Understanding Sundowning in Alzheimer’s Disease: Causes, Symptoms, and Management Strategies

Sundowning, a term commonly associated with Alzheimer’s disease, refers to the behavioral changes that often occur during the late afternoon and early evening, unrelated to the actual sunset. This phenomenon brings restlessness, agitation, and irritability to individuals with Alzheimer’s, possibly posing a challenge for their caregivers.

At NursePartners, we offer professional care for individuals with Alzheimer’s disease. Our team of trained CarePartners has extensive experience in working with Alzheimer’s patients, offering support and assistance in the comfort of their own homes.

In this article, we’ll explore the concept of sundowning, its impact on individuals with Alzheimer’s, and effective strategies for managing it. By delving into the causes, symptoms, and management strategies of sundowning, this article aims to provide valuable insights and practical guidance to help navigate the complexities of Alzheimer’s care.

What is “Sundowning” and How Does it Affect Those With Alzheimer’s Disease?

“Sundowning” in Alzheimer’s disease refers to the behavioral changes – restlessness, agitation, and irritability – that often accompany the fading of the light. This is usually the time of day when the patient with Alzheimer’s feels edgy. They may feel it is time to change direction and do something new or “head home.”

Sometimes, dusk and the darkness that follows prompts feelings of insecurity. At the same time, this is when caregivers tend to feel worn out and would love to take some time out. Instead, they have to be more vigilant than ever as confusion and distress – often associated with delusions or hallucinations – are synonymous with sundowning.

These behavioral changes or symptoms of sundowning – including wandering, yelling, or pacing – often assail the person with Alzheimer’s well into the night, making the nightly routine difficult as they struggle to fall asleep or stay in their beds. 

This often results in a vicious cycle where both the patient and caregiver are unable to get adequate sleep, and their daytime schedule is thrown out as a result – with sleep deprivation being enough to make even the most easygoing person ratty.

What are the Triggers of Sundowning?

While sundowning usually occurs during the middle and later stages of Alzheimer’s, there are no hard and fast rules. It can take effect at any stage.

Causes of Sundowning

There is no definitive explanation, but several likely reasons have been put forward for sundowning. 

These may include:

  • Damage to the brain that causes a disturbance of the Alzheimer’s patient’s biological or body clock, interfering with their sleep-wake cycles.
  • A disturbance in hormone levels, which tend to vary during the day.
  • Anxiety, depression, and/or boredom.
  • The side-effects of prescription medication.
  • Not getting enough exposure to sunlight.
  • Overstimulation, whether due to a busy or noisy environment.
  • Loss of hearing or sight.
  • Pain or unmet physical needs such as needing to go to the toilet, fatigue, or hunger. (patients may not be able to express themselves adequately)
  • Fewer people may be available later in the day to care for someone with Alzheimer’s, often due to family commitments. 
  • Sensitivity to other people’s tiredness causes the patient to feel out of sorts

Identifying which problems might be taking their toll on the patient can help in finding ways to treat the issues. Some may have to do with the time of day, but others are completely unrelated. Sometimes a change of routine during the day may aggravate the person, so it is worth trying to distract them. 

If they seem upset, distraction is an effective strategy that draws the mind away from their stress over whatever it is that seems to be upsetting them, so try diverting their attention to what they love, be it people, foods, pets, or activities.

Strategies for Managing Sundowning

When managing sundowning, it is important to remember that the familiar helps people with dementia feel more at ease. Listening to and reassuring the patient in a calming manner can also help alleviate their frustrations or confusion. This is one of the reasons why it is beneficial to create a care team earlier in the disease progression. Your loved one and the carepartner will already have formed a trusting relationship when it is needed most.

