Ah, sunset: a time for lovers to gaze at the sky and hold hands, and for the hardworking to relax. This is normally recognized as one of the most peaceful and pleasant parts of the day. But for those with Alzheimer’s and their caregivers, it can often be one of the most difficult. Learn why sundown syndrome can be synonymous with stress for certain parts of the population.
What Is Sundown Syndrome?
Sundowning, which affects up to 20% of Alzheimer’s sufferers, often starts in the middle stages of the disease. While it usually fades as the condition progresses, it can be more than a little challenging while symptoms exist. In essence, sundown syndrome marks a time of increased memory loss, confusion, anger, agitation, tearfulness, and other behavioral changes Alzheimer’s patients experience as the day fades.
Additional symptoms can include:
- Yelling
- Restlessness
- Self-injurious behavior
- Hitting or biting people
- Mood swings
- Pacing
- Mumbling
- Rocking
- Shadowing (following people around)
- Hallucinations
- Paranoia
- Wandering
What Causes Sundowning?
The exact cause of sundowning is not known, but experts believe that it may have certain triggers, including the following:
Excessive Afternoon Stimuli: Late afternoon and early evening can mean an uptick in activity as caregivers rush home to look after their loved ones. This increased activity can sometimes prove to be overstimulating for Alzheimer’s patients.
Fatigue: We all tend to grow tired towards the end of the day. But those with dementia can find themselves more easily fatigued than the general population.[1. “Poor sleep linked to Alzheimer’s-like brain changes,” October 30, 2013, https://www.earlysymptomsalzheimers.com/category/fatigue] By sunset, this fatigue can contribute to sundowning.
Hormone Imbalance: It’s possible that hormone imbalances—especially those that have to do with sleep regulation—can make sundowning worse.
Seasons: For certain sundowners, winter can exacerbate their situation. In fact, some researchers believe that sundowning may be linked to SAD (Seasonal Affective Disorder), which is brought on by reduced exposure to natural light.
Ways to Cope with Sundown Syndrome
Sundowning isn’t just a difficult time for the patient; it can be hard on friends, family, loved ones, and caregivers as well. However, there are several approaches that may be helpful:
Have a Routine: Most dementia patients thrive on routine, but it can be especially beneficial to those who suffer from sundowning. Routines help sundowners feel safe, and can minimize surprises (the reaction to which can cause behavioral issues).
Be Careful with Diet: By carefully monitoring what your loved one eats, you may find that certain things are linked to sundowning symptoms. Foods and beverages with sugar and caffeine are typical culprits and may need to be avoided.
Keep Things Quiet: Too much noise and stimulation are classic sundowning triggers. Bear in mind that “too much” may be things you don’t mind (or even notice), such as a radio or television on in the background. Try turning these off or down as the day comes to a close. Also, encourage visitors to come during the morning or early afternoon, when your loved one may be able to handle stimuli better.
Let There Be Light: There is some evidence that light therapy may mitigate the symptoms of sundowning.[2. “The use of light therapy to lower agitation in people with dementia,” November 9, 2004, https://www.nursingtimes.net/download?ac=1260652] You may want to think about purchasing a light box for your loved one or increasing the amount of light in their environment as the sun sets.
Consider Medication: Although not always the best first resort, prescription drugs do have their place on the sundowning treatment spectrum. If your loved one has depression or a sleep disorder, they may find medication particularly useful. But proceed with caution, as certain pills can interfere with energy and sleep, which may make sundowning worse.
Sundown Syndrome Can Be Managed
It can be troubling to witness someone who is sundowning, especially a loved one. And it can be equally frustrating and exhausting trying to provide care for them in such a state. But with a little trial, error, and professional guidance, there are ways to make life more comfortable for you and the individual in your life who is experiencing sundowning. Talk to your loved one’s doctor about which method is best for them, and sunset might be a more peaceful time for you both again.
If you are unsure of how to best help an aging loved one, the trained and compassionate staff at the Institute on Aging is here to help you make that decision and gain the best in at-home care for older adults. Contact us to find out more.
