Shining New Light on Sundowning

Sundown syndrome, or sundowning, is the common term used to describe the challenging situation in which symptoms such as agitation, disorientation, pacing and irritability often occur in people with Alzheimer’s or other forms of dementia, around the time of day associated with sundown, when natural light begins to fade.

Episodes of this condition make it extremely difficult for the person to relax and get to sleep at night and causes them to wander around, awake and disoriented. Research has given us some insight into why this phenomenon occurs, stating that damaged portions of the brain can no longer produce sleep-inducing chemicals, resulting in the sundown syndrome.

The reason it was called “sundowning” was that for many years, caregivers saw that people struggled with increased anxiety and agitation later in the day, routinely in the late afternoon and the evening. The medical community were skeptical of whether there was any basis to the phenomenon – it was speculated that patients themselves become fatigued and irritable as the day wears on, or that the caregivers may add to the patient’s anxiety. Pain and soreness, as well as increased blood pressure, can accumulate as the day goes on, adding to the symptoms of sundowning.

For people caring for patients or loved-ones with Alzheimer’s, if this is a concern for the one you care for we hope we can help you better understand what sundowning is and what you can do to help minimise the effects.

What contributes to sundowning

According to an article posted on the Alzheimer’s Association, some of the factors that contribute to sundowning, as well as other sleep disorders, are:

• Physical and/or mental exhaustion at the end of the day
• A biological confusion of night and day caused by an upset in the internal body clock
• Misinterpreting what they see in reduced light and increased shadows causing confusion and fright
• Reactions to nonverbal cues from caregivers who may also be exhausted
• Disorientation due to the inability to determine reality from dreams
• Less biological need for sleep, a condition that is common in older adults
• Side effects from medications
• Other various health conditions such as sleep apnea, restless leg syndrome, urinary tract infections, incontinence and others

For sleep problems in Alzheimer’s and dementia patients, non-drug measures are recommended over medication but it is important to discuss treatment options with the patient’s physician.

Natural ways to decrease sundowning behaviours

Some suggested several natural ways to cope with the problems of sundowning:

• Increase the amount of light at home in the evening to avoid the confusion and agitation that darkness and shadows produce
• Ensure that the person’s sleeping area is comfortable by adjusting the temperature, providing a night-light, and other devices such as motion detectors which alert care givers or family members if they get up
• Try to maintain a schedule for daily activities such as meals, waking up and bedtime which will help the sleep cycle
• Avoid stimulants such as caffeine, alcohol, sweets and nicotine
• Avoid large meals towards the end of the day which may cause indigestion or an uncomfortable feeling
• Get daily exercise and sunlight but avoid exercising four hours before bedtime
• Limit distractions such as loud television or music or a lot of people coming and going in the home, in the evening as they can trigger episodes of sundowning
• People who are giving care should be aware of their own mental and physical exhaustion and take measure to get proper rest

“Change the environment to suit the person with dementia, rather than changing them”.

In a program initiated at one nursing home, the staff made several adjustments to care when they realised that their residents, as well as staff members, were having a difficult time getting through the day due to sundowning and its effects. They decided that staff members would do all they could to create a comfortable environment.

Some of the changes they implemented were: speaking more quietly, not rushing around as much, taking the television out of the common area used by residents, helping the residents rest either in bed or in comfortable chairs when they looked tired and generally changing the care facility environment from chaotic to quiet. The result of their program was surprising to the staff. They didn’t know that by making “comfort the goal of everything” they would have such a huge positive result. They have not experienced sundowning there in 14 years, all because they changed the environment to suit the people.

What other suggestions can you make to assist this?