Are you caring for someone who exhibits confusion and agitation in the late afternoon and evening? This phenomenon is known as “sundowning.” According to the Mayo Clinic, sundowning isn’t a disease in itself, but a group of symptoms that occur at a particular time of day, typically in people with Alzheimer’s disease or other forms of dementia.
It’s important to know the signs and symptoms of sundowning and how to reduce its effects, not only for the benefit of your loved one but also for yourself. Below are some signs to watch out for, as well as some helpful hints to help minimize its effects.
Signs and symptoms
If one or more of the following symptoms is regularly occurring in the late afternoon or evening, your loved one may be experiencing sundowning:
- Agitation
- Restlessness
- Irritability
- Paranoia or fear
- Demanding behavior
- Disorientation
- Confusion
- Unexplained mood swings
- Hallucinations
Helpful tips
Although the cause of sundowning is not known, it may be possible to prevent it or lessen its effects by eliminating some of the factors that may trigger an episode. Start by remembering the acronym HALT, which stands for hungry, angry, lonely and tired. Try to prevent these triggers as evening approaches — offer a snack, some companionship, or some quiet time. It may help to minimize darkness, as lower light tends to create shadows that can be confusing for your loved one. Draw the curtains and use adequate interior lighting as evening approaches.
Be attentive to patterns and make note of the factors that trigger your loved one’s episodes of sundowning. Maintain a regular routine, and with consistent times for waking up, eating meals, and going to bed. Try to schedule appointments early in the day. Limit consumption of caffeine, alcohol, and nicotine, which can disrupt sleep patterns. Serve a light evening meal, and make the biggest meal of the day breakfast or lunch. If possible, discourage excess napping in the afternoon in order to promote more restful sleep at night.
Managing Episodes of Sundowning
Despite your best efforts at prevention, episodes of sundowning will occur. When this happens, stay calm! Don’t react to the behavior and don’t take anything personally — remember, it is the disease causing the behavior, and your loved one cannot control it. Don’t argue or scold, which will only make things worse. Try to determine what your loved one needs before the situation escalates. A snack, a short walk, or some soothing music may help. Leave the room if you feel your own temperature rising — just be sure your loved one is safe.
If sundowning is occurring regularly, discuss the situation with a physician. In some cases, medication may help reduce agitation or promote more restful sleep.
Don’t forget to get enough rest yourself. Sundowning behavior is challenging and may make it difficult for you to relax. However, it is imperative for family caregivers to take care of themselves. Don’t hesitate to ask for assistance when you need a break. You might arrange for a friend or family member to visit regularly to give you a respite. Alternatively, consider getting assistance from in-home care agency, such as Shepherd’s Staff In-Home Care.