Sundowning

Sundowning is a symptom of Alzheimer’s disease and dementia that causes increased confusion, restlessness, and memory difficulties in the evening. As many of 20% of those who have Alzheimer’s may experience sundowning.

What Is Sundowning?

An individual who is “sundowning” may often feel more confused as the evening sets in. This confusion is believed to occur as a result of Alzheimer’s effects on the brain, but the phenomenon is not entirely understood. Sundowning can occur as a symptom of Alzheimer’s disease and other forms of dementia. It appears most often during the middle stages of Alzheimer’s but diminishes as the condition advances.

Sundowning may lead an individual to experience (in the evening) the following:

• Increased restlessness and agitation
• Personality changes
• Increased difficulties with memory
• Disorientation
• Changes in sleep patterns, nighttime restlessness, sleep disturbances
• Anxiousness

What Causes Sundowning?

The evening can be a challenging time for people with dementia:

• Mental and physical fatigue tends to exacerbate memory problems.
• A person with dementia may pick up on the stress and fatigue of a caregiver and react with agitation or confusion.
• Nutritional issues can also cause sundowning. When those who have Alzheimer’s or another form of dementia have a disrupted meal schedule or eat a large meal late in the day, they may experience greater upset in the evening.
• Because many people with dementia live in assisted living facilities or with caregivers, they face the added stress of an unfamiliar location.
• Decreased light and increased shadows can make it more difficult to focus on and remember settings, making disorientation more of a concern when there is less light.

How Is Sundowning Treated?

There is no cure for either sundowning or dementia, but some medications may help. Regular meals can decrease the likelihood of sundowning. A well-regulated schedule can also reduce fatigue and the stress of an unfamiliar environment. Exercise, regular exposure to sunlight, and increased activity during the day may also help.

Some people with sundowning experience an improvement when they reduce their intake of caffeine, nicotine, alcohol, and other chemical substances. However, a sudden change or complete elimination of an addictive substance can increase agitation and contribute to sundowning.

People with dementia have been shown to thrive on routine and familiarity. Caregivers who provide a comforting, loving environment and allow people with dementia some control over their daily activities may find that this helps some individuals cope more effectively with symptoms of dementia, and this may reduce the frequency of sundowning or make it less severe.

References:

1. Mayo Clinic Staff. (2011, April 28). Sundowning. Mayo Clinic. Retrieved from http://www.mayoclinic.com/health/sundowning/HQ01463
2. Roth, E. (2013, August 21). Tips for Reducing Sundowning. Retrieved from http://www.healthline.com/health-slideshow/dementia-sundowning#1
3. Sleep Issues and Sundowning. (n.d.). Retrieved from http://www.alz.org/care/alzheimers-dementia-sleep-issues-sundowning.asp

Last Updated: 09-21-2015