Sundowning


What is Sundowning?


Sundowning is a symptom of Alzheimer’s disease and other forms of Dementia. It occurs when a loved one becomes agitated, confused, anxious, and restless later in the day as the sun starts to go down.


According to Alzheimer’s Society of Canada, sundowning can be a “problem for as many as 66% of people with Alzheimer’s or other dementias. It can occur at any stage of the disease but tends to peak in the middle stages of dementia and lessens as the disease progresses.”


Symptoms


The symptoms of sundowning may express itself differently depending on the person, but may include:


• Agitated, upset, or anxious

• Confusion

• Restlessness

• Suspicious of others

• Pacing or wandering

• Impulsive actions, aggressiveness

• Difficulty with tasks that appeared easier earlier in the day


Causes


Although there is no clear understanding of what causes Sundowning, the following events may trigger its appearance in older adults:


•Disruption in sleep/wake pattern; with dementia, a person may not be able to distinguish between day and night


•Existence of low lighting and shadows can create confusion


•Under stimulated during the day; those with dementia may not be as physically active or mentally stimulated with activities throughout the afternoon and therefore can become restless later in the day.


Prevention

1. Track behavior to seek patterns.


By using a notebook, caregivers can track the behavior of loved ones or those in their care. Noting activities (or lack of), daily routines, and any symptoms that may be noticeable prior to the time when their sundowning occurs.


2. Ensure basic needs are met.


Sundowning may be more likely to occur when someone is hungry, thirsty, in need of the toilet, in pain, or bored. Make sure those concerns are addressed first to prevent or lessen the sundowning episode.


3. Minimize distractions and shadows.


As daylight fades, shadows and dim lighting may trigger confusion and anxiety in older adults. To alleviate fear and increase their sense of safety and calm, reduce shadows by lighting the room before the sun begins to set.


Also, reduce their exposure to loud noises or over stimulation later in the day (i.e. TV watching or loud music) in order to set a more calming and quieter environment for them to settle into for the night.


4. Establish daily routines.


Keep older adults active during the daytime hours. This may include taking them for walks, physical fitness classes like Chair Yoga (see our previous blog for ideas!), or cognitive activities such as game play, sorting, or gardening.

Ensure that dietary needs are also met (reduce stimulants later in the day, such as sugary foods, caffeine, etc.) and sleeping routines are maintained as much as possible (nap earlier in the day, if needed, use weighted blanket or white-noise machine, etc.).


5. Familiar tasks.


To develop a sense of security and calm, perform familiar bedtime/nighttime routines, such as soft music, closing the curtains as sun comes down, turning on lights, or other familiar tasks to keep them comfortable.


Finally, sundowning affects the quality of life for those with Alzheimer’s and Dementia but can also have negative and exhausting effects on the caregiver.

It is important to remember to care for yourself as well. Reducing your own stress by taking mini breaks throughout the day, getting help from qualified organizations with PSW/companion support, or doing something you enjoy is essential for your own well-being, stress-level, and health.



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