7 Tips to Help Manage Sundowning in Alzheimer's Patients

Families affected by Alzheimer’s disease know how unpredictable each day could be, and sundowning is a phenomenon that heightens this unpredictability in the evening. The term sundowning does not refer to a disease, but rather to a collection of symptoms that adults with Alzheimer’s and other forms of dementia may experience later in the day. Sundowning remains somewhat of a mystery, as the precise cause is not well understood.

Sundowning and its corresponding behaviors typically start in the later afternoon and continue into the evening. According to the Mayo Clinic, these behaviors can range from confusion and anxiety, to aggression and ignoring directions. It can also cause the individual to pace or wander. This can be troubling for not only caretakers who are often ready for a break at this time, but also for the individual experiencing this heightened sense of confusion and disorientation. The Mayo Clinic lists certain factors that may intensify or precipitate sundowning. These include fatigue, low lighting, numerous shadows in the living environment, any disruption of the body’s “internal clock” or sleep-wake schedule, infections such as urinary tract infections, and difficulty distinguishing reality from dreams. The National Institute on Aging also highlights that, thirst or hunger, depression, pain, and boredom may increase sundowning.

One article recently published some tips to help caretakers and individuals with Alzheimer’s or dementia reduce sundowning:

Stick to a schedule

An important thing to keep in mind is that sticking to a schedule can help both you and your loved one maintain some routine and clarity in the evening. As dementia or Alzheimer’s advances, remembering and following a schedule can be a challenge. Catching someone with dementia off guard by introducing them to a new place or situation without preparation can make sundowning worse. By trying to keep a schedule every day, people with dementia will be better able to predict what is going to be happening at a certain time, and will hopefully be able to remain calm through the evening.

Light is everyone’s friend

We all know how important sunlight is for things such as Vitamin D and preventing seasonal affective disorder. However, it is probably less known that it can be beneficial for preventing the symptoms of sundowning in people with dementia. Sleep-wake cycles, also known as our circadian rhythms, are often disrupted in dementia patients, and this natural cycle of the sun rising and setting each day plays a large role in maintaining these rhythms. Exposing people with dementia to adequate amounts of light throughout the day may help alleviate their sundowning symptoms. Having your loved one spend some time outside or sit by a bright window can help reset their internal clock. Additional research also suggests that fluorescent light therapy could help as placing a light one meter away from an individual with dementia every morning for a couple hours could reset their internal clock. According to the Alzheimer’s Association, when people with dementia are feeling particularly anxious or agitated, placing a bright light near them could help alleviate symptoms.