“Sundowning” or Sundowners Syndrome, is a term used to describe a state of confusion and anxiety which typically occurs during the early morning, late afternoon, or early evening when daylight and darkness are transitioning. Individuals may show any variety of behaviors such as increased agitation, anxiety, confusion, and irritability.
The cause of Sundowners Syndrome is unknown and cannot be attributed directly to Alzheimer’s Disease or other forms of dementia. However, it is common to see these symptoms in association with the disease.
There is not a clear definition of what Sundowners Syndrome means. It’s a phrase. Some people would only include agitation in the definition. It is a range of behaviors; something that is not usual for the person. That can range from just being restless to striking out.
-Dr. Peter V. Rabins, Professor of Psychiatry in the Geriatric Psychiatry and Neuropsychiatry Division of Johns Hopkins University School of Medicine
There are some common factors which are believed to cause late-day anxiety and confusion:
- Seasonal change– Fall and Winter bring shorter days and less exposure to natural daylight. Similar to Seasonal Affective Disorder symptoms, this causes many people to feel depressed and experience sleep disturbances.
- Darkness and low light– A dark and poorly lit atmosphere can create confusion due to increased shadows and poor visibility. This is also due to a lack of natural light.
- Disruptions to one’s “internal clock”– An imbalance with an individual’s biological clock may affect one’s waking and sleeping time. This may be due to seasonal change or an imbalance in hormones.
- A change in routine– Changes in an individual’s atmosphere or schedule may lead to anxiety and confusion.
- Fatigue– An activity-filled day or a sudden decrease of activities in the late afternoon or early evening hours may cause confusion and exhaustion.
For many caregivers, it can be discouraging to witness a loved one who is experiencing an increase in dementia symptoms. Symptoms of agitation, confusion, anxiety, and disorientation can be worrisome and difficult to manage. Fortunately, there are some ways for caregivers to help alleviate the cause of these symptoms.
Listen patiently to why the person is confused or upset
- Do they feel they have somewhere to be? Do they think it is time for a meal? Are they experiencing pain? Reassure them that you understand what they need. Clearly communicate that you will help solve their problem and that everything will be okay.
Look for patterns in behavior
- Identify certain activities or environments which cause the individual to experience increased symptoms and limit or stop the triggers.
Create a peaceful environment
- Play soft and familiar music.
- Offer a snack or beverage, but avoid sugary treats and caffeine in the late afternoon and early evening before bedtime.
- Have a low energy activity available, such as puzzles, painting, or crafts.
Create a safe environment
Some individuals may begin wandering or pacing due to restlessness, frustration, or sleeplessness.
- Clear all unnecessary clutter and tripping hazards around the home.
- Keep windows and doors locked or install door sensors in case of wandering.
- Consider having your loved one wear an identification bracelet which lists their information in case they wander into an unfamiliar area.
Create a familiar routine
- Minimize unpredictable events throughout the day to avoid increased confusion or agitation.
- Fill the individual’s space with familiar items such as photographs of loved ones.
- Set a regular routine an individual can rely on for bedtime, waking, eating, and other activities.
- Limit unfamiliar locations which may cause distress.
Create a well-lit environment
One of the main variables associated with Sundowning is a change in lighting, whether it is a lack of natural sunlight, seasonal changes, or inconsistent lighting.
- Light boxes, which aide in seasonal affective disorder symptoms, may help ease the symptoms an individual may experience from seasonal changes.
- Keep rooms well-lit. Replace soft light bulbs with higher wattage bulbs.
- Plug in night-lights to reduce confusion during the night.
- Add lamps in areas that will not clutter or cause a tripping hazard.
Limit activities which cause increased fatigue
- Set high energy activities early in the daytime while exposure to natural daylight is best.
- Avoid over stimulating activities, such as loud television shows.
- Avoid loud and busy areas, especially in the late afternoon to early evening.
“At Aspen Senior Center we stick to the same schedule every day. For someone with dementia, this allows them to feel calm and secure,” says Julie Smith, Activities Director at Aspen Senior Day Center. “We’ve found that too much daytime napping and inactivity makes it harder to get a good nights sleep leading to fatigue the next day. Fatigue is a common trigger for sundowning. When we notice one of our clients is beginning to get agitated or anxious, we take them for a walk, play quiet soothing music, or look at a book together with pictures they are familiar with. We also take note of patterns that might trigger the agitation and try to remove them if possible.”