If your loved one has Alzheimer’s disease or dementia, you may be seeing changes in their behavior in the late afternoon or early evening — a phenomenon known as sundown syndrome, sundowners or sundowning.
What are the signs of sundown syndrome?
According to the Alzheimer’s Association, as many as 20 percent of people with Alzheimer’s experience sundown syndrome. When your loved one has dementia (and some other conditions, as well), the approach of sundown can trigger sudden emotional, behavioral or cognitive changes. These might include:
- Mood swings
- Anxiety
- Sadness
- Restlessness
- Energy surge
- Increased confusion
- Hallucinations
- Delusions
These may lead, in turn, to challenging behaviors like pacing, rocking, screaming, crying, disorientation, resistance, anger, aggression — even violence. Many people experiencing sundown syndrome feel the urgent need to go somewhere or do something, but they can’t always explain why.
For some, the behavior soon abates; for others it continues for hours. Some even flip their sleep schedules so they are wide awake all night and sleepy during the day.
What triggers sundown syndrome?
There are many theories about why sundowning happens, and the triggers seem to vary among people with dementia. For some, sundowning may be triggered by the dimming light — a sense that it’s time to change activities or “go home.” Evening and darkness may tap into fears of being unsafe and insecure. Whatever the cause, seeing their loved one with these symptoms can be a nightmare for family members.
In what stage of dementia does sundowning occur?
Sundowning can occur at any stage of dementia, although many families observe the behaviors primarily in the middle stages of dementia and then subsiding as the disease progresses.
We first noticed sundown syndrome in my dad, who had Alzheimer’s, when he was in the disease’s moderate stage. Questions or observations that were occasional for most of the day — “What’s the plan?” “What should I be doing?” “We’d better get going!” — became more frequent, and more urgent, around 5 or 6 in the evening. As the disease progressed, his symptoms improved, and I believe that’s at least in part due to a variety of techniques we used regularly to treat and manage sundowners.
What are the ways to treat, manage and reduce sundown syndrome?
1. Observe and minimize triggers
Watch for fatigue and other things that seem to bring on sundowning behaviors. Afternoon transitions and activities that you consider normal can be anxiety producing for your loved ones.
For example, does the household get chaotic and noisy as people get home from work? Does the TV get switched to something loud or intense, like a crime show or the news? Is there are a lot of cross talk during mealtimes? Is there a caregiver shift change?
Watch, too, for nutritional triggers, and adjust eating and drinking schedules. Cut back on caffeine and sugar, which can be too stimulating, and limit liquids later in the day, as they can cause increased toileting needs.
2. Maintain routines and structured activities
Maximize activity earlier in the day and minimize napping (especially if your loved one isn’t sleeping well at night). Try to avoid challenging, stressful tasks around dusk and at night. Keep to a regular daily routine — there’s security in the familiar.
3. Simplify surroundings
Environmental chaos can be difficult for a person with dementia to process. Too much sensory stimulation can cause anxiety and confusion, worsened by changing light. Remember: Their brain is being damaged by dementia and it can be very challenging for the brain to view and process visual information. It may feel completely overwhelming to see a lot of “stuff” in a room, and this can cause sundowning behaviors as the person struggles to understand and organize that visual stimulation.
4. Modify the sleep environment
Try to minimize physical, visual and auditory clutter in your loved one’s bedroom.
At night, keep the room calm and comfortable for sleeping (experts often suggest a temperature between 60 and 67 degrees), and dark (try light-blocking curtains or an eye mask, plus dim night-lights for safe navigation). Evaluate your loved one for sleep disturbances such as sleep apnea.
5. Validate and distract
Simply trying to reason with someone in the midst of sundowning probably won’t work. Instead, try to validate your loved one’s feelings (even if they don’t make sense to you) to let them know you are listening. Try to draw them away from troubling thoughts and anxieties by diverting or redirecting attention to favorite activities, foods, animals and people.
6. Adjust light exposure
Some experts theorize that our hormones and body clocks are regulated by exposure to light, and too little exposure throws us off. If adequate exposure to direct sunlight isn’t possible, try a light box and use bright lights in the room.
As it gets dark outside, increase indoor and even outdoor lighting.
7. Play music and calming sounds
We used music throughout the day for Daddy — instrumental music as he woke up, sing-along favorites or show tunes to activate him, and calming music when sundowning set in. I recommend trying solo piano or classical guitar, or creating a “relaxation” or “spa music” channel on a music app such as Pandora, Spotify or Amazon Prime Music.
8. Use essential oils
Lavender, rose, ylang-ylang, chamomile, blue tansy, frankincense and other essential oils can be soothing. If you want to encourage waking up and staying active during the day, try bergamot, jasmine, peppermint, rosemary or citruses such as grapefruit, lemon or orange. Test which scents your loved one responds to.
Essential oils also can be used in various ways, including for aromatherapy. Consult with a doctor or other professional to ensure you are using essential oils safely, whether topically or as aromatherapy. They can be potent, so be sure to use appropriate amounts and dilutions.
9. Give healing touch
Never underestimate the value of a hand or foot massage to relax tense muscles and increase feel-good hormones. A loving hug or holding hands can be physically calming and emotionally reassuring for your loved one, breaking the cycle of anxiety.
10. Try complementary medicine
For example, traditional Chinese medicine (TCM) involves acupuncture, Tui na massage, Chinese medicinal herbs and other techniques. Acupuncture has been used to treat anxiety and depression for many generations and is increasingly being accepted by Western medicine. Talk with your loved one’s doctor about this option, and find a traditional Chinese medicine doctor who understands dementia.
11. Use herbs, supplements and medications wisely
Ask the doctor about medications that might help with symptoms, such as antianxiety drugs and antidepressants. Be sure to ask about and monitor possible side effects; for some people with dementia, sedating drugs can cause the opposite effect. A geriatric psychiatrist is an excellent resource.
Also ask about herbs and supplements, such as lemon balm, valerian, chamomile, kava and holy basil. There are many supplements that claim to be calming and stress reducing, including melatonin, magnesium, and B, C and E vitamins. Some research studies have indicated that taking melatonin at night can lessen sundowners behaviors. Ask your loved one’s primary doctor or dementia-focused practitioner about the use and dosage of melatonin and other supplements.
Managing sundown syndrome requires creativity, flexibility, empathy and strong observational skills as we try to determine what triggers our loved ones and how to address the behaviors. No two people with dementia are exactly alike, so be prepared to test different approaches and treatments. Some may not work, but others will. Successes might be temporary or intermittent. But even a little bit of success can greatly ease your loved one’s anxieties, as well as your own stress. Source
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