Late afternoon and early evening can be difficult for some people with Alzheimer’s disease. They may experience sundowning—restlessness, agitation, irritability, or confusion that can begin or worsen as daylight begins to fade—often just when tired caregivers need a break.
Sundowning can continue into the night, making it hard for people with Alzheimer’s to fall asleep and stay in bed. As a result, they and their caregivers may have trouble getting enough sleep and functioning well during the day.
Possible Causes
The causes of sundowning are not well understood. One possibility is that Alzheimer’s-related brain changes can affect a person’s “biological clock,” leading to confused sleep-wake cycles. This may result in agitation and other sundowning behaviors.
Other possible causes of sundowning include:
Being overly tired
Unmet needs such as hunger or thirst
Depression
Pain
Boredom
7 Tips for Reducing Sundowning
Stick to a schedule
Dementia can make it hard to develop and remember new routines. Your loved one might react to unfamiliar places and things with feelings of stress, confusion, and anger. These feelings can play a large role in sundowning.
Stick to the same schedule every day to help your loved one feel more calm and collected. Try to avoid making changes to routines that work for you both. If you need to make changes, try to adjust their routine gradually and as little as possible.
Light up their life
Your loved one might experience sundowning as the result of changes in their circadian rhythms — their sleep-wake cycles. Adjusting the light in their home might help reduce their symptoms.
Some studies suggest light therapy can reduce agitation and confusion in people with dementia. Consider placing a full-spectrum fluorescent light about one meter away from your loved one for a couple of hours each morning. You can also try brightening the lights when your loved one feels confused or agitated, suggests the Alzheimer’s Association.
Keep them active
Many people who experience sundowning syndrome have trouble sleeping at night. In turn, fatigue is a common trigger of sundowning. This can create a vicious cycle.
Too much daytime dozing and inactivity can make it harder for your loved one to fall asleep at bedtime. To promote a good night’s sleep, help them stay active during the day. For example, go for a walk in the park together or clear some space to dance. This might help improve their sleep quality and reduce their sundowning symptoms. It can also help them enjoy better physical health.
Adjust their eating patterns
Adjusting your loved one’s eating patterns may also help reduce their sundowning symptoms. Large meals can increase their agitation and may keep them up at night, especially if they consume caffeine or alcohol. Encourage your loved one to avoid those substances or enjoy them at lunch rather than dinner. Limiting their evening food intake to a hearty snack or light meal might help them feel more comfortable and rest easier at night.
Minimize their stress
Try to help your loved one stay calm in the evening hours. Encourage them to stick to simple activities that aren’t too challenging or frightening. Frustration and stress can add to their confusion and irritability.
If they have mid-stage or advanced dementia, watching television or reading a book might be too difficult for them. Instead, consider playing soft music to create a calm and quiet environment. It might be a nice time for them to snuggle with a beloved cat or other pet.
Provide comfort and familiarity
Think back to the last time you were sick. Chances are you wanted to be surrounded by comforting thoughts, things, and people. For someone with dementia, the world can become a scary place. Comfort and familiarity can help them cope with this difficult time in life.
Help fill your loved one’s life and home with things they find comforting. If they move into a hospital or assisted living facility, furnish the space around them with cherished items. For example, bring their favorite blanket or family photos to the new facility. This may help ease the transition and curb their sundowning symptoms.
Track their behavior
Each person has different triggers for sundowning. To help identify your loved one’s triggers, use a journal or smartphone app to track their daily activities, environments, and behaviors. Look for patterns to learn which activities or environments seem to make their symptoms worse.
Once you know their triggers, it will be easier to avoid situations that promote agitation and confusion.
If Problems Persist
If sundowning continues to be a problem, seek medical advice. A medical exam may identify the cause of sundowning, such as pain, a sleep disorder or other illness, or a medication side effect.
If medication is prescribed to help the person relax and sleep better at night, be sure to find out about possible side effects. Some medications can increase the chances of dizziness, falls, and confusion. Doctors recommend using them only for short periods of time.
Resource: https://www.healthline.com/health/dementia-sundowning#track-behavior, https://www.nia.nih.gov/health/tips-coping-sundowning