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Alzheimer’s symptoms: sundowning

Alzheimer's caregivers
About one in five people with Alzheimer’s disease experience “sundowning,” a common Alzheimer's symptom. Sundowning is when people with Alzheimer's exhibit behaviors of fear, frustration, agitation, tension and/or anxiety beginning around dusk – or sundown. For some, this phenomenon may even last throughout the night, which places a great deal of stress upon Alzheimer's caregivers. This Alzheimer's symptom typically peaks in the middle stages of the disease and lessens as it progresses.
Experts aren’t exactly certain why sundowning occurs, but they believe that a number of factors are involved: mental and physical exhaustion at the end of the day, a re-wiring of the body’s “internal clock,” changes in sleep patterns, reduced daylight, signaling nighttime fears, or an increase in shadows that cause confusion. In the past, most experts thought that shorter days and less light led to sundowning behavior, but recent studies suggest that being overly tired contributes more to the disorder than light conditions.
How to reduce sundowning effects
Here are a number of tips that the Alzheimer’s Association, experts and Alzheimer's caregivers offer to help you reduce the negative effects of sundowning:
Keep days active. A person who rests most of the day will likely be up at night. Taking walks, doing chair exercises, helping with chores such as folding clothes or doing something meaningful would be helpful. Getting them to an adult day center a few times a week would be an excellent choice to keep them active.
Avoid over-exhaustion. On one hand, you want to keep the person active; on the other, don’t pack too much activity into any one day. Schedule doctor appointments, visits from family members and friends or other outings during the morning, when the person is more equipped to handle higher levels of stimulation. Taking a bath or shower is probably best done as a morning activity.
Watch for triggers and over-stimulation. Keep commotion to a minimum. Vacuuming around the house or turning on some other noisy appliance, a loud radio, television, or a fast movement on your part can trigger a sundowning episode. Keep the environment calm and predictable.
Watch their diet. Offer sweets and caffeine only in the morning. Monitor sugar content in food when serving it later in the day. You might want to keep a food diary to see if certain foods trigger anxiety or agitation within an hour of consuming it. Maintain a routine for dinner and serve it early. Offer only light foods before bedtime. You may find that a warm cup of milk or chamomile tea can be calming at the end of the day. This routine may also send the body a signal that it is time to sleep.
Create a quiet time before sundowning. If your parent seems to be affected the same time every day, it would be helpful to create a calming activity about thirty minutes before he usually becomes agitated. You might play very soothing music while they relax in a favorite chair or wherever is most peaceful.
Seek medical advice. Don’t just assume this “is just the way it’s going to be.” There may be a physical condition fueling his agitation or making it difficult for him to sleep. Your doctor may be able to prescribe medication to help “take the edge off ” and enable a full night’s rest. Don’t settle, however, for a medication that will make him or her groggy all day.
Keep their surroundings simple. You might want to go through the house and remove knickknacks, items on tables, clutter, and obstacles in pathways such as small tables or rugs that either mentally overload him or make it difficult to negotiate his or her way around the house. A large mirror or a portrait hanging on the wall might make your parent fearful that someone else is in the room. Keep rooms partially lit so that the surroundings don’t become dark and unfamiliar.
Maintain a sense of time. If they’re confused about the time of day, gently remind them of the time and make a connection to it such as, “Dad, it’s 12:30 p.m. in the afternoon, we just ate lunch.” Do this throughout the entire day, so your parent is given a sense of time and order.
When your parent does become upset or agitated be sure to approach them calmly. Find out if there is something they need – don’t assume it is just due to sundowning. They may be experiencing some sort of discomfort from feeling hungry, too hot or cold, or maybe they are in pain, have an upset stomach or have soiled themselves. Words escape them, so they become agitated or frustrated. Just keep in mind it’s best to avoid arguing or asking for explanations as it will simply upset them more. Keep reassuring them that everything is all right because that’s what he or she really needs. 
The bottom line
  • About one in five people with Alzheimer’s experience “sundowning,” which is when they exhibit behaviors of fear, frustration, agitation, tension and/or anxiety beginning around dusk – or sun down.
  • A number of factors may cause sundowning, but experts agree that exhaustion or over-stimulation are the biggest culprits.
  • Experts suggest that to minimize sundowning, you should make sure your parent isn’t overly tired or over-stimulated by their surroundings. Also, try to limit caffeine and sugar intake.
  • The most important thing to remember if the person becomes agitated or confused, you should respond calmly and avoid arguing or asking for explanations. Instead, reassure them that everything is all right.



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