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Helping Caregivers Cope with Sundowning

For caregivers of patients with Alzheimer’s disease (AD) or other types of dementia, the late afternoon and evening hours can be an especially challenging time. Often referred to as “sundowning” or “sundown syndrome”, people with Alzheimer’s can experience the onset of or worsening of neuropsychiatric symptoms, such as restlessness, agitation, and confusion.1 For some people, these increased symptoms can last through the evening and well into the night, which can be tough for caregivers who may be tired and needing a break.2

Why does sundowning occur?

While researchers are still unsure exactly why people with Alzheimer’s experience sundowning, they do have a few theories on why it may occur. Currently, one of the most common theories is that AD disrupts a person’s circadian rhythms.2 Circadian rhythms are responsible for setting a person’s internal clock and control the wake/sleep cycle. Because these cycles become disrupted, people with Alzheimer’s become agitated as the daylight changes into the evening. There is scientific support for this theory; older adults tend to have lower levels of melatonin, a hormone that helps regulate the circadian rhythm.2 AD patients have even lower levels of melatonin, and some physicians believe that these patients may benefit from a melatonin supplement.2

Some physicians believe that sundowning can be related to other physical symptoms that AD patients may have difficulties expressing, such as pain, being overly tired, hungry or thirsty, and experiencing boredom.1 It may even be related to depression symptoms or other mood disorders.2

What are ways to cope with sundowning?

There are ways that you can help alleviate symptoms of sundowning and ways to cope with these symptoms.

  • Light – Exposure to light can help reduce symptoms associated with sundowning, as it can help to reset a person’s internal clock.1 If you can take your loved one outside and take a walk, this may also help, as exercise can help alleviate symptoms as well. If walking is not an option, try getting your loved one to sit near a window, or in another sunny spot, indoors or outdoors.
  • Minimize unnecessary distractions – Make the late afternoon and early evening the quiet time of day.1 Reduce noise and clutter and try limiting visitors at this time. Making a routine of taking a walk, reading a book or playing music that the person likes can help reduce agitation.1 Try to avoid napping as this can disturb sleep patterns.2
  • Stay physically active – Keeping your loved one active can help prevent sundowning symptoms.1 Even if you choose to keep the late afternoon and early evening quiet, this may be a good time to plan more challenging activities to keep the patient distracted from their symptoms.2
  • Get plenty of rest at night – Talk to their physician about the best ways to improve sleep for people with Alzheimer’s. Naps during the day are fine, but keep them short and earlier in the day. If the person is having trouble sleeping, you may want to ask their physician if a melatonin supplement is right for their needs.2
  • Attempt to distract the patient – If your loved one with Alzheimer’s appears to be getting agitated, try distracting them with an activity such as an easy household chore or a favorite game.1 You may want to offer them a snack or a drink (though you should avoid caffeinated beverages and alcohol) as hunger and thirst can lead to sundowning symptoms.2 You may want to read to them or watch a favorite TV program, but try to avoid the news or other shows that could cause further agitation or upset.

If symptoms continue to worsen, or caregivers feel overwhelmed, you should definitely seek advice from your healthcare team. They should have specialized resources for your situation and may be able to help figure out the source of the person’s sundowning symptoms. They may also be able to help adjust medications, either to reduce side effects that can cause sundowning or to help with sundowning symptoms. Know that you are not alone, that there are resources both for people with Alzheimer’s and their caregivers, and don’t hesitate to ask for help in coping with these symptoms.

  1. Tips for Coping with Sundowning. National Institute on Aging. https://www.nia.nih.gov/health/tips-coping-sundowning. Published 2019. Accessed May 31, 2019.
  2. Canevelli M, Valletta M, Trebbastoni A et al. Sundowning in Dementia: Clinical Relevance, Pathophysiological Determinants, and Therapeutic Approaches. Front Med (Lausanne). 2016;3. doi:10.3389/fmed.2016.00073

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