Fall is here and this is the time of year when “sundowning” can be more prevalent, especially for individuals in the middle stages of dementia. During autumn, the days begin to get shorter. I notice it already, but that’s because I am outside most of the time. We will be turning the clocks back before you know it, and this will only make a bad situation worse.

 

Sundowning is the phenomenon where people with Alzheimer’s disease or other forms of dementia become increasingly confused and agitated during the early evening hours of twilight and sunset. This time of day can be especially distressing for dementia patients, and it places a great deal of pressure on the caregivers who try to help them stay calm and oriented. Pacing, restlessness and shadowing can become more pronounced during these times. Additionally, hallucinations, delusions, wandering, and violent or paranoid behavior can manifest in more severe cases.

There are several things you can do to minimize the symptoms of sundown syndrome. They can be simple, such as turning on all the lights in the house before it starts getting dark or slightly changing a loved one’s evening routine to compensate for the time change. There are many types of dementia, and each one manifests differently in each person. Therefore, trial and error is the best method for finding out what techniques can help minimize troubling dementia-related behaviors.

Different Approaches to Managing Sundowner’s Syndrome

Symptoms of sundowning can be brought on by too much activity or noise toward the end of the day, increased fatigue, shadows caused by low light, and hormone imbalances (which can affect a person’s internal clock). Look for patterns in your loved one’s behavior that will clue you in as to what may be bothering them or exacerbating their behavioral changes.

For example, if they become more tired and frustrated in the evenings, then encourage a short nap in the early afternoon (not too late, or they’ll be awake all night) and make a point of keeping nighttime activities soothing and low key. If visual hallucinations and disorientation spike after the sun has set, make modifications throughout the home to minimize shadows, reflections and distorted images that could be misinterpreted by their broken brain.

Sometimes medications (e.g. antipsychotics, benzodiazepines, antidepressants), supplements like melatonin, increased lighting, soft music, light therapy, or a carefully tailored routine can help minimize the confusion and agitation associated with sundown syndrome.

Unfortunately, I haven’t yet found anything that helps me. This isn’t meant to discourage you, but lighting up the house like a Christmas tree doesn’t work. And changing my routine has a nasty snowball effect, causing confusion and frustration in other areas of my life. Keep this in mind when you are considering changing your loved one’s routine. If you make changes, make them as subtle and incremental as possible.

Sundowning and the Seasons

Be aware that as the days get shorter sundowning can become an increasing issue. If your loved one is already experiencing symptoms, then they will likely get worse. It does for me and every other patient I know. It has to do with our internal biological clock. Everything gets confusing when we lose so much daylight and we have to endure all those dreary, dark and cloudy days that usher in winter. Even people without dementia can experience fatigue and mood changes this time of year—symptoms that may point to seasonal affective disorder (SAD).

 

To complicate things further, sundowning doesn’t always happen in the early evening, either. I can have bouts of increased symptoms in the middle of a bright, sunny day. Some patients even experience a form of this syndrome called “sunrising” during the early morning hours. Others spend entire nights sleeplessly wandering, searching for something or trying to escape from their home.

Typical sundowning behaviors are tied to changes in a patient’s brain and internal clock, but be sure to rule out other causes, like medication interactions/reactions, infections (especially urinary tract infections), pain and dehydration. These underlying issues often produce similar symptoms in seniors with AND without a dementia diagnosis.

Do your best to learn about dementia behaviors like sundown syndrome. Try everything you can to remedy them, then try everything you can again. It’s all you can do. What doesn’t work today may do the trick tomorrow, and what works tomorrow may never be effective again. That is life with dementia.

Sources: Sundowning: Late-day confusion (https://www.mayoclinic.org/diseases-conditions/alzheimers-disease/expert-answers/sundowning/faq-20058511)