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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 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

What is sundowning? Scientists don’t totally understand why sundowning occurs in 1 out of 5 people with Alzheimer’s or why even people without dementia can experience it. 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.
What causes sundowning? 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 okay. 
  • Don’t physically restrain your loved one. If needed, allow them to move around or pace while keeping a close eye. 
  • Try to 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. 

12 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. 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. Track their behavior. If you think your family member is exhibiting symptoms of sundowner syndrome, start keeping a journal. Write down their symptoms, time of day, what helps ease them and what seems to make them worse. People with dementia can express symptoms in different ways. 
  1. Keep to a schedule. Your loved one might have difficulty with unfamiliar places and things, which could cause feelings of stress, confusion and anger. To help, set and stick to a schedule for waking up, eating meals and going to sleep.  
  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. 
  1. Get comfy. Sleeping areas should be at their preferred sleeping temperature with comfortable blankets and mattress. Play soft music or calming nature sounds to create a soothing atmosphere. 
  1. 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. 
  1. Stay active (but not too active). Adequate exposure to light helps create a strict day and night pattern. 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. 
  1. 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. 
  1. Head outside. Sunlight exposure can help reset a person’s body clock. 
  1. Cut the noise. Make early evening quiet time. Keep background sounds to a minimum, play cards, read or take a walk. 
  1. Practice self-care. Pay attention to your own mental and physical well-being. Try to 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. 
  2. 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 
  1. 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 in Spring, Texas

The Village at Gleannloch Farms offers an innovative program called Heartfelt CONNECTIONS – A Memory Care Program™ that works to preserve everything that brings meaning to your loved one and your family in a comfortable home-like setting. Understanding and explaining dementia to family members can be difficult. To learn more about how we support sundowning and other aspects of dementia, use our Community Assistant chat feature or contact us here.