Do you have a family member suffering from Alzheimer’s disease or another form of Dementia? Then this person can experience heightened symptoms of confusion in late afternoon and evenings.
I observe it daily, how the behavior of some of my patients changes during the afternoon. One starts to become restless by calling, getting angry and commanding. While the other wanders through the corridors in his wheelchair.
It’s the so-called “Sundowning Syndrome” also known as “late-day confusion.”
Your loved one shows, restlessness, agitation, irritability, being overly tired, depression, pain, boredom, hunger, thirst, or confusion, that can begin or worsen as daylight begins to fade.
In comparison, these symptoms may be less pronounced earlier in the day.
Especially with Alzheimer’s disease, the sleep center in the brain is affected.
Sundowning can continue into the night, making it hard for people with Alzheimer’s to fall asleep and stay in bed.
As a result, they, you and their caregivers may have trouble getting enough sleep and functioning well during the day.
Sleep problems can also result from medical or psychiatric problems such as depression, side effects of medication or environmental and behavioral factors.
Although you may not be able to stop your loved one’s sundowning symptoms completely, you can take action to help manage this challenging time of day (so you both sleep better and function better during the day). Also, let your loved one’s doctor know what changes you have witnessed.
Coping with Sundowning
In the past, I worked in a psychogeriatric care department for elderly people with Dementia in the Netherlands. As a caregiver, I was always alert to behavioral changes in my patients. And especially in the evenings, when they became restless and confused.
Staying calm, thinking creatively and never getting angry is my motto since that time to deal with Sundowning syndrome.
If your loved one has the mid-stage to advanced dementia, it is most likely they experience sundowning.
Look for signs of sundowning in the late afternoon and early evening.
These signs may include increased confusion or anxiety and behaviors such as pacing, wandering, hitting or yelling. If you can, try to find the cause of the person’s behavior.
If the person with Alzheimer’s becomes agitated, listen calmly to his or her concerns and frustrations. Try to reassure the person that everything is OK and distract him or her from stressful or upsetting events.
A good formula
A good formula to remember when dealing with sundowning symptoms is:
- to validate,
- to reassure,
- to distract.
This means it’s helpful to start by validating the person’s feelings. Say something like, “it sounds like you’re feeling really afraid or anxious right now, and that’s okay”.
Reassure them that everything will be alright, and do what you can to make them feel calm and comfortable. Then, distract them with something that they enjoy and find soothing.
Each person has different triggers for sundowning. To help identify your loved one’s triggers, use a journal or smartphone app to track his or her daily activities, environments, the people he or she is engaged with, and the behaviors.
Look for patterns to learn which activities and environments seem to make symptoms worse. Once you identify these triggers, it will be easier to avoid or minimize situations that promote agitation and confusion.
Environmental triggers for behaviors
It is as much about triggering negative behaviors or symptoms, so remove some of those triggers from the environment.
Loud noises can be upsetting and some television shows -even talk shows and old westerns – might be frightening to someone with Alzheimer’s disease. Once you’ve eliminated negative triggers, add positive environmental factors, play classical music or put on a television show about animals.
What about Sundowning in the winter?
As the days get shorter, sundowning can be more of an issue during the winter.
If your loved one is already experiencing sundowning symptoms, they will likely get worse during this season.
Everything gets more confusing for people with Dementia when daylight is lost.