Reducing Sundowning
Sundown syndrome (also called sundowners or sundowning) is the term used to describe an increase in symptoms of confusion, agitation, and restlessness that occurs as evening approaches, usually in people with dementia or Alzheimer disease. As the name implies, sundowning symptoms appear as the sun goes down, and may or may not continue into the night.
A clear definition of sundowner disease (which is not actually a “disease”) is not yet agreed upon due to the diverse set of symptoms and factors that are related to the syndrome.
The Alzheimer’s Association data show that up to 20% of Alzheimer patients may experience a sundown syndrome, while up to 66% of those living at home with Alzheimer disease may experience the condition.
While there is no way to completely "reverse sundowning," it is found that routine, changes in the environment, and quality caregiving can help to greatly alleviate symptoms of sundowning in families.
Symptoms of Sundowners Syndrome
Sundowning symptoms appear or worsen as evening draws near. In some patients, symptoms last a short period. In others, they can last through the night and even invert their sleeping schedule, causing them to remain awake all night and to sleep during the day.
Patients with sundowning can also experience an increase or worsening of symptoms during the fall or winter.
When someone is experiencing sundowning, they may be:
- Agitated
- Restless
- Irritable
- Confused
- Disoriented
- Demanding
- Suspicious
People who are sundowning experience increased activity at night that includes pacing, wandering, and shadowing (following a caregiver around and even mimicking behaviour). They may also be less likely to follow instructions or listen to others during this time, which can affect caregiving.
Other sundowner's symptoms include:
- Yelling
- Rocking
- Paranoia
- Delirium
- Aggression
- Extreme anxiety
- Hallucinations
- Sleep disturbances
- Sudden unexplained changes in behaviour
While some may look for ways to "reverse sundowning," it is important to realize that sundowning is normally a symptom of dementia, not a distinct condition. The aim is to limit the number of triggers and create peaceful evenings.
A full explanation of what Sundowning Syndrome is can be found here.
Can You Reverse Sundowning?
Though sundowning cannot be cured or reversed entirely, many who have dementia suffer from reduced symptoms with proper routine, physical activities during the day, sound sleeping patterns, and quiet evenings. These tips can be useful for making the evenings better for the person living with dementia and their caregivers.
10 Tips to Ease Sundowners Symptoms
Due to the wide range of factors that play a role in sundown syndrome, there are a number of methods that have been found to be helpful. The following behaviour modifications and environment changes can help your loved one when they experience sundowning.
1) Reducing Sundowning: Increase Light Exposure
One main factor thought to contribute to sundowners is the disruption of the body’s circadian rhythm, or the “internal clock.” The circadian rhythm involves the body’s response to daily light cycles. If the body’s internal clock is out of alignment with the day/night cycle, sundown symptoms may occur.
To offset this imbalance, be sure that your loved one gets plenty of exposure to bright light during the day. Exposure to bright light during the afternoon/evening hours has been found to reduce sundowning episodes and restless behaviours, and to improve agitation and nighttime sleep quality.
During the day while inside, open window shades in the house and be sure your loved one spends time in a bright room. At night, illuminate dark rooms with night lights to help reduce the risk that your loved one becomes confused or frightened of dark shadows.
For example, close curtains or blinds before it gets dark outside to minimize reflections in windows.
2) Begin a Regular Exercise Program
Many people with sundowners have poor sleep quality, which can compound the effects of sundowning symptoms and even cause them to remain awake all night and want to sleep during the day. To help reverse this effect, regular exercise has been found to be helpful. For most elderly people, walking is the best form of exercise.
An irregular walking schedule and less than one hour of walking weekly have been found to be more likely to contribute to sundown symptoms in elderly dementia patients.
A regular walking routine with longer walking time, on the other hand, has been found to improve sleep quality and alleviate sundown syndrome. In particular, walking with a spouse or family member is more beneficial than walking with a non-family caregiver.
Regular exercise has also been found to reduce physical and verbal abuse as well as wandering in patients with dementia.
Most studies recommend walking for at least 30 minutes, three times weekly.
