sundowning so noteworthy for caregivers is the sharp symptoms that accompany it. They include several drastic behavioral changes that are uncharacteristic of the person you’re caring for, including:

  • Agitation

  • Anxiety

  • Aggression

  • Combativeness

  • Confusion

  • Forgetfulness

  • Mood Swings

  • Pacing

  • Paranoia

  • Restlessness

  • Yelling

Treating and Avoiding Sundowning

Unfortunately, the specific cause or triggers for sundowning are unknown, though there is wide speculation about potential causes and preventative actions caregivers can take to avoid episodes of sundowning.

In fact, the possible causes of sundowning range widely and include all of the following:

  • Pain

  • Poor Nutrition

  • Infections

  • Medications

  • Constipation

  • Noisy environments

  • Sleep Disruptions

  • Reduced Lighting

  • Exhaustion (mental and physical)

  • Body Clock Interruptions (days and nights are mixed up)

  • Difficulties Distinguishing between Reality and Dreams

For the most part, this is a stage dementia patients experience that is temporary, most commonly in the middle stages of the disease. Sundowning often diminishes with the progression of the disease.

Dealing with Sundowners

The most important thing when dealing with sundowning is to keep your cool. Remind yourself that this is not the normal behavior of your loved one. It is only another symptom of the sickness that is robbing you all of so much. Consider taking preventative actions to reduce the likelihood that the person you’re caring for will experience these disorienting symptoms.

  • Discuss medications with the doctor to see if any could be contributing factors, such as a urinary tract infection or sleep apnea that may be making the sundowning symptoms worse.

  • Work with the physician to develop a strategy for relieving the symptoms and agitation when they do arise.

  • Keep the home well lit as the sun goes down. Sometimes, it’s all a matter of confusing shadows. Eliminate them with adequate lighting.

  • Plan intense activities in the morning and quieter activities as evening approaches.

  • Play soothing music around sundown each day.

  • Plan repetitive activities and/or tasks (folding towels, setting the dinner table, sorting things) around sunset.

  • Keep a schedule.

Be a calming presence to comfort and reassure your loved one that everything will be OK.

The Alzheimer’s Association has a few more tips for dealing with sundowning that you may find helpful in their sleep issues and sundowning section.

Don’t forget to take care of yourself at times like these, too. It’s difficult to watch a loved one change before your eyes. Consider stress reducing activities, for both of you, before and after sunset each day to help avoid sundowning episodes when possible and to also help recover from them after they’ve occurred.

If you need help, don’t forget to consider respite care to give you a break, as well as networking with other caregivers to learn how they’re personally coping with sundowning – sometimes it just helps to know you’re not alone.





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