What Is Sundowning and How Can I Help My Loved One Avoid It?

Posted: 5/24/2018 12:11 PM by Interim HealthCare

11 Tips for Easing the Agitation

Contributed by Kathleen Doheny 
The day is going along just fine for you and your loved one with Alzheimer's disease. You've talked, laughed and enjoyed a TV show together. Then comes dinnertime — and a sudden burst of confusion and agitation.
Your loved one isn't the only one who is upset. You’re unnerved and perhaps a bit frightened, trying to figure out what's happening and how to help.
Doctors call the phenomenon “sundowning” because it occurs in late afternoon or evening. The exact cause is unknown, and the behaviors vary from person to person. Sundowning often involves confusion, anxiety, aggression or withdrawal. Some people may be more likely to pace and wander.
While not everyone with dementia experiences sundowning, it’s a common symptom, says James Hendrix, PhD, director of global science initiatives for the Alzheimer's Association. People tend to think of Alzheimer's (the most common cause of dementia) as a condition involving memory issues, but that’s just part of the disease, he notes. "Actually, very few people, less than 5 percent, have only cognitive symptoms."
Even armed with that knowledge, it can be difficult to cope with a loved one’s sudden about-face, when he or she goes from loving and gentle to aggressive and difficult. But there are steps you can take to minimize sundowning. Try these tips, from experts who care for people with dementia and from the Alzheimer's Association.
1Take a deep breath. Remember that sundowning is part of the disease, and that any aggression is not aimed at you personally. Getting upset will make matters worse, not better.
2. Consult with the doctor. You may think it's sundowning, but it's a good idea to check in with the person’s doctor. He or she may want to rule out other possible causes of the behavior, such as infection or dehydration. 

3. Encourage physical activity. Physical activity is beneficial, as a person who is idle most of the day may be more restless after sunset. It may reduce sundowning symptoms by lowering levels of the stress hormone cortisol. In a study that looked at exercise and its effect on cortisol levels in Alzheimer’s patients, exercise not only lowered cortisol levels but also decreased sundowning symptoms. It’s best to wrap up any physical activity at least four hours before bedtime. 

4. Dial down late-day activity. Try to limit activities in the late afternoon and evening. Have visitors drop by or relatives phone earlier in the day. Make doctor's appointments for the morning if possible. If a meal out is on the agenda, make it lunch, not dinner. 

5. Watch for lifestyle triggers. Many factors can make sundowning worse, such as changes in the routine, lack of sleep, dehydration, caffeine and alcoholic beverages. Serving a larger meal at lunch and a smaller one at dinner may make it easier for your loved one to sleep at night. Also, take note of your own stress level. If you’re stressed out, your loved one could pick up on that and react badly. 

6. Encourage napping. Encourage your loved one to take a short nap in the early afternoon. That might recharge the brain and help the rest of the day go easier. 

7. Shed some extra light. Turning up the lights as the sun begins to set and keeping them on until bedtime may help. That’s because darkness or shadows can increase confusion in people with dementia, especially if they are not in their usual surroundings. 

8. Journal the details. Consider tracking the sundowning behaviors, noting the time of day they occurred, what they involved, who was around and what else was happening. You might identify certain triggers that could be avoided in the future. 

9. Break out the ice cream. Ice cream is one of those foods that evoke good memories and can help a person with dementia feel loved and nurtured. If there aren't any restrictions on fat or dairy, suggest a bowl — maybe with two spoons. 

10. Press the pooch into service. If you have a friendly dog or cat and your loved one is also an animal lover, encourage a cuddling session with the pet. It can have a soothing effect. So can music, massage and looking at art. 

11.  Discuss medication. If these measures don't work, talk to the person’s doctor about whether medication, such as an antidepressant or antipsychotic, might help reduce the agitation and put your loved one more at ease. 

For many of us, thoughts of sunsets, whether over the ocean or at home, prompt feelings of romance and calm, so it can be hard to grasp that this time of day can trigger confusion and fear in a person with dementia. But following the tips above can go a long way toward ensuring smooth sunset sailing for everyone involved.

Kathleen Doheny is a Los Angeles-based journalist who specializes in health, behavior and fitness reporting.