Sundowning: What it is, What you can do

It is estimated that 1 in 5 people with Alzheimer’s disease or dementia will exhibit symptoms of “Sundowning,” a psychological condition in people with cognitive impairment that is characterized by anxiety, restlessness, confusion and other behaviors. The term Sundowning is used because the symptoms often begin in the evening, as the sun is setting.

Sundowning is usually seen in those with mid-stage Alzheimer’s and decreases as the illness progresses.

Someone with Sundowning syndrome tends to become disoriented and agitated as the day begins to wind down. They may become confused and unable to process information, thereby becoming irritable and angry. They can be demanding or suspicious, and some may even have auditory or visual hallucinations that add to their anxiety. In an effort to cope with their confusion and the changing evening environment, they may wander, pace, and act out, which further complicates the process of settling down for sleep.

The exact cause of Sundowning is not known, but some research suggests that Alzheimer’s affects the person’s biological clock, inhibiting their natural transition from day to night. Fatigue could be a contributor, as could the fading light of day, which can make visibility more difficult for an elderly person. Also, the quiet of the evening gives the affected more time to focus on problems, which could lead to depression.

Sundowning is distressing for both the person and their caregiver, but steps can be taken to manage the symptoms. Ensure that the person affected engages in some activity during the day but does not become overly fatigued. Provide a calm environment as the day progresses by reducing activity, noise, and clutter. Distract an agitated person with a snack, a quiet TV show, or soothing music. Provide adequate lighting until the person is ready to fall asleep. And most important, be exceedingly kind and patient.

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