As the sun begins to set, have you noticed changes in a loved one’s behavior? For people with Alzheimer’s disease and other forms of dementia, it’s not uncommon to experience unpredictable agitation and confusion during this time of day.
Sundowner’s syndrome, also called sundowning or late-day confusion, is a group of symptoms that occur in someone with memory loss that can start around late afternoon and continue into the night. It can cause increased confusion, disorientation, anxiety, agitation, pacing and even wandering.
“We know that most people with dementia will experience behavioral symptoms during the course of their disease, particularly during the moderate stage of Alzheimer’s disease and earlier in other types of dementia,” said Lori Nisson, a licensed clinical social worker and Family and Community services director at Banner Alzheimer’s Institute and Banner Sun Health Research Institute. “They are working much harder to complete tasks and activities that used to come easily to them, so they are expending more energy and can wear out easily as the day progresses.”
While there is no one explanation for its cause, factors that typically trigger changes in behavior include fatigue, sleep disturbances, boredom, restlessness or unmet needs, such as hunger, thirst or the need to use the restroom.
What signs of sundowning should I look out for?
The symptoms of sundowning typically occur between the hours of 4:30 p.m. to 11 p.m. and may be worse during the fall and winter months when the daylight hours are shorter.
As a caregiver, some signs to look out for include:
- Signs of fatigue or unmet needs, pain or discomfort
- Agitation, anger or irritability
- Confusion, delusions or hallucinations
- High levels of anxiety
- Pacing or wandering
Symptoms of Sundowner's syndrome can stop abruptly, change and fade over time, which can be very difficult for caregivers to manage. If you are caring for a loved one experiencing sundowning behaviors, you may wonder how to cope with these symptoms.
7 tips for caring for someone with sundowning
Sundowning syndrome is not a simple condition, but it is a common occurrence that many loved ones and caregivers struggle with. While you may not be able to stop sundowner’s syndrome completely, Nisson provided seven ways you can help prevent sundowning, reduce symptoms and best cope.
1. Look for triggers
Certain activities and environments can trigger your loved one’s sundowning, things like fatigue, loud noises, discomfort, taxing activities or changes in environment or caregivers. Use your smartphone or journal to track what triggers or worsens symptoms so you can avoid situations that promote agitation and confusion.
2. Create structure in the day
Daily routines can help your loved one feel safe by minimizing surprises and reducing anxiety and confusion. Offer structured meaningful activities earlier in the day, including physical exercise and movement.
3. Get outdoors
Take a walk and get some sunlight and fresh air. Sunlight can help set their internal body clock (circadian rhythm) as well as help reduce pent up energy.
4. Support good rest
Fatigue and lack of sleep can worsen symptoms. Alternate activity with brief periods of rest and ensure your loved one gets a good night’s sleep.
5. Limit stimulation in late afternoon and early evening
Lower lights, limit caffeine intake, close curtains or blinds, minimize noise and reduce clutter. Use soothing scents like lavender and soothing touch when appropriate.
6. Be gentle
Approach the person calmly using a peaceful tone of voice. Validate your loved one’s feelings and distract them with soothing music or relaxing activities.
“Watch your own behavior. As a caregiver, you may be tired, frustrated or short-fused, which can trigger behavioral responses in the person with memory loss,” Nisson said.
7. Seek support
“Sundowning syndrome can be draining on your loved one with dementia, but for you too,” Nisson said. “It requires patience and extra support for you both.”
If you have concerns, speak with your loved one's doctor. They can develop strategies to cope with the symptoms and provide ways to support you through this.
As a caregiver, it’s important you take care of yourself too. Make sure you get regular exercise, eat well and get enough rest. Seek support from family members and friends. Ask your doctor about respite care or support services to give yourself a necessary break from your caregiving duties.
Banner Alzheimer’s Institute also offers a twice monthly Beacon newsletter filled with caregiver tips, educational classes, support strategies and virtual support groups, as well as life enrichment programs, like Sing for Life Choir or the Passport to Music, to support someone with dementia.
To learn more information about sundowning, visit the National Institute on Aging’s Alzheimer’s and related Dementias Education and Referral Center.
For more articles related to Alzheimer’s disease and dementia, visit bannerhealth.com. You can also listen to our Dementia Untangled podcast which offers guidance and support to caregivers to help better navigate this complicated and challenging role.