Some safe and easy home exercises for seniors can be found here.
Avoid exercising late at night since this can cause difficulties falling asleep.
3) Use Music as Therapy
In patients with dementia, music can ease a variety of difficult symptoms. Live interactive music has been found to reduce apathy in dementia patients, for example. Other studies of music therapy have resulted in improvements in agitation and anxiety.
Playing familiar songs—and singing along or using a percussion instrument in time to the music—may be a helpful and fun intervention that your loved one can benefit from.
Play soft and gentle music in the late afternoon or early evening, not loud or stimulating playlists.
4) Consider Aromatherapy
Aromatherapy involves the diffusion of scented oils into the room. Lavender oil has been found to alleviate agitation in a study with dementia patients. In another study, diffusion of rosemary and lemon essential oils in the morning and lavender and orange in the evening has been found to improve personal orientation (knowing one’s location) in Alzheimer patients.
Essential oil diffusers are widely available and may be helpful for your loved one.
5) Plan Activities During the Day
Planning activities that your loved one enjoys during the day is a great way to keep them engaged and active at a time when they may tend to fall asleep. Light activities that they enjoy like crafts, art, light gardening, walking, playing dominoes, or visiting a park may help to keep them awake and alert during the day, which can help them sleep better at night. Be careful to not overextend your loved one, however, because fatigue can also contribute to a worsening of sundown symptoms.
If a nap is desired, attempt to limit naps to about 20 minutes long, which is just long enough for your loved one to benefit from rest, but not so long that it affects their nighttime sleep schedule.
It may be wise to arrange more challenging activities, appointments, and social interactions in the morning rather than later in the day.
6) Create a Regular Routine
A regular routine can help your loved one maintain familiarity and orientation. It can also help you as the caregiver to recognize triggers that lead to a worsening or improvement of sundown symptoms. Careful observation of your loved one’s habits throughout the day will help you to create the best routine. Take note of what seems to work well, and what seems to get in the way of your loved one’s well-being.
Evening rituals such as dimming lights slowly, minimizing background sounds, and eating at the same time each night might also be helpful.
7) Meet Your Loved One Where They’re At
Experts used to believe that reorienting dementia patients to the present was the best way to help them maintain a better quality of life. We now know, however, that it’s more helpful to meet them where they are at. In other words, if your loved one is experiencing confusion about where they are or what is occurring, trying to reason with them can only make the situation worse. Instead, try to validate their feelings and at the same time let them know that they are safe.
This simple change in approach can go a long way toward calming your loved one (and yourself). Once you are able to enter their reality and allay any fears, try to distract them back to the present with a simple activity such as folding towels or wiping the counter to help ground them in the moment without contradicting their previous reality.
8) Stay Calm
Staying calm is easier said than done, to be sure, but remaining gentle will go a long way toward keeping your loved one in a peaceful state. Your loved one will pick up on even subtle nonverbal behaviors and respond in like manner, which can quickly escalate a difficult situation. Do your best to be aware of your own stress level, and use any calming techniques you can to maintain a mild demeanor.
Do not forget that your body language and tone of voice can be as important as your words.
9) Get Medical Advice
When lifestyle and environmental modifications are not enough to alleviate your loved one’s sundowners syndrome, seek medical advice. At times, certain medications or interventions may be necessary.
In particular, if symptoms come on or worsen suddenly, an underlying medical condition such as a urinary tract infection (UTI), dehydration, electrolyte imbalance, or medication interaction may be to blame.
It can also be beneficial to consult a healthcare specialist who will help find any underlying conditions which could be causing problems in the evening.
10) Reducing Sundowning: Get Help
If your loved one is becoming difficult to manage at home, or if you are unable to care for your loved one with dementia as you would like, consider a home care company that can provide you with the peace of mind you seek.
Guardian Home Care is committed to reliable, trustworthy, invaluable senior care. Contact us today to learn more about how we can assist you and your loved one with individualized care.
For a broader overview of dementia care at home, read our complete Dementia & Alzheimer's Care Guide