Sundowning is a phenomenon sometimes seen in patients with Alzheimer’s disease or other forms of dementia. It can cause an exacerbation of symptoms, sometimes to such an extent that the person becomes very difficult to deal with. Someone who only seems to suffer from mild confusion and memory loss during the day may become much more confused and forgetful at night. They may be moody, agitated, restless, and prone to lashing out or saying things they would never say during the daylight hours. They may feel the need to indulge in self-soothing behaviors, such as rocking or pacing. In extreme cases, people might hallucinate, feel paranoid, or wander off without telling anyone where they are going. The cause of sundowning is not universally agreed upon. Some think it shares a link with Seasonal Affective Disorder, while others think it is simply fatigue caused by overstimulation during the day or an imbalance in hormone levels.There is no single treatment approach for sundowners, so treatment will probably involve some trial and error.
Sundowning – Some things to try:
Keep rooms bright. Especially if your loved one has vision problems, try adding a few extra lamps to their room; if mobility is an issue, lamps set on automatic timers are even better. Something as simple as being able to see surroundings clearly can make a great deal of difference. Just as with Seasonal Affective Disorder, the use of full-spectrum light boxes may be helpful.
Rely on routines. If your loved one finds it difficult to unwind at night, propose a bedtime routine for them to follow. Seniors living in assisted care facilities will often have a built-in routine, but if your loved one is at home, there is no reason they can’t have one too. Encourage a regular rhythm in the hour or two before bed: perhaps a warm bath or shower, followed by a cup of decaf tea and reading in bed. Anything that helps them to relax can work. If your loved one lives in a care facility, encourage visitors to come well before bedtime to allow time for unwinding afterwards.
Get back to basics. Check your loved one’s diet and exercise routine. They will want to avoid caffeine and heavy or sugary foods starting in mid to late afternoon if they have trouble falling asleep. Be sure that any exercise they take is finished by early afternoon. If they tend to nap during the day, encourage them to try to stay awake from early afternoon on.
Do activities, but do them early. While some think that sundowning may be due to overstimulation during the day, others think it could actually be exacerbated by under stimulation. If a regular bedtime routine does not help relax your loved one, try adding more activities to their day. One or two things to look forward to each day is just about right for many seniors, but remember this doesn’t always have to involve you! It could be a weekly movie date with a friend, a club or support group that meets regularly, or a regular Tuesday night phone call from a sibling. The key is to do what you can, involve other people, and try to get activities into as regular a routine as possible. This will benefit both you and your loved one.
Finally, do check in with your loved one’s physician. Sleeping pills, antidepressants, or melatonin may occasionally be prescribed for those suffering from sundowning, but these should only be taken under careful supervision.