August 24, 2017
The term “sundowning” or “sundown syndrome” refers to a state of confusion in the late afternoon or early evening. Often associated with dementia, sundowning has been observed and described as a combination of confusion, exhaustion and restlessness. Sundowning can cause a variety of behaviors, such as anxiety, aggression, ignoring direction, pacing and wandering.
As dementia progresses, it damages areas in the brain that regulate the body’s internal clock. This can disrupt and disturb the natural sleep/wake cycle. This can then lead to increased napping during the day and difficulty staying asleep at night.
When sundowning occurs in a residential care facility, it may be related to the flurry of activity during staff shift changes or the lack of structured activities in the late afternoon and evening. The arrival and departure of staff may cue some people with Alzheimer's to want to go home, check on their children, or other behaviors that would have been appropriate in the late afternoon in their past.
Other factors that may aggravate late-day confusion include:
• Fatigue
• Low lighting
• Increased shadows
• Disruption of the body's "internal clock"
• Difficulty separating reality from dreams
• Presence of an infection such as urinary tract infection
If you’re sensing a behavioral shift in someone with dementia later in the day, the team at UCLA’s Geriatric Medicine practice recommends the following strategies:
• Try to maintain a predictable routine for bedtime, waking, meals and activities.
• Plan for activities and exposure to light during the day to encourage nighttime sleepiness.
• Limit daytime napping to a few hours.
• Limit caffeine and sugar to morning hours.
• During the day, open the drapes to let natural light in.
• Before the sun starts to go down, close the drapes and turn on plenty of indoor lights.
• In the evening, try to reduce background noise and stimulating activities, and create a calm environment (e.g. turn off the TV and put on soft music).
• Keep a night light on to reduce agitation that occurs when surroundings are dark or unfamiliar.
Sundowning may occur more frequently when a person is away from familiar settings, for example, during a vacation or over the holidays while away from home. Try to be mindful of additional and unusual factors that may be causing late-day confusion so as to better address the symptoms.
