Sundowning and Alzheimer's Disease

The term "sundowning" in Alzheimer's patients refers to the escalation of behavior problems and disorientation late in the day. Sundowning can start anytime from mid-afternoon to dusk and continue throughout the evening. The Alzheimer's Association reports that as many as 20 percent of Alzheimer's patients will exhibit signs of sundowning.

Causes

• The cause of sundowning is not known; however, there are factors that seem to trigger late-day confusion in Alzheimer patients. Physical and mental fatigue from the day's activities seems to decrease the brain's functionality. Also, dim lighting and increased shadows late in the day may lead to problems with perception and visual image interpretation. Some patients seem to have a problem with their biological clocks, leading to confusion between day and night. It is also common for older adults to need less sleep; therefore, they may have difficulty falling asleep or sleeping through the night. They may also have problems separating dreams from reality.

Effects

• Sundowning can be frustrating for caregivers and may lead to caregiver exhaustion. The confusion and disorientation associated with sundowning can lead to agitation and behavior problems that are difficult to deal with. When sundowning behaviors occur, the patient will need extra reassurance and understanding. Additional precautions may also need to be taken to keep the individual safe.

Considerations

• Sundowning and nighttime restlessness do not last forever. In Alzheimer's patients, sundowning is usually most prevalent in the middle stages, and it decreases as the disease advances. If the individual is in a care facility, sundowning behaviors may be related to shift changes late in the afternoon. This can also cause a person to feel she needs to go home. It may help to engage her in an activity during that time.

Prevention

• While sundowning cannot be completely prevented, there are some ways to reduce these behaviors in Alzheimer's patients. It helps to plan daytime activities and exposure to sunlight to encourage sleepiness at night. Be sure to give the individual some quiet time during the day to rest. A short nap is okay if it does not interfere with nighttime sleeping. Caffeinated beverages and sugar are best consumed in the morning. It may also help to serve an early dinner, with a light snack prior to bedtime. Also, reduce activity level and noise in the late afternoon and evening hours.

Helpful Tips

• When sundowning does occur in Alzheimer's patients, there are some ways to deal with the behaviors in a positive manner. If the individual tends to wander at night, limit outdoor access by locking doors or installing tall safety gates. Install motion detectors or door sensors. If the person is upset, caregivers should approach him calmly and find out if he needs something. Avoid aggravating the situation by arguing or demanding explanations. Try to reassure him that everything is okay, and gently redirect him to an appropriate activity or back to bed.