Tips to Take the Edge off Sundowning

  • Restrict the patient’s caffeine, nicotine, and sugar intake, particularly after lunch.
  • Alcohol can add to the confusion and stress. The teetotal route is probably safest, but drinking any liquids in the latter part of the day could create issues in terms of increased toileting needs at a time when caregivers may be preoccupied with other things, like preparing dinner.
  • Ensure the patient gets daily physical exercise, but a full schedule of activities can be tiring, so space out activities and balance the patient’s schedule with rest between periods of activity. Routine and structure are essential.
  • Having the person with Alzheimer’s spend time outside in the sun or near a window, where they are exposed to sunlight, can help reset their body clock.
  • If they spend time sleeping during the day, try to ensure these short “power naps” don’t take place later in the day, or they can harm the person’s night-time sleep schedule.
  • Avoid overstimulation – if different household members come home in the latter half of the day, things might become more hectic and unsettled for the person with Alzheimer’s. Sensory stimulation like the news channel, crime shows, or loud music might overburden them, causing anxiety. There may be several lines of communication going on between family members that are hard to follow, or there could be a change in caretaker which may be challenging to process. You might want to try calming them by turning on a light-hearted show they enjoy or even giving them simple, repetitive tasks, like folding laundry.
  • Giving the Alzheimer’s patient time to decompress in the afternoon might help. Ensuring that they are in a quiet space where there are fewer people, noise has been eliminated as much as possible, and clutter is at a minimum is ideal.
  • Talking about a memory that has positive associations for them or dimming the lights in the evening so that the contrast between daylight and night is more tangible is also helpful in overcoming the worst effects of sundowning.

Sleep Disturbances and Sundowning

Sleep disorders in those with dementia are common and can worsen over time as the condition progresses.

Sleep Disturbances Associated with Dementia include

  • Insomnia – Studies of the brain waves reveal both dreaming and non-dreaming sleep stages are reduced. Some patients tend to be restless; they might wander or will shout out at night, disturbing their caregivers’ sleep.
  • REM (rapid eye movement) behavioral sleep disorder, also referred to as dream-enacting behavior or RBD
  • Sleep-disordered breathing – sleep apnea impairs memory and executive function and has also been associated with dementia risk. Ask the patient’s doctor about the treatment available for sleep apnea.
  • Difficulty keeping awake during the day
  • Restless leg syndrome 

If none of the tips below help, and sundowning remains an issue, a medical examination may pinpoint a problem such as medication side effects, sleep apnea, urinary problems, or pain. Keeping a journal of when the sleep problems occur can assist in the diagnosis.

Some doctors might recommend trying sleep medication for a short while if all else fails, but generally, sleep medication does not help a sleep-deprived patient. It’s not usually recommended for those with dementia as it can cause increased confusion and possibly lead to falls.

There are several ways to change the patient’s bedroom that may help them sleep:

  • A dim nightlight and comforting security object might be necessary to help the person sleep better.
  • Keep clutter to a minimum and ensure the room is quiet. A calm, dark environment is best for sleep. (Dark, lined block-out curtains or an eye mask might be a worthwhile investment.)
  • The temperature should ideally fall between 60 and 67 degrees.
  • Lavender essential oil in a diffuser can be a soothing scent often used to help people sleep.
  • Cholinesterase inhibitors should not be administered before bed. Monitor the side effects of all medications. Sedatives can sometimes have the opposite effect on people with dementia, so having a geriatric psychiatrist on hand to give advice is advisable. Some doctors may recommend supplements like magnesium, melatonin, and Vitamins B, C, and E.

Self-Care for Caregivers Dealing with Sundowning

Guilt is a common problem for anyone caring for an Alzheimer’s patient, but it is important to recognize you are not alone and that the role of a carer is a stressful one. Stress can be problematic for the patient and carer since burnout is a real danger.

Symptoms of stress include anxiety, exhaustion due to sleep deprivation, lack of focus, depression, anger, irritability, and frustration at the patient because they can no longer do what they were once able to. Withdrawal from friends and even health issues can result from stress, so it is vital to seek help.

Professional Nurse Care in Philadelphia, Delaware, and Montgomery Counties

When it comes to ensuring the personal hygiene and well-being of your aging loved ones, the task can often feel challenging. However, with the support of NursePartners, you have access to a team of experienced private nurses dedicated to maintaining their dignity and meeting their medical needs.

At NursePartners, our compassionate CarePartners specialize in assisting individuals with personal hygiene and understanding the importance of preserving their dignity. Additionally, they are highly trained to provide comprehensive medical care, ensuring your loved ones receive the attention and support they deserve. All carepartners are certified nursing assistants receive five hours of dementia training annually.

For more information or to learn more about our services, please call 610.323.9800 for a free consultation today.

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.