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Sundowning and People with Alzheimer’s: A Challenge for Caregivers and Patients Alike

People with Alzheimer’s disease may make a dramatic turn in the late afternoon or early evening. They may become more confused or agitated. They may pace or repeat behaviors. They may become confused about the time and place, or become more aggressive towards others.

The Alzheimer’s and Dementia Caregiver Center reports that as many as one in five Alzheimer’s patients may experience this phenomenon, called “sundowning.” The causes are not well understood at this point, though the National Institutes of Health reports that it may be due to changes in sleep-wake cycles. Other theories are that it may be from being tired, thirsty or hungry, from pain or boredom or depression.

While what causes sundowning is not fully understood, it may be possible to lessen its effects on people with Alzheimer’s and those who care for them.

  1. Stay on schedule. Predictable times for sleeping, waking and eating can help lessen the effects, especially if it is triggered by being tired or hungry. Reduce caffeine and sugar in the afternoons.
  2. Plan activities for morning. In the evening—when the symptoms tend to appear—try to create a calm, quiet atmosphere.
  3. Let there be light. Since the lessened sunlight may trigger sundowning, having a brightly lit home or room can help. A nightlight in the bedroom can help prevent agitation when waking.
  4. Check your attitude. Some agitation may be a response to nonverbal cues from a tired caregiver.
  5. Pay attention. Sundowning triggers vary for each person, but tend to be somewhat consistent for that patient. Keeping notes on what each day holds may help patterns emerge. Reducing those triggers can alleviate the symptoms.

Sundowning may be caused by pain or illness or may be a side effect of medication. Talk to your medical professional about this, as well as potential sleep aides.