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How to Cope With Sundowning Symptoms

girl on a video call with senior parents

Early evening is the time when many people are unwinding from the day. But for some people with Alzheimer’s or other forms of dementia, fading daylight marks the start of sundown syndrome — episodes of restlessness, agitation and confusion.
Sundowning typically occurs between 4:30 and 11 p.m. and can last through the night, making it difficult for people with Alzheimer’s and dementia to fall asleep and stay in bed. This means they (and their caregivers) may not get enough sleep to function well during the day, which can lead to more behavioral issues.

Factors that contribute to sundown syndrome

Scientists don’t totally understand why sundowning occurs in 1 out of 5 people with Alzheimer’s and other forms of dementia; however, it also can occur in older people who don’t have dementia. One possible cause of sundown syndrome centers on the area of the brain that signals when you’re awake or asleep. That area breaks down in people with Alzheimer’s, which affects a person’s internal body clock. The subsequent sleep-wake cycle disruptions can lead to personality changes and a state of confusion.
Several factors may aggravate sundown syndrome, such as fatigue, hunger, thirst, depression, pain, boredom or sleep issues. Other events that may lead to sundowning symptoms include illness or infection such as a urinary tract infection, hospitalization, moving to an unfamiliar place, hormonal imbalances or medications wearing off.

How to know when your loved one is sundowning

Caregivers may notice personality changes that are dramatically different from their loved one’s normal behavior or daily routine. Fading light seems to be a trigger, with symptoms progressing through the night and usually improving by morning.
Behavioral changes may include restlessness, mood swings, energy surges, confusion, inability to identify people, paranoia, and difficulty speaking and thinking clearly. Other sundowning symptoms many include sleep issues, yelling or aggressive behavior, pacing, rocking, wandering, and seeing or hearing things that aren’t there. Many of these symptoms are paired together.

How to deal with sundowning

While these behaviors can be frightening for both the individual and caregiver, there are coping strategies and non-medical ways to reduce the symptoms. If a person is awake and upset, the Alzheimer’s Association offers these recommendations to help you cope with sundown syndrome behaviors.

  • Approach your loved one in a calm manner.
  • Gently remind them of the time and listen to any concerns or frustrations.
  • Find out if there is anything your loved one needs.
  • Avoid arguing and offer reassurance that everything is OK.
  • Don’t physically restrain your loved one. If needed, allow them to move around or pace while keeping a close eye.
  • Try and distract the person from the stressful or upsetting event with a snack, pet, favorite object or movie, photo album, or a simple task, such as folding a towel.

10 tips to help manage sundown syndrome behaviors

Although it’s difficult to stop sundowning completely, you can work to minimize it. Take these steps to help manage this challenging time of day, so both you and your loved one can sleep better and be less tired during the day.
Keep in mind managing behaviors requires careful attention to details, ongoing monitoring and maintaining a daily routine for waking up, eating, activities and sleeping. And because every person with dementia reacts differently to triggers and treatment, it may take some trial and error before discovering what solutions work best.

1. Let there be light (in the evening). Proper lighting will help minimize shadows and may help reduce agitation when surroundings become dark or unfamiliar.

2. Get comfy. Sleeping areas should be a comfortable temperature. Play soft music or calming nature sounds to create a soothing atmosphere.

3. Stay safe. Use appropriate door and window locks, plug in a nightlight, set up a gate to block stairs and put away any potential hazards. Also consider getting a baby monitor, motion detectors or door sensors that can let you know if your loved one is wandering.

4. Stay active (but not too active). Adequate exposure to light helps create a strict day and nighttime. Encourage daily exercise, but no later than four hours before bedtime. Plan activities such as bathing, medical appointments or errands in the morning or early afternoon.

5. Soothe by touch. A quick hand or foot massage can help calm someone down and reduce agitated behaviors. A loved one also may respond well to essential oils or acupuncture.

6. Head outside. Sunlight exposure can help reset a person’s body clock.

7. Cut the noise. Make early evening quiet time. Ask a friend or family member to call, keep background sounds to a minimum, play cards, read or take a walk.

8. Practice self-care. Pay attention to your own mental and physical well-being. Try and get plenty of sleep at night. If you’re feeling frustrated, your loved one may pick up on it and become confused or agitated. While it’s completely normal for caregivers to feel exhausted and overwhelmed, try to manage those emotions around your loved one.

9. Ditch the stimulants, clutter and extra zzzs. A number of things seem to worsen sundowning and should be limited or avoided altogether:

  • Coffee, soda and drinks with caffeine
  • Alcohol, sugar and nicotine (or any stimulant that may affect sleep)
  • Planning too many activities in one day
  • Daytime napping (rest is fine if needed)
  • Watching television during periods of wakefulness at night

10. Ask for help. Taking care of a loved one with memory impairment requires a great deal of flexibility, creativity, patience and empathy. It also may require outside help from experts and transitioning your loved one to a senior living community that offers memory care.

Memory care and dementia care in Spring, Texas

At The Village at Gleannloch Farms, we enrich the lives of our residents with Alzheimer’s disease and other related dementias by supporting improved dignity and overall health and well-being.

Our memory care residences provide the safety, security, people, and programs to help preserve the things that bring meaning and order to the life of your loved one, including those with dementia who have sundowner syndrome. Learn more about our memory care services.