Ways to Reduce Sundowning


SUNDOWNING, OR SUNDOWN syndrome, is a condition that affects those who have dementia and Alzheimer’s disease, and is a phenomenon that occurs when dementia patients get confused and agitated as the sun goes down.  The medical community calls it “sundown”.

Sundowning may prevent people with Alzheimer’s and dementia from sleeping very well throughout the night as well. It may also make them more likely to wander.  Sundowning happens to nearly 20% of people who have Alzheimer’s disease or other kinds of dementia, causing symptoms such as – restlessness, confusion, anxiousness, agitation, delirium, aggression, combativeness, yelling, hallucinations, paranoia, disorientation, insecurity and forgetfulness.

Sundowning typically occurs more frequently during the middle stages of dementia, and because sundowning symptoms are difficult to deal with, especially due the stress it puts on caregivers, sundowning is a common cause of caregiver burnout.

What Causes It

Although the specific causes of sundowning are not fully understood, some studies suggests that sundowning may be linked to changes to the brain’s circadian pacemaker, a cluster of nerve cells that keeps the body on a 24-hour clock.  Chemical changes in the brain that are characteristic of Alzheimer’s disease may play a role as well.  Older Alzheimer’s patients make more of an enzyme, which may be associated with anxiety and agitation before they go to sleep, than middle-aged patients do.

Researchers have identified several contributing factors that can increase risk for sundowning symptoms as well.  These symptoms include improper nourishment, poor sleep quality, constipation, medication interactions, pain and circadian rhythm disruption.

Ways to Reduce Sundowning

If you or your caregiver suspect you have sundowning, pay a visit to a doctor to investigate the underlying problems of your sundowning occurrences.  Make sure you take your caregiver with you. Your doctor will help you identify your symptoms, as well as checking whether you have pain or an infection. Your doctor will also advise you of certain medications to ensure there are no side effects or interactions that can contribute to the problem.

It’s also wise to stay active more during the day. This can alleviate the severity of sundowning syndrome at night. Avoid naps as well, and instead plan activities and exercise during the day to really wear yourself out.  Doing so will reduce the severity of the sundowning symptoms, particularly restlessness and wandering.  Keeping the house or indoor environment well lit may also help regulate restlessness.

Keep an eye on your diet as well. You should limit the amount of caffeine and sugar to the morning hours. And avoid serving heavy meals late in the day, or snacking in the evening.  Heavy eating and late-night snacking will keep you up at night, particularly if you suffer from sundowning.

Exposure to bright lights, like the sun, during the day may reduce some sundowning symptoms, especially when used in combination with exercise, like walking.  Your doctor may describe this as “light therapy”. It’s also important to have a good sleeping environment, so be sure to sleep in a comfortable bed.

David NovakDavid Novak is a international syndicated newspaper columnist, appearing in newspapers, magazines, radio and TV around the world. His byline has appeared in GQ, National Geographic, Newsweek, The Wall Street Journal, Reader’s Digest, USA Today, among others, and he has appeared on The Today Show, the CBS Morning Show and Paul Harvey Radio. David is a specialist at consumer technology, health and fitness, and he also owns a PR firm and a consulting company where he and his staff focus on these industries. He is a regular contributing editor for Healthline. For more information, visit http://www.healthline.com/.


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