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Understanding Sundowning

by Shannon Lee

When the shadows grow longer, many Alzheimer's patients might experience sundowning. Learning how to deal with the agitated behavior and increased activity that are the hallmarks of sundowning can help you be a more effective caregiver.

Alzheimer's can wreck havoc on the mind in countless ways, and many of the symptoms are still not entirely understood. One of those is "sundowning," a symptom that up to 20 percent of people with Alzheimer's might experience.

What is Sundowning?

Sundowning is a symptom of Alzheimer's characterized by a state of confusion and agitation. It occurs at the end of the day and sometimes lasts into the night.

A person with sundowning may be anxious and possibly argumentative. They may be fatigued, but feel the need to be active. They might be frightened and unable to express what they are feeling. They could want to go home, check on their children, or otherwise fulfill responsibilities they have always associated with the late afternoon hours.

For the caregiver, sundowning can be a difficult time. Your loved one is upset, and you want to fix the problem--but it can be impossible to know what the problem is. Is it any wonder that sundowning can make a caregiver feel frustrated and helpless?

What Causes Sundowning?

There are numerous suggestions as to what causes sundowning. Some researchers believe it is caused by the lower level light in the late afternoon, which prompts patients to believe they have something pressing to do, such as go to work or pick children up from school.

Other research suggests that being overly tired or unable to deal with stressful situations can lead to the hallmark anxiety of sundowning. There is also some speculation that disorientation, or the inability to separate dreams from reality, might play a part.

Tips on Handling Sundowning

There are a few things you can try when sundowning begins. It may take time to find the solution that works best for your loved one, so don't get discouraged. If one approach doesn't work, move on to another one.

  • Don't offer foods containing caffeine or sugar after the morning hours.
  • Plan activities during the day to increase exposure to natural light.
  • A short nap or a period of quiet time in the afternoon might make sundowning less likely.
  • Make certain they are comfortable. Hunger, feeling too hot or cold, or other discomforts can make agitation worse.
  • Keep a nightlight on at night to make it easier for your loved one to relax.
  • Speak to the physician about medical ailments that might contribute to sundowning. Urinary tract infections, allergies, or a simple cold can all play a factor.
  • Give your loved one a private area they can retreat to when they begin to feel overwhelmed.
  • Do not ask for explanations, and avoid being drawn into an argument. These things might only confuse your loved one even more, and that can frustrate both of you.
  • Offer reassurance that everything is fine, everyone is safe, and there is nothing to worry about.

Stay Calm, Loving, and Patient

During a period of sundowning, your loved one may be agitated and upset--but they may have no idea why they feel that way, and the confusion only adds to their frustration. The best thing you can do is simply take a deep breath, stay calm, and offer understanding until the episode passes.