Alzheimer’s Disease and Sundowning

Sundowning syndrome – also referred to as sundowning and sunsetting – is a pattern of more severe behavioral symptoms in the late afternoon and evening.  This pattern is common in people with Alzheimer’s disease and dementia.

Sundowning and the Full Moon

People forge a connection between sundowning and the effects of the full moon, possibly because both terms refer to solar system objects.

I found limited information to support the effects of the full moon – or barometric pressure – on nursing home patients (see “Alzheimer’s Disease and the Full Moon“).

But sundowning syndrome is extensively discussed.

Sundowning is attributed to changes in light level at the end of the day, and to end-of-the-day fatigue and restlessness, among other things.

The syndrome appears to be another of those topics without exhaustive research and about which there is some disagreement.

But the syndrome does appear to be broadly accepted, extensively explored, and there are generally consistent causes and suggestions.

Sundowning

The most complete and accessible explanation of sundowning I found is on “Sundowning | Just the Facts” – apparently created by the California Southland chapter of the Alzheimer’s Association.

The syndrome is described by explaining that, in late afternoon and evening, the patient “may become demanding, suspicious, upset or disoriented, see or hear things that are not there and believe things that aren’t true.  Or they may pace or wander around the house when others are sleeping.”

I will briefly echo the points in the article.  You can of course click through to the complete text.

The sundowning problem may be due to:

  • Difficulty seeing well in dim light,
  • Hormone imbalance disturbing their “biological clock”,
  • Fatigue at the end of the day,
  • Restlessness due to late day inactivity,
  • Anxiety caused by caregiver communicated fatigue and stress.

Try to reduce sundowning behavior by:

  • Making the later hours less hectic,
  • Exercise,
  • Diet adjustment,
  • If nighttime sleeplessness is a problem, encourage activities and discourage napping,
  • Reduce noise and activity,
  • Consult with physician about possible medication to encourage sleep,
  • Make it easy to use the bathroom,
  • Keep rooms adequately lit.

Remain flexible and consider the person’s needs:

  • Let them sleep on the sofa or in a chair,
  • Reassure and comfort the person,
  • Avoid arguing or asking for explanations.

Then, finally, remember to care for yourself.

  • Get adequate rest.

The “Just the Facts” article also explains that “sundowning” is often accompanied by “shadowing,” where the person with Alzheimer’s follows or mimics the caregiver, or talks, interrupts, and asks questions repeatedly.  This explanation of “shadowing” is accompanied by a list of suggestions.

A web site called “A Place for Mom” (an elder care referral network) has a “Sundowners Syndrome” page with a suggestion that I didn’t find elsewhere.

Establishing a routine.  Routines help sundowners feel safe.  Routines minimize surprises and set up daily rhythms that can be relied on.”

The “Place for Mom” page explained that sundowners “affects up to 20% of the more than 5 million Americans with Alzheimer’s.”  It also observed that the syndrome will occasionally “affect people in the early morning hours.”

I close with a poignant description of sundowning from the patient’s point of view.

“[...] you have to always keep in mind what their day is like – they are holding on with their fingernails, and life has become a swirling, confusing jumble that makes no sense.  Their days can be filled with boredom, obstacles, mistakes and failures – it’s actually very stressful for them.  They also will have perception problems.  The brain damage from Alzheimer’s can cause disturbances to body rhythms as well, so sleep and wake pattens are disrupted.”
[Site: AllExperts – Page: “Alzheimer’s Disease – Sundowners” – Writer: Mary Gordon]

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One response to “Alzheimer’s Disease and Sundowning

  1. GLORIA KENNEY

    I AM CURRENTLY GERIATRIC DENTAL FELLOW IN BROOKLYN, NEW YORK

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