That’s why it’s essential to look for signs of sundowning and be prepared to handle situations in which a loved one might be dealing with it.
Causes of Sundowning
Not all individuals living with Alzheimer’s will experience sundowning. “It most commonly occurs in patients during the middle and later stages of their disease process,” Dr. Kapur says. Dr. Christopher Dennis, Chief Behavior Health Officer of Landmark Health, says sundowning may also occur due to changes in a person’s circadian rhythm, thereby impacting sleep-wake cycles.
Hunger Pain Overstimulation Tiredness Anxiety Depression Sensory impairment, Disturbed hormone levels, Lack of regular exposure to sunlight
“This may result in agitation and other sundowning behaviors, generally beginning around dusk,” Dr. Dennis says.
How to Cope With Sundowning
While sundowning can be a huge challenge for individuals living with Alzheimer’s and their loved ones, there are many ways to cope.
Look Out for Triggers
According to Adria Thompson, MA CCC-SLP, a certified dementia practitioner, caregivers can examine whether certain triggers lead to sundowning behavior. For instance, if one caregiver leaves home at 3 P.M. and another takes their place, an individual with Alzheimer’s may think they need to leave, too. “This triggers confusion, disorientation, and agitation for the next [caregiver],” Thompson says. Moving forward, caregivers can be more discrete when leaving to not trigger sundowning symptoms in individuals with Alzheimer’s.
Identify Patterns
Furthermore, Thompson points out that caregivers can use patterns in sundowning to their advantage. For instance, if your parent with Alzheimer’s begins exhibiting symptoms around 3:30 P.M. each day, you can start giving them a task at 3 P.M., like sweeping the floors. This can help minimize or delay the onset of sundowning symptoms.
Maintain Regular Routines
Thompson also says it’s important to stick to routines. “Keep the environment calm in the late afternoon with predictable routines,” she states.
Support Sleep-Wake Cycles
Furthermore, Thompson says those living with Alzheimer’s should limit alcohol, caffeine, nicotine, and naps. Stimulating substances and sleeping during the day can interfere with the body’s natural sleep-wake cycles. Sun exposure can help maintain that internal rhythm, as well, especially in the winter, when the daylight hours are shorter.
Decrease Cognitive Load
You can decrease the cognitive load individuals with Alzheimer’s experience throughout the day. This means limiting the amount of cognitively challenging situations they experience. Jill’s sundowning symptoms can be explained by her being overwhelmed with new situations. “Next time, Jill should keep her morning routine, and family can visit in small shifts over the next three days,” Thompson says.
Incorporate Daily Exercise
Exercise is important for individuals living with Alzheimer’s, as it can help mitigate sundowning symptoms. Walking, especially in the afternoon, can be especially beneficial.
Avoid Physical Restraint
While it may seem like physical restraint may be the only option at times, Dr. Dennis says it will only make agitation worse. “Involving members of your loved one’s home-based medical care team may help to ease the challenges,” he says. It can also help identify treatment and management strategies that can improve your loved one’s quality of life.
A Word From Verywell
Sundowning can be an immense challenge in Alzheimer’s disease—both for those affected and their caretakers. Not only does it present later in the day, but those experiencing it are often unable to explain what is bothering them, whether that’s hunger, pain, or boredom. However, several coping strategies—from identifying triggers, maintaining regular routines, and engaging in exercise—can help alleviate sundowning symptoms. If your loved one is beginning to exhibit sundowning symptoms, it’s important to discuss their challenges with a physician.
