As the sun goes down, caregivers might notice disturbing changes in people with Alzheimer’s, including worsening symptoms and bouts of confusion or agitation.
This common behavior is called sundown syndrome, or sundowning, and is associated with Alzheimer’s disease or other forms of dementia.
Sundown syndrome is characterized by episodes of confusion, anxiety, agitation, disorientation or even paranoid delusions and hallucinations that may last a few hours or throughout the night. Sufferers may not know whether it is night or day, and make odd decisions like getting up in the middle of the night in order to go for a walk. Technically, sundown syndrome can occur at anytime, but it gets its name because it happens most frequently in the late afternoon or early evening.
Scientists don’t know exactly what causes sundown syndrome. Some believe that it is the cumulative effect of sensory stimulation during the day that overwhelms the person and cause fatigue and stress. Others point to hormonal imbalances that occur at night or anxiety caused by reduced ability to see as well in the dark. Still more say, sundowning might be associated with a drop in blood pressure after a meal, where hunger or changes in blood glucose levels may trigger symptoms.
Several studies have also shown a connection between sundown syndrome and changes in the internal biological clock, circadian rhythms that control sleeping and waking and influence how active we are at different times of the day and changes in the body that regulate behavior. These studies theorize that people with Alzheimer’s have somehow experienced alterations to their internal clock because of a reduction in brain function.
Whatever the cause, sundown syndrome can be draining for the person with Alzheimer’s disease and his caregivers – and, in bad cases, dangerous. Caregivers dealing with sundown syndrome will have to resort to trial and error for strategies that work best for their situation, but there are some efforts that often prove successful.
- Keep the house well lit and close the drapes before sunset to minimize the transition from day to night.
- Try to help the person relax. This could include distracting your loved one with a favorite activity or TV show, or serving decaffeinated herbal tea or warm milk. Soothing music, a quiet room or a short neck or hand massage might help as well.
- Try to find out what triggers the Alzheimer sufferer’s agitation and confusion, and if possible, eliminate or reduce those stimuli.
- Researchers have found that exposing a person to full-spectrum fluorescent lamp for several hours in the morning can get the biological clock back on track and making him or her less agitated at sundown.
- Schedule your day so that the more difficult tasks are done early in the day, when the person is less like to become agitated. Active days without afternoon naps can encourage better rest at night.
- Watch the person’s diet and eating habits. Restrict sweets and drinks with caffeine to the morning hours. Try serving the person a late afternoon snack or early dinner.