What is Sundowning
Sundowning or late afternoon confusion is a state of mind for people with Alzheimer’s disease or other types of dementia. It usually happens in the late afternoon or early evening when people with dementia have problems sleeping or are increasingly agitated.
According to the Alzheimer’s Association, up to 20% of people with dementia experience sundown syndrome.
The exact causes of sundowning are not confirmed, but it is believed that all forms of dementia cause damage to a person’s natural body clock or circadian rhythm, making it harder to maintain a sleep schedule on point.
Causes of Sundowning
The exact causes of sundowning cannot be pinpointed, but one possibility is that Alzheimer’s disease-related brain changes can affect the person’s natural body clock, which can lead to confused sleep-wake cycles. This can result in different behaviors like a person being agitated, irritated and confused and not being able to sleep at night.
Some other possible causes of sundowning include:
- Tiredness
- Unmet needs such as hunger
- Boredom
- Pain
- Being upset
- Not enough sunlight exposure during the day
- Overstimulation
- Sensory impairment
- Other health issues
Equally, dealing with the effects of dementia daily means that people with this condition will more likely have low energy reserves as the day progresses and can become even more tired by the end of the night.
Early Signs
Signs may go unnoticed in the early stages of Sundowners syndrome. However, these signs become more regular and pronounced as the condition progresses.
When it comes to sundowning, the time of onset varies from one person to another, and the symptoms mostly interfere with sleep. Sleep deprivation is the leading cause of triggering behaviours such as irritation, confusion and restlessness while, at the same time, contributing to other dementia symptoms. Some of the most common Sundowning symptoms include:
- Pacing around a room
- Rocking in a chair
- Following a family member or a caregiver very closely
- Being highly emotional
- Being very sad
- Feel Anxious
- Fearful
- Restlessness
- Irritability
Sundowning is also associated with some more severe mental states like:
At their peak, these signs will develop in the late afternoon and likely continue throughout the night.
How Long Does Sundowning Last in Dementia
A usual sundowning episode is temporary and generally occurs during the early evening or late afternoon. The episodes may occur for a day or longer, but then a person with Alzheimer’s disease, for example, might not experience another episode for a while.
However, if there is a consistent pattern in behavior changes at sundown for a few days to weeks, then sundown syndrome might develop. Fortunately, the impact of sundowning fades after the episode has ended, and most people with dementia revert to their usual selves.
What Triggers Sundowning
While there isn’t a known trigger for Sundown syndrome, there are some possible causes that can usually be spotted in a person with dementia:
- Fatigue: everyone can experience a weakened memory when tired, even more so people with Alzheimer’s. This can also make having a sleep routine complex.
- End-of-day activities: having unexpected guests or more plates to clean up might lead to confusion or anxiety
- Low lighting: when the sun sets, shadows increase, making it more difficult to see outside. Familiar surroundings can also seem strange or look altered, increasing agitation.
- Sensory impairment: a loss of hearing can lead to increased anxiety
- Winter season: the nights last longer, and waking up in the dark making the person more agitated
- Other health conditions
However, it’s equally possible that people without dementia may also experience sundowning due to general loss of brain mass. The changes in the brain can lead to other sundowning-like behaviours without being diagnosed with dementia.
Sundowning vs Delirium
The main difference between Delirium and Sundowning is that the former happens suddenly and can come and go throughout the day.
Delirium is characterized by an acute onset of behaviour changes that can fluctuate during the time of day, perhaps triggered by an underlying health condition. Delirium might gradually improve as the underlying health condition is resolved. On the other hand, Sundown syndrome is characterized by a rapid onset of behaviours that occur every day, usually in the early evening or late afternoon.
Sundowning and delirium share many symptoms, and although they don’t share the pathophysiological mechanisms, they share the disrupted circadian rhythm, making it harder for a person to go to sleep.
Coping with Sundowning
Sundowning is not a simple condition, but it occurs commonly in people with Alzheimer’s, an occurrence that many loved ones and caregivers find difficult. While it is unlikely to stop the syndrome completely, there are a few ways to provide support for a loved one:
- Reduce clutter, noise and the number of people in the room
- Provide the person with Alzheimer’s with their favourite snack, activity or an object
- Make the early evening a quiet time of day
- Play soothing music, read or go on a walk
- Adjust the lightning
- Get outdoors
- Get fresh air
- Promote sleep and good rest
- Create a structure/routine for the day
How to Help Someone Who Is Sundowning?
Managing sundowning requires flexibility, empathy, creativity and dedication which is what we at Unique Community Services try to always provide. Our team works to determine the triggers and how to address the changes in behaviour. No two people with dementia are alike, which is why we aim to create individually tailored care plans for your loved ones.
Our team of experts has personalised approaches for every person they care for and support. If you want to learn more about how our team can help, contact us or visit our website.
