A diagnosis of Alzheimer’s disease is already distressing enough for the person and the loved ones. However, it can become even more complicated once the illness progresses.
By then, they might exhibit hard-to-understand behaviors. One of these is sundowning.
What Is Sundowning?
The term sundowning describes a range of caregiver stress behaviors that accompany Alzheimer’s disease, such as confusion or irritability in the evening. As with most aspects of Alzheimer’s disease, there is no hard and fast definition of sundowning.
In general, however, it means agitated behavior after dark, often around bedtime or when it gets dark outside. The affected person might look for things that aren’t there, get out of bed repeatedly at night, call out loudly in apparent confusion, turn on all the lights in the house (or leave all the lights off), watch TV without being able to follow a plotline, or answer simple questions about what they have just seen on screen. Sundowning can make a person difficult to manage and a caregiver very stressed.
What Causes Sundowning?
No one knows for certain what causes sundowning, but it’s thought that the condition is related to fluctuations in light and dark and melatonin, a hormone thought to play a role in setting our body clocks.
People living with Alzheimer’s might not distinguish between day and night because their brains aren’t working properly. The same part of the brain that controls memory also regulates circadian rhythms. When this area is compromised, Alzheimer’s disease sufferers lose track of time and the difference between night and day.
As a result, they think it might be bedtime during the early afternoon or mistake any lamp-lit room (especially one with a television) for being the bedroom. Other possible causes include:
- Drug side effects also contribute to sundowning. Some anti-anxiety medications have strong sedative effects that peak in the evening and can cause confusion in people who take them, while others actually cause agitation in some patients. Drugs used to treat Parkinson’s disease, which impairs motor skills, sometimes induce sundowning behaviors.
- Mood swings or medical conditions like urinary tract infections or delirium trigger symptoms of sundowning.
How Can You Manage Sundowning?
Caregivers and loved ones can do many things to manage sundowning:
- They Might Benefit from Being in a Facility
Being in an assisted-living facility can significantly reduce the stress of loved ones and ensure that the person with Alzheimer’s disease remains safe every time they exhibit the behavior. These places can keep track of their movements, see that the resident takes medication promptly, and provide other support that might decrease sundowning behavior.
- Change Your Loved One’s Environment
Because light signals play an important role in regulating circadian rhythms and influencing our moods throughout the day, dimming or turning off the lights for an hour or two before bedtime can make a real difference in calming sundowning behavior. You can also try turning on fewer lights and closing blinds and curtains to help your loved one distinguish between day and night.
Also, you should move coffee tables and other items that create shadows so as not to artificially increase darkness at night. Finally, keep rooms dark during the day because bright light exposure during those hours could contribute to insomnia later on.
- Address Underlying Causes
If you notice that your loved one is suddenly wandering around the house at night, check for possible reasons, including pain or discomfort that they might be trying to communicate. Some possible causes might be incontinence resulting in an uncomfortable level of wetness or irritation, low blood sugar (which can occur when water intake is insufficient), loose shoelaces, or ill-fitting clothing.
In the case of incontinence, changing into a dry nightgown or outfit or cleaning your loved one’s skin with a clean wet towel might be enough to reduce agitation levels.
- Clock Your Agitation Levels
Be aware of how agitated your loved one is by keeping track of what time you notice changes in their behavior. If you note that symptoms such as loud noises, pacing, wandering out of the house, or agitation typically occur at about 10 p.m., you can avoid that behavior by taking proactive steps to calm your loved one down earlier in the evening.
For example, if your family member with Alzheimer’s seems agitated at 10 p.m., distracting them with a board game or watching television together might help reduce agitation levels and make it easier for everyone to go to sleep before sundowning symptoms kick in.
Sundowning behavior can be distressing for both caregiver and patient, so it is important not to ignore it but instead find ways to manage the condition effectively. Learn more about the signs of sundowning and know that professionals are available to help.
Meta title: What Is Sundowning?
meta desc: Many people with Alzheimer’s disease experience sundowning. Learn more about this syndrome and know tips to manage it.
