People diagnosed with Alzheimer’s disease or dementia sometimes have trouble sleeping, or seem to be agitated or upset starting in the late afternoon or at dusk, lasting long into the night. This type of behaviour is known as sundowning.
Typically, sundowning peaks in the middle stages of Alzheimer’s, and then diminishes as the condition progresses. Although we don’t fully understand why these disturbances happen to people with Alzheimer’s or dementia, it is believed that the changes are as a result of the impact that these diseases have on the brain.
Signs of sundowning in Alzheimer’s or dementia patients
A person may exhibit one or more of the below behaviours from the early evening and through the night:
- Suspicious of people or surroundings
- Confused, agitated, or anxious
- Restless conduct such as pacing, wandering, or yelling
- See or hear things that are not there
- Question reality and believe things that are not true
- Have a change in their sleep patterns
- Be fidgety during the night
You may also notice an increase in behavioural problems during the day as a result of the disruption to the person’s sleep-awake cycle.
What triggers sundowning in people with Alzheimer’s or dementia
Negative behavioural expressions in the evenings and sleep disturbances overnight can be caused by a number of factors, including:
- Exhaustion at the end of the day
- Boredom, or a lack of routine during the day
- Daytime napping, especially too close to the evening
- Confusion between daytime and nighttime, caused by a disturbance to their internal body clock
- Disorientation from being unable to discern the difference between dreams and reality
- Fear or anxiety caused by shadows in a low light environment
- Reduced need for sleep, which is common in older adults
- Reactions to nonverbal cues of the caregiver’s stress and exhaustion near the end of the day
How to communicate with someone who is sundowning
A person who is sundowning is experiencing something beyond their control, and needs to be treated with love and compassion in order to keep themselves (and you) safe.
It’s very important that no matter how upset the person is, you remain calm and avoid arguing or speaking harshly. Always use a warm, comforting voice when speaking to them. If they want to move around or pace, allow them to do it under your supervision.
Another strategy is to try to understand the reason or trigger behind the behaviour, as we did with Doreen*. Doreen had a history of agitation and sometimes aggressive behavior in the evening which quickly got worse when the caregiver tried to calm her down.
When we met Doreen, we found out she was a widow who was married to her husband Joe for 60 years. Joe worked in a bank and Doreen was a housewife. Joe passed away several years earlier. After analyzing Doreen’s situation, we believed that her routine was that she would wait for Joe to come home every evening, and would become agitated when the caregiver told her Joe had passed away.
We changed our strategy; instead of telling Doreen that Joe has passed away, we focus on Doreen’s feelings about missing her husband. We asked our caregiver to engage her with conversation about Joe as the evening started, including stories about him, going through the old photo albums, and talking about his favourite foods – sometimes even cooking it together.
Over time, Doreen’s agitation disappeared. She chatted about Joe joyfully, and it was becoming easier to redirect her focus on something else when necessary. She even told the caregiver one time, “You know what? Joe is dead.”, with complete calm in her voice.
Our treatment with Doreen showed how important it is to discover the trigger of the sundowning and find ways to address that trigger before the situation starts to escalate.
How to prevent sundowning due to Alzheimer’s and dementia
There are certain strategies you can use to help minimize the chances of sundowning in a person with Alzheimer’s or dementia. Many of them involve creating a comfortable environment, keeping them on schedule, and managing nutrition.
Here are some things you can try to minimize the effects of sundowning:
- Expose the person to bright light by going outside or sitting by the window to help reset their internal clock
- Keep your home well-lit to reduce anxiety to help them identify familiar people and objects when their surroundings are dark
- Include physical activity or exercise into their daily routine, but no closer to four hours before bedtime
- Provide the person with items of comfort such as a favourite pillow or blanket
- Minimize daytime naps, keeping hem short and not too close to the end of the day
- Reduce noise, clutter, or the number of people in the home to minimize stress
- Keep the curtains or blinds closed at nightfall to reduce shadows that may cause confusion
- Ensure that their sleeping area is kept at a comfortable temperature, has door and window locks, and sensors that can alert you if the person is wandering
- Stick to a consistent schedule, ensuring that waking up, meals, going to bed, and other activities happen at the same time every day
- Avoid serving them coffee, cola, or other caffeinated drinks late in the day
- Do not serve alcoholic drinks, as they might add to the person’s anxiety and confusion
- Discourage watching television, using the computer, or using other brightly-lit screens during periods of nighttime wakefulness as they can be overstimulating
- Keep early evening activities light, such as listening to soothing music, reading, or pleasant conversation
One other important factor to successfully handle someone who is sundowning is to always be mindful of your own mental and physical health. If the person you’re caring for picks up on your stress, it may cause them to be agitated or confused. Be sure to eat well, take some time out for yourself, and get plenty of rest so you’re recharged for the following day.
Most importantly, don’t hesitate to reach out for support if you feel you need it.
Ask for help from a home health care professional
Caring with someone who has been diagnosed with Alzheimer’s or dementia can be exhausting. At the end of the day, you just want to relax – and you deserve it! A loved one’s sundowning can cause you additional stress and frayed nerves, especially if you’re not specially trained to handle people with Alzheimer’s or dementia.
That’s why when you need a little help, or want to focus on other important areas of your life such as family, career, and hobbies, it’s a good idea to arrange for someone who can help you care for your loved one.
When you need support, CareHop is here. Our caregivers specialize in professional Alzheimer’s disease and dementia care. We provide thoughtful, respectful, and empathetic care that helps make the journey easier, and brings joy and fulfillment into that special person’s life. With CareHop providing part or full-time in-home care, you can be assured that all of their needs will be met, bringing peace of mind to your entire family.
Helping our clients and their families cope through an Alzheimer’s or dementia diagnosis is a passion of ours. If you’d like to learn more about our customized home care services, please contact me or a member of my team anytime.
