Alzheimer’s Sundowning 

Sundowning refers to behavioral and mood changes in people with Alzheimer’s disease,  occurring in late afternoon or early evening – around sunset. Caregivers witness this phenomenon regularly.  So being prepared for these changes helps family and caregivers cope better. Learn strategies to improve comfort and calmness so difficult behaviors are minimized.

Common Behaviors of Sundowning

Peak hours of Sundowning are between 4:00 and 6:00 p.m. in most places. Because of a spike in confusion at this time, people with dementia become more frustrated and perhaps more fearful.  They are less able to say what they need or want. Often yelling, grabbing, pushing, striking out or wandering happens. To get attention or express their frustration, they may become more demanding, restless, anxious, irritable and suspicious. Any of these behaviors are unsettling to the family member, person and caregiver.

What Causes Sundowning?

There isn’t a consensus  on what causes people to “sundown”.  It may be after a lifetime of school and work, we are used to a schedule where we stop and transition home around sundown. Since the person doesn’t maintain such a schedule anymore, and they can’t express the confusion of it all, acting our behaviors occur.

Another theory is that the disorientation and confusion are caused by changes in the brain. Their internal body clock, “circadian rhythms” are thrown off.  The brain isn’t transmitting correctly about the time of day. So, they don’t know what time of day it is, why they are in the location they are in and what happens next.  Such disorientation leads to agitation, causing outbursts.

Interventions to Minimize Sundowning

Speak to your doctor regarding any treatments for changes in circadian rhythms.

Establish and maintain a consistent routine starting from late afternoon to try and ward off the Sundowning.

Plan an activity, or project to redirect the person to, even watching a television show together.

Keep meal and bedtimes similar throughout the week.

Activities around sleep time, teeth brushing, undressing, any music, turning off lights, bedtime rituals ought to be maintained at regular times.

Have the same person, whether family or a hired caregiver help the person at bedtime.

Eliminate noise at bedtime, i.e. loud music, television, dishwasher or washing machine/dryer or deliveries.

Mute other stimulation  such as lighting.  Be careful not to create shadows as they can be disturbing to people with dementia.

Some people do well with an afternoon nap. However some don’t so see how your loved one reacts.

Know when it tends to happen and muster up all of your patience. Even with interventions, Sundowning can still happen and with aggressive behaviors. Speak to your doctor as use of a mild sedative may be indicated. Give yourself a needed break, by hiring help for an afternoon/evening shift.