Tips for coping with ‘sundowning’

Late afternoon and early evening can be difficult for some people with Alzheimer’s disease. 

At this time, people with the disease can experience restlessness, agitation irritability, or confusions. Experts call it ‘sundowning’ and the symptoms can worsen as daylight begins to fade.

Sundowning can continue into the night, making it hard for people with Alzheimer’s to fall asleep or stay in bed.

Symptoms of sundowning are subtle in the early stages of the condition, but people who are susceptible to this reaction are considered at higher risk of developing Alzheimer’s disease or dementia.

Unlike symptoms in fully developed sundowner’s syndrome, where night-time agitation and confusion are quite obvious and consistent, the changes in personality are more subtle in the early stages of sundowning.

The individual may seem only slightly irritable, mildly confused, or ‘a little off’ in the late afternoon or early evening. These changes in personality may not develop each afternoon in the early stages of sundowning, but do become more consistent as the syndrome progresses.

No one is sure what causes sundowning, although it seems to result from changes that are occurring in the brain. People with Alzheimer’s tire more easily and can become more restless and difficult to manage when tired. Because people are tired at the end of the day, their tolerance for stress declines, and a minor problem can generate a major outburst.

An already confused person may be overstimulated when several people are in the house, dinner preparations are under way, and the television is on. Dim light may also contribute to a person’s misinterpretation of visual information.

Coping with Sundowning
For those who are caring for people with Alzheimer’s, there are several ways to try and cope with this condition.

  • Early afternoon rest – If fatigue is making the sundowning worse, an early afternoon rest might help. Keep the person active in the morning and encourage a rest after lunch.
  • Familiar activities in the evening – Early evening activities that are familiar from an earlier time in the person’s life may be helpful. Closing the curtains, a pre-dinner drink or assisting with preparing dinner or setting the table may be helpful.
  • Avoid physical restraint – Don’t physically restrain the person. Let them pace where they are safe. A walk outdoors can help reduce restlessness.
  • Encourage comforting pastimes – Some people are comforted by soft toy animals, pets, hearing familiar tunes, or an opportunity to follow a favourite pastime. Some people find warm milk, a back rub or music calming. Nightlights or a radio playing softly may help the person sleep.
  • Minimise noise and lights – Consider the effect of bright lights and noise from television and radios. Are these adding to the confusion and restlessness?
  • Avoid upsetting activities – Try not to arrange baths or showers for the late afternoon if these are upsetting activities. The exception may be the person who is calmed by a hot bath before bed.

Do you ever find yourself getting more irritable as the evening begins to end? Are you worried this could be an early warning sign for dementia?

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Disclaimer: This article contains general information about health issues and is not advice. For health advice, consult your medical practitioner.

Written by Ben

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