What is Sundowning or Sundown Syndrome?
As daytime turns to evening, you may start to notice a person living with dementia becoming increasingly agitated, pacing, or expressing worry. This restlessness and confusion around the late afternoon is a common dementia-related symptom called sundowning or sundown syndrome.
The exact causes of sundowning are unknown, though experts believe it is tied to changes in the brain that regulate a person’s internal body clock, called circadian rhythm.
Sundowning begins during the middle to late stages of Alzheimer’s disease. It tends to happen at a time of the day when a person living with cognitive change is beginning to feel tired, and responding to variation in outdoor light, the pace of activity around them, or a shift in routine. Common responses might include seeking an exit or saying “I want to go home” even though they are in their home.
Other symptoms or responses as the day turns to evening may include:
- Pacing, wandering, or shadowing
- Anxiety, agitation, and mood swings
- Paranoia or hallucinations
- Yelling, aggression, or not following directions
- Insomnia and disrupted sleep-wake cycles
- Physical discomfort such as hunger or thirst
Managing the possible triggers can minimize symptoms and help calm the person in your care. Environmental and routine adjustments can aid in reducing the impact of sundowning:
- Maintain a consistent yet flexible routine: Keep time for waking, meals, activities, and bedtime approximately the same each day, but don’t be rigid with the schedule. The routine is a guide. Make space for the unexpected.
- Schedule appointments, bathing, and outings for morning or early afternoon.
- Don’t forget self-care for you. It’s important to balance the responsibility of caring for others with caring for yourself, lest you burn out. Include time for rest, fun, and self-care are part of the daily routine. Take the Caregiver Burnout Quiz to see if your flame is about to fizzle.
- Mind the stimulants: Limit caffeine and sugar consumption to the morning. Limit alcohol consumption as well.
- Spend time outdoors early in the day. Exposure to natural light and fresh air can do wonders.
- Interior lighting. Turning on the lights before the sun sets helps to keep the indoor environment bright and reduces evening shadows, which can cause confusion.
- Be mindful of evening activity levels. Make late afternoon and early evening routines calm and soothing. Be attuned to noise and activity levels and minimize disruptions in the evening. Limit daytime napping to encourage better sleep at night.
- What does the person in your care find comforting? Listening to music? Singing? A short walk? Being read a story or poetry? Washing dishes after dinner? A hand massage with lavender lotion?
Caregiving is complex and exhausting. Family caregivers frequently report experiencing high levels of stress. It can be overwhelming at times, and too much stress can be harmful to both of you.
With patience, pausing, and practice, you can find a rhythm and pace that works best for the person in your care, while also caring for yourself.
Feeling overwhelmed? You are not alone!
Our Aging Life Care Professionals™ at Aging Wisdom are both compassionate and offer years of experience to help you develop a workable routine, a self-care plan, and find the support you need. Click here to schedule a get-acquainted call to learn how we can support you on the journey.
