How to Manage Sundowning In Alzheimer’s Patients


Parents of toddlers call it “the witching hour.” It’s that time after dinner and before bedtime when chaos ensues: crankiness, tantrums, and a need for increased attention (at just the time that Mom most needs a break!). Unfortunately, seniors with Alzheimer’s disease also suffer from this behavior pattern, although it manifests differently, resulting in greater confusion, disorientation, anxiety, and even delusions or hallucinations. This symptom of the disease is called sundowning. It’s exacerbated because older people typically need less sleep and, so, may have trouble falling asleep or staying asleep. Sundowning symptoms may even last all night.

The good news is:

  • Sundowning occurs in only about 20 percent of Alzheimer’s patients
  • there are ways to diminish sundowning symptoms
  • experts recommend ways to cope with sundowning when it happens to alleviate symptoms on the spot

If you’re a caregiver and a member of the sandwich generation coping with sundowning, think back to those times when your babies behaved this way in the evening and remember: This, too, shall pass. Sundowning typically occurs in the middle stages of Alzheimer’s Disease.

Understanding Why Sundowning Occurs
As with other aspects of Alzheimer’s, it helps to understand why the patient is reacting in a particular way. The Alzheimer’s Association website describes Alzheimer’s as “a downhill daily course from morning competence and cooperation to evening confusion and irascibility.”

Researchers don’t know exactly why sundowning occurs, but most attribute fatigue as a key factor. If you keep this pattern in mind, you’ll plan social activities for earlier in the day, gradually winding down to a simple, relaxing dinner and quiet, repetitive tasks the senior enjoys in the evening before bed.

Minimize confusion in the surroundings in the late afternoon and early evening, to help alleviate some of the confusion going on in the patient’s mind. Here are some more ways caregivers can cope with sundowning in Alzheimer’s patients.

Minimize caffeine
Trouble sleeping may be a factor in sundowning, so limiting foods and beverages with caffeine after the morning hours can help.

Encourage a good night’s sleep with active morning and afternoon activities.
From exercise to plenty of sunlight and lots of enjoyable social activities, including walks, planning a full, active day can help seniors with Alzheimer’s to sleep and may diminish the symptoms of sundowning. Just be sure to balance the day’s activities with calming activities at night. Seniors with Alzheimer’s may enjoy light, easy housekeeping tasks at night, such as folding towels, or may just enjoy listening to quiet music. Avoid loud, action-packed, visually stimulating TV shows in the evening, which can increase confusion and agitation.

Be understanding, but take a break if you need it.
The best thing to do with a senior who is sundowning is to try to re-orient them by reminding them where they are and what they are doing. They can’t pinpoint why they’re so agitated, so don’t try to talk them out of it. Just offer kindness and understanding.

If the symptoms of sundowning are getting to be too much, ask a friend or relative for some help in the evening so you can take a short break, such as an evening walk or a bath.

If you absolutely need a break and no help is in sight, engage your loved one in an easy activity they can do without your help, set a timer for five or ten minutes, and escape to the bathroom or bedroom to decompress through deep breathing, meditation or whatever works for you. Let your loved one know exactly when you’ll be back. Make sure any doors to the outside are locked if your loved one with Alzheimer’s has a tendency to wander.

The increased confusion, disorientation and restlessness of sundowning can be scary, both for the caregiver and the person with Alzheimer’s. By minimizing chaos in the Alzheimer’s patients’ surroundings, you can create a calming environment where your loved one can rest easy in the evening.

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