Time of day can have a powerful and seemingly strange effect over some people with Alzheimer’s and other forms of dementia. Your loved one may be content and quiet in the morning, agitated and pacing by the early evening. Here’s what you need to know about the phenomenon known as sundown syndrome or sundowning.
What is sundown syndrome?
Sundown syndrome, or sundowning, describes confusion and distress that sometimes occurs in people with various forms of dementia during the late afternoon and evening hours. While most of us are winding down, those with sundown syndrome may actually feel a burst of energy and become unusually active towards the end of the day.
Sundowning isn’t a disease, Mayo Clinic notes; it is a common name for a cluster of different symptoms experienced by dementia patients. When a person experiences sundown syndrome they may find the condition agitating and frightening. The disorientation can cause the person to pace, hallucinate, act out or show signs of aggression and even violence.
The condition can develop as a byproduct of old age, and may not always be a sign of dementia or more serious health issues. But research also suggests that perhaps one in five people with dementia will develop sundowning as a symptom of the condition.
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What are the symptoms of sundown syndrome?
Sundown syndrome is more than just being a night owl. As day transitions to night, those with sundown syndrome may experience:
- Confusion or disorientation.
- Increased irritability or agitation.
- Inattention to tasks or instructions.
- Mood swings, such as being more demanding.
- The impulse to pace.
- Visual or auditory hallucinations.
- The impulse to scream and yell.
- The urge to wander.
What causes sundown syndrome?
Researchers haven’t narrowed down the exact cause of sundown syndrome, but many believe that dementia can wreck havoc on the internal clock that regulates the body’s sleep-wake cycle. As a result, it can trigger personality changes as light wanes.
Another possible cause may be that other symptoms of dementia are simply exacerbated as it gets darker, feeding into a sufferer’s already heightened state of confusion and anxiety. Shadows at night, for example, might trigger delusions or uncharacteristic fears.
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How to handle sundown syndrome
The key to minimizing the effects of sundowning is to identify a person’s unique symptoms, and then find constructive workarounds or tools to eliminate those symptoms. There isn’t a single “best treatment” for sundown syndrome, but here are a few treatments and modifications that have been shown to help:
Bright light therapy
Bright light therapy can help reset the body’s sleep-wake cycle, so someone with sundown syndrome can get back to a normal sleep schedule. This can make the evening a less restless time.
You’ll need to consult a doctor to determine if light therapy is the right course of treatment for your loved one. If it’s not, you can still use natural light to your advantage by maximizing exposure to daylight and minimizing light pollution at night. Keep the shades closed in the later afternoons and evenings, and keep the lights dim at home.
Creating a routine
People with dementia thrive on predictability. When the plan for the day stays relatively the same, it can lessen confusion. Having a solid routine during the day and in the evening can reduce how much sundown syndrome impacts a person’s life. A sudden change of plans, on the other hand, may spark disorientation and make things worse.
If a change in routine is necessary, during travel for instance, consider traveling with familiar reminders of the usual daily schedule. That could mean packing the person’s evening reading blanket and other familiar items or playing the same music that usually signals it is time to prep for bed.
Getting consistent sleep
Sleep is important for all seniors, but especially for those with dementia. Sleep improves brain performance and mood, as well as offering a host of other benefits. Having a consistent bedtime and creating a comforting bedtime routine can lead to a more restful slumber.
Listening to music
Some caregivers report that soothing music can calm agitation in the early evening hours for those with sundown syndrome. Playing particular melodies at different times throughout the day (such as one tune at breakfast and another when it’s time to put on pajamas) can also help establish a predictable routine, which may alleviate anxiety in some people with dementia.
Figuring out and avoiding triggers
Caregivers to those with dementia may be able to lessen symptoms of sundown syndrome if they pay attention to their patient’s or loved one’s special triggers. If loud noises, clutter or certain TV shows seem to produce unusual behavior in the evening, simply removing the stimuli may reduce sundowning effects.
