What is Sundowning?
Sundowning, also called sundowner’s syndrome, is not a disease but a set of behaviors associated with dementia. People experiencing sundowning may show:
- Increased confusion or disorientation
- Anxiety and agitation
- Hallucinations
- Pacing or restlessness
- Difficulty sleeping
While the exact cause of sundowning remains unclear, it is often linked to changes in the brain due to disease progression.
Factors That Contribute to Sleep Issues and Sundowning
Several elements can trigger or worsen sleep problems in Alzheimer’s:
- Mental and physical fatigue: A busy day of activities can leave the person exhausted.
- Confusing environment: Unfamiliar spaces or changes in routine can increase agitation.
- Disrupted internal body clock: Dementia can cause the person to feel tired during the day and awake at night.
- Low lighting: Shadows may cause confusion or hallucinations.
- Caregiver stress: The person with dementia can sense stress or frustration in others, which may trigger agitation.
- Disorientation from dreams: Confusion about dreams versus reality can disturb sleep.
- Reduced sleep needs: Common in older adults, sometimes making nighttime wakefulness normal.
Tips for Managing Sleep Issues and Sundowning
Establish a Daily Routine
- Encourage regular wake-up, meal, and bedtime schedules.
- Plan doctor visits, bathing, and outings during the morning or early afternoon when the person is more alert.
- Limit daytime naps if nighttime sleep is disrupted.
Promote Restful Sleep
- Spend time outdoors in natural sunlight to help regulate the internal body clock.
- Keep the home well lit in the evening to reduce shadows and confusion.
- Offer a lighter evening meal and a more substantial lunch to avoid nighttime restlessness.
Reduce Evening Stimulation
- Avoid loud music, TV, or household chores during the evening.
- Identify calming activities, such as listening to soothing music, looking at photographs, or watching a favorite movie.
- Gentle walks can help reduce agitation and promote relaxation.
Monitor Triggers
- Keep a log of events that precede sundowning episodes.
- Identify patterns that may help prevent or reduce confusion and agitation.
Supporting Yourself and Others
Caregiving can be stressful, but support is available:
- Join ALZConnected®, a free online community for caregivers and people living with dementia. Share experiences, ask questions, and connect with others facing similar challenges.
When Sleep Issues Persist
If non-drug strategies are not enough, consult a doctor. Medical conditions such as urinary tract infections, restless leg syndrome, sleep apnea, or pain may worsen sleep issues. Medication may sometimes be necessary for severe agitation, but non-drug approaches are usually preferred. Always discuss the risks and benefits of medication with a healthcare professional.
Handling an Upset Person at Night
When a person with dementia is awake and distressed:
- Approach calmly and gently.
- Identify and meet any immediate needs.
- Remind them of the time if needed.
- Avoid arguing or forcing compliance.
- Offer reassurance that everything is okay.
- Allow pacing if necessary, with supervision—avoid physical restraints.
Managing sundowning and sleep issues in Alzheimer’s requires patience, consistency, and understanding. With careful planning, supportive routines, and caregiver self-care, both you and your loved one can experience calmer evenings and more restful nights.
